Former college catcher Jon Wilhite closed his eyes and teetered slightly, balancing first on his left leg, then on his right in the exam room at UC Irvine Medical Center. For this battery of neurological tests, he also named the months of the year in reverse order and tapped the fingers of each hand against his thumbs in quick succession.
It had been just 14 weeks since Wilhite arrived unconscious in the medical center's emergency room after a car crash that killed Angels rookie pitcher Nick Adenhart and two other friends. The doctors at Orange County's only Level I trauma center soon discovered that the impact had torn neck ligaments and fractured the bone connecting the 24-year-old Wilhite's spine and skull. The only things holding his head in place were skin, muscle and a rigid collar put on him as a precaution by Fullerton paramedics.
Ninety-five percent of people with this kind of dislocation, sometimes called internal decapitation, die immediately. The rare survivors are gravely impaired. Yet here was Wilhite, parrying questions with sly humor and describing the miles he'd logged on the family treadmill. A few weeks earlier, Fox Sports videotaped him throwing the opening pitch at a baseball game at Cal State Fullerton's Goodwin Field with the barest hint of stiffness from the metal rods connecting his head and spine.
In the exam room, Dr. Suzy Kim was impressed by his progress. "I'm sure I'm not the first to tell you, Jon, but your recovery is just amazing - in so many ways," said the director of UC Irvine's Acute Spinal Cord Injury Program and survivor of a surfing accident during medical school.
Crowded into the small room, his father, mother and younger brother were visibly relieved. Wilhite, however, let a flicker of impatience show, wishing that his body would cooperate more, that his speech was a little faster, that he didn't feel so exhausted all the time.
"This has been - what? - three months' recovery?" Kim responded. "Most patients don't recover that quickly even after a simple orthopaedic injury."
Defying the odds
Only a handful of people are known to have recovered from atlanto-occipital dislocation, says UC Irvine spine surgery chief Dr. Nitin Bhatia, who fused Wilhite's head and neck together with a titanium plate, rods and screws in a delicate five-hour operation.
"He should have died, like everyone else in the car," Bhatia says. The early morning crash claimed the lives of Adenhart, 22; Cal State Fullerton student Courtney Stewart, 20; and Wilhite's childhood friend Henry Pearson, 25.
"Everything had to go just right - from the paramedics and firefighters who pulled Jon from the car to our ER team and the UC Irvine trauma surgeons and neurosurgeons who kept him alive," Bhatia says. "If he'd been pulled a centimeter in any direction, his spinal cord would have been damaged. If any one of the links in our chain weren't as strong, he might not be alive today."
As UC Irvine's experienced trauma team quickly learned, internal decapitation was just one of many life-threatening injuries the 2008 Cal State Fullerton graduate would have to overcome.
April 9, 2009
12:10 a.m.: Fullerton emergency officials receive a report of a high-speed collision at Lemon Street and Orangethorpe Avenue. Adenhart, who had pitched six scoreless innings for the Angels a few hours earlier, was heading with his friends to a local dance club when the driver of a minivan ran a red light and broadsided their silver sports coupe.
12:17 a.m.: The first fire engine arrives at the scene. Pearson, in the right rear seat, is found to have no pulse.
12:19 a.m.: The first ambulance arrives as the fire crew prepares to cut away the car's roof to get to Stewart, in the driver's seat, to Wilhite, seated behind her, and to a badly injured Adenhart in the front passenger seat. Stewart dies moments later.
The unconscious Wilhite appears to have only minor cuts. Still, paramedics follow protocol, placing a rigid collar around his neck and sliding a board behind him to stabilize his back. Slowly and carefully, several firefighters lift him from the mangled car.
12:34 a.m.: The ambulance speeds toward the medical center in Orange. With Wilhite strapped to the fiberglass board in "full spinal precaution," paramedics cut apart his shirt and jeans to check for injuries. En route, Fullerton firefighter Rich Zeller notices that his unidentified patient's pupils have become unequal, suggesting pressure building in the brain.
12:42 a.m.: The ambulance arrives in the hospital's ER bay. Fullerton paramedic Capt. Ben Garrett recites the patient's vital signs and symptoms as UC Irvine's waiting trauma team takes over. "It was like a pit crew in a stock car race," Garrett relates. "All 10 or 20 of them had a job, and they were all doing it at once."
12:44 a.m.: With Adenhart strapped to a backboard, another ambulance leaves the crash scene for the medical center. A second UC Irvine trauma team scrambles into place as the first team tends to an unresponsive Wilhite.
12:50 a.m.: An ultrasound and X-ray find no bleeding in Wilhite's lungs or abdomen, and his blood pressure is good. But his body temperature has plummeted to hypothermia level.
1:01 a.m.: A CAT scan of Wilhite's brain, spine and vital organs reveals the break in the bony joint linking his skull and neck. It also reveals broken ribs, a broken shoulder blade and collapsed lungs, and a fracture at the base of his skull. There is serious internal hemorrhaging above his left ear as well as diffuse micro-bleeds, evidence that the brain had slammed against the skull bone and sheered back on itself. Wilhite is rushed to the intensive care unit.
Paged at his residence, spine surgeon Dr. Douglas P. Kiester takes one look at the CAT scan on his home computer and orders that a cagelike device called a halo be attached to patient's skull to immobilize his head and neck. The ICU and trauma teams race to treat Wilhite's other life-threatening injuries.
An hour or so later, ICU surgical director Dr. Darren J. Malinoski and the second trauma team lose the battle to save Adenhart. Police arrest the suspected drunk driver of the van, who fled on foot. (Andrew Thomas Gallo, the 22-year-old van driver whose blood alcohol level was twice the legal limit when he was taken into custody, faces trial on three counts of second-degree murder for the deaths of Adenhart, Pearson and Stewart.)
1:15 p.m.: Wilhite's breathing and other vital signs are sufficiently stabilized that he's given an MRI scan, which lets doctors view soft tissue inside his body. It confirms extensive swelling in the brain and around the spinal cord, which must recede before surgery to reconnect the head and neck. A grave-faced Kiester meets with Wilhite's parents, Tony and Betsy Wilhite, who didn't learn of the accident until they awoke that morning.
"Dr. Kiester had tears in his eyes," Betsy Wilhite recalled. "You could tell he was sympathetic to us. He said he was going with his gut and telling us they needed to put off the surgery to reattach Jon's head and neck - he and Dr. Bhatia both. We trusted them."
In the hours and days that followed, the ICU and trauma teams labored to keep Wilhite's brain suffused with oxygen-rich blood and his lungs infection-free while a ventilator breathed for him. Surgeons inserted a filter in his abdomen to trap blood clots before they could cause damage to his heart or lungs. Family members took shifts at Wilhite's bedside.
Finally, on April 15, Bhatia performed the surgery to fuse the head and spine, leaving Wilhite with an 8-inch vertical scar. Now it was time to let his athletic young body heal. By the time he left the hospital for inpatient rehabilitation on April 30, the 10-pound protective halo was long gone and he was walking, albeit with help.
"That's when we knew his was a really exceptional recovery," Kim says. "And not just from the internal decapitation. He was able to speak a few words, swallow and initiate some walking. That's absolutely extraordinary."
When Wilhite and his family visited with the trauma team about two months later, it was clear that he had recovered all his mental faculties. He joked that he was not only recovering but taller, thanks to the spine straightening. "Expressing himself may have been a challenge speechwise," Malinoski says, "but making a room full of doctors laugh takes intelligence and wit."
For now, Wilhite keeps busy with speech, vision and physical therapy. Kim also recommended that he stack pennies to hone his fine motor skills and play computer games to improve his eye-hand coordination and acuity. "See, Jon, come to me and I give you a prescription for money and games," she joked during the exam.
He has tossed the first pitch at a number of Major League Baseball games, including an Angels' home game on Aug. 29, which coincided with a blood drive in memory of Adenhart that was sponsored by the team, the American Red Cross and UC Irvine.
The tributes and public attention has been great fun, but Wilhite is eager for things to quiet down. "I want to get back to normal, to be able to run, work out, go to batting practice," he said. Down the line, when Bhatia gives the go-ahead, he wants to try surfing and snowboarding, sports that were off limits to a competitive baseball player lest he hurt himself.
In his heart of hearts, Wilhite knows what he'd like to do in future. "I at least want to coach kids. I want to somehow be involved in baseball."
Michael Greenlee, Cal State Fullerton's media director for baseball, thinks that just might happen. "I've already seen too many miracles from Jon, so I wouldn't count him out."
- Kristina Lindgren, Health Affairs Communications