Why We Do It Patient Stories My remarkable sister Hayley Hayley’s incident happened on 23rd May 2019 while she was exercising a horse at William Fox-Pitt’s training establishment near Sturminster Newton. She was on the gallops, travelling at speed, when the horse lost its footing and she was thrown off. Dorset and Somerset Air Ambulance were tasked to the incident. They provided life-saving care and airlifted Hayley to Southampton Hospital; a journey that certainly helped to save her life. Despite wearing a riding helmet, Hayley suffered life-changing brain and spinal injuries, which included a traumatic brain injury (diffuse axonal grade 3 and subarachnoid and intraventricular haemorrhage, hypoxic brain injury), as well as a spinal injury (a tri-column fracture at T6 and T7). She also suffered a broken nose, broken ribs, knee ligament damage, lung contusions and a third nerve palsy, which has since affected her sight. Hayley’s journey has been long and complicated. From the start, it was made clear that her injuries were severe and as well as being life-threatening, they were also life-changing. Hayley spent 33 days in a coma on the Neuro Intensive Care Unit at Southampton Hospital. She was then repatriated to the Critical Care Unit at Poole Hospital on 25th June 2019 where she remained for a further three weeks, before being moved to an Orthopaedic Ward for her spinal injury. She was then transferred to the Brain Injury Rehabilitation Unit on 6th August 2019 where she stayed until 13th May 2020; literally 10days short of being in hospital for 12 months. On that day, Hayley left Poole Hospital with a Guard of Honour from the staff and began nearly five months in the Peartree House Rehabilitation Centre in Southampton, before being discharged home on 5th October 2020. Right from the start, the Intensive Care Unit team told us to keep a diary and we are so glad that we did, as we would never have remembered everything. The initial battle was Hayley’s brain injury versus her spinal injury. A CT scan and x-rays showed fractures to her spine, but she was not well enough for an MRI scan. Under normal circumstances the orthopaedic surgeons would have operated on her back, but due to the brain injury this was not possible as she would not tolerate an anaesthetic. We were warned the journey could be bumpy and they weren’t wrong! Hayley was immediately placed on a ventilator. On day four she contracted pneumonia and on day seven she got worse and her sedation was increased. I received a phone call from Hayley’s neurosurgeon on day eight to say fluid was beginning to build, compressing the brain tissue and that they urgently needed to perform a right frontal burr hole by drilling a hole in her skull to relieve the pressure. The day after that she spiked a temperature. After day 14, Hayley began stabilising enough for them to slightly reduce her sedation and morphine, but she only began responding with very tiny sporadic movements such as a finger moving. She wasn’t considered well enough for an MRI until day 21, which took two and a half hours. The following day, we were delivered further bad news that the MRI had shown hypoxia, which meant the brain injury was more severe than originally thought. Over the next few days, Hayley’s sedation was gradually reduced even more, but she was not ‘waking’ as quickly as everyone was hoping. However, every finger that moved and every toe that wiggled meant that she was improving and still with us. On day 33, Hayley was readily prepared to be moved from Southampton Hospital to the Critical Care Unit at Poole. She travelled with a team of six clinicians including her consultant and an anaesthetist. A tracheotomy was fitted the following day and the day after that, Hayley was finally off the ventilator. It was then that she began opening her eyes and tracking us. She also started to make larger movements with her arms, which posed other issues such as pulling her feeding tube out numerous times. When day 38 arrived, staff took Hayley (in her bed) outside for some fresh air and sunshine; you can’t keep an outdoor girl inside and it worked wonders for her numbers. The day after that she was measured up for a full body brace to help with her spinal injury. Although Hayley had a speaking valve on her tracheotomy, she did not speak. We had to rely on actions when asking her questions, but her responses were erratic, so it was difficult to know whether she was truly understanding what was being said to her. She also had to learn how to swallow again, so speech and language physios visited her daily, slowly introducing a spoonful of custard a day. On day 53 a PEG was fitted (a tube fed directly into the tummy for feeding). After being moved to the Orthopaedic Ward, Hayley had a spinal brace fitted on day 63. This was the first time she was able to sit in a chair. On 6th August (day 75), Hayley was transferred to the Portland Ward, which became ‘home’ for the next nine months. There, she learnt how to do everything all over again, from swallowing, eating, drinking, writing, talking and walking. During this time, I was able to be fully involved with her therapy sessions with physios, occupational therapists and speech and language therapists. This was invaluable as it gave me an understanding of Hayley’s capabilities. I later assisted her with lunches and joined her journey of learning how to do everyday things again such as feeding herself, making a cup of tea and baking. In February 2020, we began discussing Hayley’s next steps for when she left hospital and it was apparent that she needed further rehabilitation. A place was sourced at a rehabilitation unit in Surrey, but then the COVID-19 pandemic arrived so her stay at Poole was extended. Hayley left Poole Hospital on 13th May and began her time at Peartree House Rehabilitation Centre in Southampton. There, she spent five months in a purpose built bungalow, which was shared with four other patients to prepare her for home. The hardest part of this move was not being able to visit her due to the pandemic. We had a short period of time where we could visit for just one hour a week outdoors. Her therapy team worked wonders though and Hayley was ready to return home to her partner Mark and daughter Rhianon, assisted by 24-hour care on 5th October 2020. Although Hayley will need a wheelchair for the foreseeable future, she is able to walk short distances with a walking frame and we are hoping that, with additional work, her mobility will improve over time. Since returning home, she no longer has a night carer, which is great progress. Her memory has been hugely affected, but her sense of humour hasn’t! Her goal is to get back on a horse and with the help of the Fortune Centre in Bransgore, we hope this dream will become a reality once the pandemic is under control and we are able to return to normal. Throughout Hayley’s journey, we have had the most incredible support from all the medical teams at Southampton and Poole Hospital, with particular thanks to a few special people. However, I am constantly reminded that Hayley would not have survived, or been able to receive that care, without Dorset and Somerset Air Ambulance. Without Sean Santos, Dave Thom, Mario Carretta and that incredible helicopter, my sister wouldn’t be here now, so our eternal thanks will always go out to them. VIEW FROM THE CREW: When our critical care team arrived at Hayley’s incident, she was lying on her side after being found by a friend and colleague having fallen from a horse. She had obvious facial injuries, a very low conscious level and one of her pupils was dilated, indicating a traumatic brain injury. Our team gave Hayley an anaesthetic, which put her off to sleep. This allowed them to safely secure her airway and provide ventilation ready for her transfer to Southampton Hospital. They also administered strong medication to help prevent any further brain swelling, as well as antibiotics, which help prevent any infection from her injuries. Hayley was then transferred to Southampton Hospital, as this was the nearest Major Trauma Centre for ongoing intensive care and neurosurgery. Tanya also explains how our Patient and Family Liaison Nurses provided amazing support after Hayley’s incident. I was first introduced Jo Petheram and Kirsty Caswell on 1st July 2019. This was a few days after Hayley was transferred from Southampton Hospital to Poole. They came to visit us on the Critical Care Unit and I immediately warmed to them both. As trained nurses, it was good to have their medical knowledge, but it struck me that they were much more than that. Having a lifeline of support outside of the hospital was so reassuring. Jo gave me her mobile number so we could keep in contact via WhatsApp. She made it clear that she was there for us 24 hours a day and always on the end of the phone – even if it were to offload and have a cry! Right from the word go, they offered us support in the form of comfort, medical advice, a listening ear, whilst doing so much research for us. They even looked at getting a therapy horse into hospital to see Hayley, but unfortunately the charity running this were extremely busy with requests. However, this led us to arranging a visit from one of Hayley’s own Shetland ponies. She affectionately calls him Bean (baked bean as he is round and orange!). On 15th November, we made this happen and Jo was there in person to assist! We kept in contact the whole time and when Hayley achieved various things, I was able to send her photos to share the joy! In December, Kirsty organised a special visit from William Fox-Pitt, who also had his own experience of a brain injury. Kirsty even went to pick him up and drove him to the hospital; Hayley was elated. Although she has no recollection of her accident, she was fully aware of who William was and his status in the equestrian world. Both Jo and Kirsty continued their regular visits while Hayley was in hospital, trying to find ways of helping us moving forward, whether that be researching mechanical horses, disabled riding centres or rehabilitation facilities and talking to people for advice and guidance. When Hayley moved to Peartree in May, she was understandably nervous. Especially as this was during the pandemic and the family were unable to be with her. Jo organised some heart-warming videos from Sean and Mario sending well wishes and messages from Jo and Kirsty themselves. Kirsty filmed her message alongside her daughter’s horse, which was so thoughtful. She then went on to finding a disabled riding centre and started the ball rolling. We had just about got this set up and then we went into another lockdown, so unfortunately, we haven’t been able to pursue this yet. Jo’s support didn’t stop there. When our father was diagnosed with cancer and was very ill, she was such great support right up until he passed away in September 2020. Since Hayley has been home, we have managed one socially distanced visit outside with both Jo and Kirsty, who organised a big personalised welcome home card with photos of the momentous occasions over the previous months. They are always full of positivity, enthusiasm and wisdom. Most importantly, they are two of the most genuine, kindest ladies, we have been privileged to have on this journey, who we now consider friends.