There was not a cloud in the sky on October 8, 2011, when Colleen Kelly-Alexander hopped on her bike for the 10-mile ride home from her office. A seasoned triathlete, Kelly-Alexander, now 37, regularly rode up to 300 miles a week not just to work, but also as part of her six-day-per-week training schedule. Shortly before noon, as she was riding on the shoulder of a main road in Madison, Ct., a 30-ton freight truck rolled through a stop sign and slammed into her, its front and rear tires crushing both her and her bike.
A crowd had gathered by the time Patti Palaia, a paramedic, arrived on the scene. “She was moving everything and talking and breathing, but when I saw the tire track across her abdomen, I knew that was going to be bad,” says Palaia.
Kelly-Alexander was a regional manager for PeaceJam Northeast, a nonprofit that encourages teens to commit to change themselves and the world. But she wouldn’t be returning to work anytime soon. Her lower body was mangled and she was hemorrhaging, but she remained conscious in the ambulance that carried her to Yale-New Haven Hospital (YNHH). Within minutes of arriving, she went into cardiac arrest. She had suffered devastating injuries to her lower body, nearly bleeding to death and flatlining twice.
Kelly-Alexander was dying, according to trauma surgeon Lewis Kaplan, M.D., Her pelvis had been crushed, and her blood supply had been cut off from below her left knee up to her pelvis and sacrum. “She had a lot of injuries and she had time during transport during which they bled, so by the time she got here she was in a very difficult place,” says Dr. Kaplan.
Treatment by a multidisciplinary team
But in the world of advancing medicine, Kelly-Alexander’s story demonstrates what can happen with luck, motivation and attention from a highly specialized multidisciplinary team of health professionals. It began in an YNHH operating room, where surgeons controlled the hemorrhaging from her left thigh and created soft-tissue coverage to close her wound temporarily. Orthopaedic trauma surgeon Michael Baumgaertner, M.D., was called in to repair Kelly-Alexander’s “open book” pelvic fracture—her pelvis had actually snapped in two.
“The problem was there were so many other things going on,” Dr. Baumgaertner says. “She had all these soft-tissue injuries that really could never be expected to heal without having a skeleton for them to exist on.” He and his team used a special operating table to help position Kelly-Alexander’s pelvis. Then, while consulting X-rays, and working through an incision, they used fluoroscopic guidance to manipulate her pelvis into its proper position. Two large screws fixed her pelvis in place.
Dr. Kaplan also called on colorectal surgeon, Vikram Reddy, M.D., Ph.D., to repair Kelly-Alexander’s anal sphincter, but she was too badly injured to handle the reconstructive surgery it would have required. Dr. Reddy suggested placing a colostomy bag for the time being to avoid infection, with the idea of doing repairs later in the healing process.
Finally, after an initial round of surgeries, Kelly-Alexander was admitted to the surgical intensive care unit, where she almost bled to death again from damage to an artery in her leg. Dr. Kaplan, who was in charge of her critical care and continues to oversee her treatment, describes the 48 hours following the accident as a “hemodynamic nightmare” due to the cardiac arrests and traumatic shock. The impact from the truck, the massive tissue injury she suffered, and the large volume of blood transfusions she received contributed to a severe acute lung injury that made it difficult for her body to oxygenate her blood and clear carbon dioxide from it.
Meanwhile, John A. Persing, M.D., tried to save as much tissue as possible. Early on he brought Kelly-Alexander into the operating room to clean her wounds and preserve as much soft tissue as he could to maximize the quality of the reconstruction and function that would come later on. Dr. Persing used wound VAC, a negative-pressure wound therapy system, to suck out the excess edema fluid and help her wounds contract. This method temporarily closes the wound with a special sealed dressing, optimizes blood flow, and decreases the chances of infection, allowing the wound to shrink much more rapidly than it would otherwise.
Intubated and heavily sedated for more than 30 days, Kelly-Alexander remembers nothing of that period, although she still suffers from vivid nightmares. Her husband, Sean Alexander, stayed by her side virtually nonstop, leaving only for short periods to go to his job as a postal worker.
In mid-November, she was finally transferred to a specialty rehabilitation center, where she underwent several hours of wound care each day and learned to walk again before going home and preparing for her next round of surgeries.
Physical activity and social activism
Despite her arduous recovery, Kelly-Alexander began to pursue physical activity and social activism once again within months of the accident. Last September, she set her sights on the New Haven Road Race. “I had a heart-to-heart with Dr. Baumgaertner and asked if I could try to jog without my walker,” she says. “He said to take it easy, maybe try one mile, and see how it goes.” She jogged the entire 5K event slowly, wearing a shirt to which she had pinned a sign thanking the Yale medical staff for saving her life.
Dr. Persing is still working on Kelly-Alexander’s leg as he tries to give the most normal shape possible to her body. She will require several surgeries over the next couple of years to remove scar tissue and put in fatty tissue that’s missing to plump up her thigh, providing the cushioning she needs to cycle. “She typically exceeds expectations because she’s so motivated, so there is potential for significant improvement, but she will have some scars and some asymmetry in her legs,” says Dr. Persing.
Coping with adversity
Kelly-Alexander now cycles and runs again, but awkwardly and with a limp. Her experiences have inspired her to advocate for helmets and other bike and motorist safety measures. She also raises money to benefit organizations that have helped her, like the Red Cross. Her first time cycling on the road was last October, when she rode with the Madison police department during a safety awareness ride. “Getting out and riding 75 miles or running five miles is the least I can do,” she says. “It’s not about me anymore. I’m a product of all these people.”
“There are a lot of unsung heroes in this,” says Dr. Kaplan. “Everyone from the Emergency Department technicians, to the nursing staff, to the people in the operating room that ran to get blood played essential roles in her care. If that whole team didn’t work well, she probably wouldn’t have survived this.” Still, those who have treated Kelly-Alexander acknowledge that her remarkable recovery is due largely to her strength and perseverance. “When you give people a second chance, some take the ball and run with it,” says Dr. Baumgaertner. “Her glass has always been half full and it should be a lesson to all of us.”