Carmela’s comeback: Recovering from a crushing traumatic injury
May 20, 2021
Carmela’s comeback: Recovering from a crushing traumatic injury

    Carmela’s comeback: Recovering from a crushing traumatic injury

    Carmela, trauma patient at CHoR, throwing her first pitchCarmela Clary has been playing softball since she was 4, so throwing out the first pitch for her rec softball league this spring may not seem like a big deal. And really, it wasn’t – it was monumental.

    In the weeks leading up to the big pitch, 11-year-old Carmela and her family weren’t entirely sure if she’d be able to walk to the mound. Doctors were still considering amputating her left leg.

    On September 21, 2020, Carmela was in a utility terrain vehicle – or UTV – on a path near her home when she was struck by an SUV. The UTV’s roll bar, intended to protect riders should the vehicle overturn, caved in, trapping Carmela and crushing her leg.

    Hurrying to help Carmela

    The Clarys live in a rural area near South Hill, Virginia, so Carmela’s parents – Angie and Henry – were able to get to the accident scene before the rescue teams.

    “Bystanders were holding the arteries in her leg to keep her from bleeding out. We asked Carmela what hurt and she told us, ‘My arm is broken, it’s kinda hard for me to breathe and I think my wrist is broken.’ She thought her leg was broken, but she wasn’t sure. I just told her she was going to be okay,” said Angie.

    When the paramedics arrived, they applied a life-saving tourniquet to her leg to stop the blood loss. Our team was the first flight crew to arrive. Paramedic Cary and nurse Kacey quickly got Carmela into the helicopter and administered blood while in route to the hospital – the next of many steps to save her life and leg.

    Coordinated trauma care for complex injuries

    Carmela was brought into the trauma bay for evaluation. Because she came to a Level I Pediatric Trauma Center and academic medical center, she had the benefit of specialists in caring for her complex injuries, as well as the unique needs of a child with severe trauma. Dr. Laura Boomer, pediatric trauma surgeon, oversaw and coordinated her care from start to finish.

    “They told us the leg was badly broken. She also had an injury called degloving, where the skin from the knee to the ankle had been ripped away from the muscle. The one artery that hadn’t been severed supplied the blood to her toes. The next 24 hours would be very important,” said Angie.

    In addition to her leg, Carmela’s extensive injuries included fractures of both arms, multiple broken ribs, a wedge fracture in two of her vertebrae, along with lung and internal organ injuries. She had a series of surgeries over the next several days, her parents naturally on pins and needles each time.

    “Carmela had what we refer to as a mangled leg,” said Dr. David Cinats, orthopaedic surgeon. “She sustained a compound tibia fracture with about six inches of missing bone. She also had a large amount of tissue loss from the inner thigh down to the ankle. My colleagues, Dr. Perdue and Dr. Mountziaris, and I first reconstructed her tibia with the missing bone, and then transferred healthy tissue from her other thigh to the leg in what is called a “free flap” to replace the lost muscle and skin. She had multiple surgeries to clean the leg out when she first came to us, but her final reconstruction took 16 hours and is one of the most complex surgeries we have performed to date.”

    The beginning of a long recovery

    “They couldn’t tell us for sure the percentage use she would have in her calf. They also put a rod in from her knee down to her ankle, and they told us she probably wouldn’t have use of her ankle – like to push a gas pedal,” added Angie. “Then one day I looked over and noticed she was moving it in the bed and I thought, ‘Oh my God, she can use it!’”

    While this triumph brought great relief, there was still much work to be done. Carmela typically had wound care procedures on Monday, Wednesday and Friday mornings. She’d follow them up with lunch, virtual math and English lessons, and physical therapy. Music therapy was usually saved for last as a reward.

    “Carmela’s second grade teacher had taught the class sign language several years ago, which ended up coming in handy. When she was on the ventilator, she would sign to me that she wanted water and music. That’s how music therapy started,” added Angie. “She’s a natural music lover. She really likes the old stuff, like Conway Twitty and George Jones.”

    Even when she was stuck in the hospital, Carmela was learning new things and finding joy.

    “No matter what kind of day Carmela was having, the music never failed to cultivate a positive atmosphere of smiles and laugher,” said Carmela’s music therapist, Brooke. “Throughout our time together, sessions varied from me providing light music that allowed her to fall asleep when she was experiencing pain, to singing and listening to country songs together, to learning the guitar and ukulele. I always laugh thinking about how much that 11-year-old young lady loved singing old country songs. Music is so powerful but can be very personal, and it’s an honor to be able to use it to connect with families in a deeper way and provide musical experiences that feel familiar and safe.”

    Making the most of her hospital stay

    Carmela’s parents describe her as one of a kind, with an old soul that makes her easy to talk to – everyone gravitates to her, even when she’s not feeling her best.

    “We live in a small town and she’s never met a stranger. She’ll say hello to people in the grocery store and her dad and I have no idea who they are. When she was in elementary school, she knew all the teachers, the principal, the entire staff. She would know who was out sick and why. We jokingly called her the school manager,” laughed Angie.

    Not surprisingly, Brooke wasn’t the only friend Carmela made in the hospital. Nurse Kyley from the pediatric intensive care unit was always willing to take her down to the gift shop for some retail therapy when cleared by the medical team.

    “I was usually the one to go to the gift shop with Carmela and her nurse. She wanted to go before her flap procedure. The ladies at the shop got to know her and before I knew it, our trips became a daily habit,” said Dad, Henry.

    Carmela would invite her nurses to watch movies with her when their shifts were over. The family joked they were going to need more chairs and a popcorn popper! One of Carmela’s regular nurses in acute care pediatrics, Lindsay, grew quite fond of Carmela and her family – even playing Life with them occasionally when time allowed.

    “It was amazing to see her progress and get more independent over time. She was empathetic towards the other patients, and her family would do little things to brighten other patients’ stays too – decorating the outside of her room for Christmas and other holidays, helping child life wrap presents for the other kids that had to be hospitalized on Christmas Day, etc. Carmela is unlike any other kid I’ve cared for, and I hope she knows that her spunk brightened many of my days,” said Lindsay.

    More than medical care for Carmela and her family

    Carmela at CHoRWhile the Clary family was known for the joy they brought to the hospital, they appreciated the extra love they received too. The PICU nurses provided Carmela’s care in the beginning, while also tending to Mom’s emotional needs. In particular, nurse Erika helped explain the trauma, how all of the machines were helping Carmela and her path to recovery – answering questions with each step.

    “We live an hour and 45 minutes from Richmond. When the accident happened, Henry rode in the helicopter with Carmela and I packed a few things and hopped in the car to drive to the hospital – but I didn’t bring enough. The child life team helped find me clothes so I could have a shower, change my shirt and get comfortable. Child life was ah-mazing,” said Angie.

    Henry was appreciative of the food RMHC provides for families in the hospital.

    “Dana from RMHC always made sure I was fed,” said Henry.

    RMHC also gave Carmela some items to help make her stay better and housed Angie and Henry for several nights.

    CJ’s Thumbs Up also fed and cared for us. They gave us a really nice Thanksgiving dinner. I was a little concerned about not having a traditional dinner and then it turned out to be so wonderful,” added Angie.

    Of course, the team couldn’t let Carmela miss out on a family milestone during her hospital stay. Though she couldn’t attend her older sister’s wedding in person, nurse Brennan in the PICU made sure the celebration was brought to her. The team did Carmela’s hair, makeup and nails; set up the Zoom so she could be there virtually; brought sparking juice to the room for the toast; and even ordered a cake from the Panera downstairs. Child life brought flowers and made it feel as though the wedding was happening right there in Carmela’s room!

    Carmela was also well-known for her abundant mail deliveries from classmates, community members, friends and people who simply heard about her from near and far. Mom made garland from the notes and pictures to decorate her room for an extra dose of cheer.

    Mended leg, merrier days ahead

    With the expertise of her medical team – and plenty of well wishes and prayers from friends and strangers – Carmela’s leg was saved. And, after 95 days in the hospital, she went home for good on Christmas Day.

    “That was our Christmas present,” said Henry.

    She returned to school March 1 and she’s back to all her favorite activities – with some physical modifications, but 100% heart. She uses her walker at dance class to practice for her upcoming recital, and she never stopped her duties as secretary of her 4-H club. She’s also still focused on selling her Girl Scout cookies.

    “One year she sold 3,700 boxes of cookies. This year we were busier with PT and everything, but she sold 1,800 boxes with the help of our awesome family, friends and community. She’ll still get her name on a brick at Girl Scout Camp,” laughed Mom.

    While Carmela hasn’t been cleared to play softball just yet, she’s in the dugout as manager for her middle school team – and boy are her teammates glad to have her by their sides once again.

    Discover more about how our Level I Pediatric Trauma Center cares for kids with the most critical injuries.

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