Her Honda CRV didn’t stand a chance against the cargo van.
“It happened very fast,” said 30-year-old Andrea Zink. The crash on I-480 trapped her in the driver’s seat. Rescuers used the Jaws of Life to extract her from the wreckage; the car was so mangled, they had to lift her out the back window.
Later, she would be glad she was wearing a seatbelt. And she would be glad very experienced trauma surgeons were standing ready for her when she arrived by squad at the Level I Trauma Center at CHI Health Creighton University Medical Center.
“I remember looking at my legs,” she said. “Seeing my injuries – I was shocked. I was so alarmed.” Zink had two broken legs, a broken arm, a fractured ankle and significant hip injuries.
Trauma surgeons were also very concerned about her extensive internal injuries; there was a significant amount of blood in her abdomen. Her liver was severely injured, sustaining Grade IV injuries as rated on the organ injury scale established by the American Association for the Surgery of Trauma. Grade IV and V injuries are the most serious and affect a large part of the liver.
Trauma Surgeon Anthony Udekwu, BM, B.Ch, FRCS (C), FACS, worked on her liver injuries and those in her large and small bowel by removing portions, then reconnecting them.
“When I woke up in the trauma-surgical intensive care unit, I was intubated and I was very confused about what had happened,” Zink said. “I didn’t know where I was.” She described herself as a “pretty level-headed and calm person” with a Type A personality. She had to learn to be patient, she said: “I had to learn to not force things to happen. I really respected the doctors’ professionalism. They certainly were patient with me.”
Although her liver was healing, she developed a leak from one of her drains – it turned out to be fluid from her pancreas. This was a very unusual development, said Juan A. Asensio, MD, FACS, FCCM, FRCS (England), KM and Chief of Trauma Surgery, because her pancreas had been examined previously and drained. Dr. Asensio ordered a magnetic resonance cholangiopancreatography (MRCP) procedure to visualize the pancreatic ducts. It failed to show any pancreatic injuries.
Trauma surgeons persisted in looking for the cause and consulted with Gastroenterologist Savio Reddymasu, MD. Dr. Reddymasu used an endoscopic retrograde cholangiopancreatogram (ERCP) to examine the ducts that drain the liver, gallbladder and pancreas. Doctors found a laceration in an accessory pancreatic duct of Santorini and placed a stent there. The injury was not detectable during the earlier operation because it didn’t exist yet; leaking enzymes, which digest food, had actually digested a portion of the connected bowel, causing the leak.”
Dr. Asensio, who is nationally and internationally recognized for his work on pancreatic injuries and has published extensive research on the subject, said he’d never seen this type of injury. “It’s extremely uncommon,” he said. He realized there was a leak from the bowel anastomomis – where the large and small bowel are connected. And after seeing that her abdomen was inflamed, potentially resulting in a higher risk of complications, Dr. Asensio returned the patient to the operating room.
“The vessels were very well-hidden so we did a thorough exploration. It required careful mapping of the superior mesenteric vessels with a Doppler probe and use of fluorescein angiography to determine which portion of the large and small bowel would be viable afterward,” he said. Later, another bowel anastomosis was performed.
Dr. Asensio called the successful outcome a team effort: “She’s very fortunate she had the expertise of two very senior trauma surgeons (Dr. Udekwu and Dr. Asensio) here.”
“They removed about a foot-and-a-half of my colon,” said a disbelieving Zink. “I learned you have to have a kind of resilience to survive this.” To stay upbeat, she positioned her wedding photo near her bed, along with a sign that read: “Life isn’t about waiting for the storm to pass, it’s about learning to dance in the rain.”
Zink appreciated that her trauma surgeons and nurses took time to “really talk” with her and her family. Her father is a retired professor of gastroenterology from Vanderbilt University. “They always explained everything to all of us,” Zink said. “I feel blessed that I was on this journey with the great team of people!”
She called Trauma Surgeon Udekwu “fabulous” and the Chief of Trauma Surgery Asensio “world class.” Her nurses in the Intensive Care Unit were “unbelievably attentive.” She added: “I have a whole new respect for nurses. One of them, Alisha (Ponsar), cried when I left. I cried too. She really cared about my healing. She really wanted me to get better.”
A high point for Zink was being able to eat regular foods again. “I went 48 days without eating,” she remembered. Being able to stand up after long weeks in a hospital bed was a relief too, but harder than she expected. She had both physical and occupational therapy ahead of her before she could return to work at the Kroc Center as special events manager. “I’ve been here so long I want to see how it’s going to turn out.”
Dr. Asensio predicted she would have no longterm health issues related to the crash.
After almost two months at CUMC, Zink could say she felt “awesome. I’m so glad I didn’t have any injuries to my head, neck or brain.”
She looked around her hospital room. “Processing all this took a while,” she said. “It challenged me in terms of patience and perseverance. It was also very humbling. It reminds me of all the cliches, like ‘Take one day at a time.’ It reminded me of the beauty of life.”
Zink was a featured survivor and speaker at CUMC’s Trauma Symposium recently. Read more of her story at Omaha.com.