One Lucky Unlucky Boy

Bobby PalangePhoto: Christian Witkin

Medical Miracle #5
Problem: Two-year-old boy playing in his driveway. Father accidentally runs over him while backing up his truck. Boy’s skull crushed; he arrives at the hospital near brain death. Emergency neurosurgery, including skull removal, required.
Doctor: Michael Egnor
Patient: Bobby Palange

On a snowy day this past February, 2-year-old Bobby Palange was helping his father, Bob, shovel snow in the driveway outside their Bellport, New York, home. “Bobby loves to help his father—he wants to do everything his father does,” says Bobby’s mother, Kim. “He’s always following Bob around.” Kim and her four other children were inside, putting on snow gear to get ready for a family visit to the dentist. “Bobby kept coming inside and going back out,” says Kim. “Finally, he came in and said his hands were cold. I asked him where his gloves were and he said, ‘By Daddy,’ so I said, ‘Go get them and then come back in.’ ” Kim closed the door after Bobby went out, thinking that her husband was still shoveling, when, in fact, he was about to pull his Dodge Durango out of the driveway. “Bob thought Bobby was still inside with me,” says Kim, “but Bobby had gone behind the car to look for him. Bob didn’t see him, and when he pulled out, he thought the bump he ran over was snow, but it was Bobby.”

A moment later, Bob saw Bobby lying motionless in the driveway. He jumped out of the car and carried him into the house. “When I first saw him, I thought Bobby had just fallen,” Kim says. “But then I saw his head rolling back, and I realized how hurt he was.” Bob had backed up over Bobby, and the impact of the vehicle had crushed his skull. “He wasn’t breathing,” says Kim, “so when the police got there, they decided not to wait for the ambulance. We just got in the car and sped to the hospital.”

Bobby was stabilized at Brookhaven Memorial Hospital. But the pediatric-surgery team at Stony Brook University Hospital was better suited to handle his injury, so he was quickly transferred there.

“When I first saw Bobby, his pupils were dilated,” says Stony Brook pediatric neurosurgeon Michael Egnor. “That’s a very bad sign—it means the patient is extremely close to brain death.”

A brain scan showed massive swelling. When pressure in the brain rises, the brain essentially begins to strangle itself. Egnor told Kim and Bob that he would need to remove almost the entire top of Bobby’s skull, starting at his forehead, to allow the brain room to swell. “If there’s space, the swelling will eventually go down, and the person has a chance to make it,” says Egnor. “If there’s no room for the brain to swell, the patient will most certainly die.” “I said, ‘I’ll sign anything you want,’ ” says Kim. “ ‘Just try and save my baby, and make sure he feels no pain, if anything happens.’ ”

Bobby’s surgery lasted about an hour and a half. Four large pieces of his skull were removed, then stored under skin on his abdomen to keep them viable for reattachment if Bobby made it through the surgery (doctors have found that storing bone in the body produces less risk of contamination than storing it by artificial means). After the skull had been opened, “I was fairly pleased with the way that Bobby’s brain looked,” says Egnor. “When we checked his pupils, they were normal.” The surgical team then inserted a catheter into Bobby’s brain to drain fluid and reduce swelling, and Bobby was placed in a medically induced coma to further reduce swelling and to minimize the risk of brain injury.

Bobby was gradually taken out of the coma after a week, and his recovery has been remarkable. He has a slight vision problem in one eye, but doctors think that it may improve with age. The scarring on Bobby’s reattached skull is disappearing as his hair grows back in, and he recently returned to day care. “The chance of Bobby having serious long-term complications is very small,” says Egnor. “His brain scan looks great, and neurologically he’s doing very well. He’s a normal kid—walking around and playing. If anything, his mom says he’s more focused now than he was before the accident.”

Bobby and his family have been spending a lot of time together this spring. “We’ve been doing lots of yard work as a family,” says Kim. She and Bob are setting up the backyard so that the kids can play there on their own. “We have a nice fenced-in area,” she says. “Away from the cars.”

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One Lucky Unlucky Boy