Defying Death, Through Neurosurgery

defying death through neurosurgery
Damir Tursanovic shows off his specially equipped vehicle to his physician —
and friend — Jonathan Hott, MD, who saved his life after a motorcycle crash.

"Some of my friends say I like to live on the edge," says Damir Tursanovic, 29. "I think I've walked about as close to the edge as you can get without going over."

To look at Damir, you might not guess he's come close to death — more than once. But his friends are right. He's walked very close to the edge, indeed.

As a young teen in the early 1990s, he and his family survived the horror of war in Bosnia and immigrated to the United States.

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Five years ago, Damir walked the edge again. Riding a motorcycle from Lake Pleasant just west of Interstate 17, traveling about 70 miles an hour on a two-lane highway with excellent road conditions, Damir's bike went into a skid.

He laid down the bike well, but his tires hit a post, flipping the bike one way and Damir another. He sailed through some cactus and palo verde branches, stopping when his head hit a rock. He was not wearing a helmet.

Paramedics rushed Damir to the Level I Trauma Center at John C. Lincoln North Mountain Hospital. He was very close to death.

Damir's initial CT scan showed a significantly depressed fracture on the right side of his skull and a blood clot, an epidural hematoma, between his skull and brain.

"It was a very severe traumatic brain injury," said Jonathan Hott, MD, a skilled trauma neurosurgeon. "The CT scan showed bleeding on the surface of the brain and in the brain stem, and a skull fracture — neurologically, he was doing very badly."

defying death through neurosurgery
Jonathan Hott, MD, and Damir Tursanovic discuss Damir's progress after a four-month coma and long rehab. Behind them is the scan showing his brain injury after the motorcycle accident.

Even if Damir recovered, returning to anything like a normal life could take years. In his favor were his age, physical condition and a fighting spirit.

The neurosurgeon removed the fractured bone pushing on Damir's brain and replaced it temporarily with titanium mesh. He also removed the blood clot, easing more pressure on the brain.

But, as is often the case with brain injuries, the swelling soon worsened. "I had to take him back to surgery," Dr. Hott said.

He removed a large portion of Damir's skull to give his brain space to swell. Otherwise, swelling would press on the brain stem, which controls breathing, and might have been deadly.

Four Months in a Coma

"I have been told I was in a coma for four months," Damir said. "Dr. Hott told me they weren't sure I would come out of it."

For weeks in the ICU, Damir did not regain consciousness. His clinical condition, however, had stabilized, and he improved enough for discharge to a rehab facility.

"Right before he was discharged — during the last 24 hours he was with us — he began to follow a command intermittently," Dr. Hott said. "That gave me a glimmer of hope that the door was open to make real improvement."

However, another complication brought death close again.

In the rehab facility, Damir acquired Clostridium difficile, a debilitating infection of his colon. The infection led to pneumonia and cascading organ failure.

"His chances of surviving an infection like that on top of the head injury were not great," Dr. Hott said. Damir returned to North Mountain Hospital in a coma.

Again he battled back. The brain swelling finally began to subside. For months he'd lived without a large section of his skull, his brain shielded by a protective helmet. In yet another surgery, Dr. Hott was able to reconstruct Damir's skull.

A Challenge, Not a Burden

"Damir ultimately made an excellent recovery," Dr. Hott said, crediting John C. Lincoln's patient care and "top-tier trauma program."

"When it comes to Dr. Hott, I rate him five stars," Damir said. "I consider what happened with my care at John C. Lincoln to be somewhat miraculous."

"Damir looks at everything as a challenge, not a burden," Dr. Hott said. "He's tenacious and dedicated, working extremely hard in rehabilitation. He's still at it. I think that's a big reason he's been able to come back from the edge and make such progress."

Doctor and patient still keep in touch. At Damir's request, Dr. Hott has visited the rehab facility to watch him work.

They talk about what Damir can achieve, his limitations, his next goal.

The relationship finds Dr. Hott relating as a friend and mentor, as much as physician to patient.

It's been a long road, and it's a victory they share.

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