Deanne Niedziela lay in a surgical Intensive Care Unit bed not far from her corner office in a tower at Mission Hospital in Mission Viejo.
On May 28 in Costa Rica, Niedziela was crushed to the ground when a tree limb randomly dropped from the jungle overhead onto her left shoulder, leaving her in a fight for her life and paralyzed from the chest down.
The 53-year-old executive director of Acute Care Services in Mission Hospital’s Neuroscience Institute needed emergency care and then nine hours of surgery followed by a medical evacuation back to Orange County. And she is convinced she’ll be able to be back at her job in the place she’s worked for 30 years.
“My office is just beyond my doors,” said the longtime nurse and now administrator of the location just beyond her ICU room. “I want to come back to work.”
To that end, she’s been doing all she can to make it happen, even if it’s her reminding doctors and nurses about evidence-based treatment that she knows she needs. While she has no control over her lower body, she knows she has to keep it functioning no matter what. To get her spine to come alive again, she undergoes physical therapy multiple times a day, among myriad other restorative treatments.
Recently, Niedziela pointed out a whiteboard at the foot of her bed where she makes sure nurses and other providers jot down her thoughts on treatments she wants to make sure she gets. Like for example, a special foot brace boot that will prevent foot drop – something that happens when the foot is paralyzed or its muscles are weakened.
She also insisted on using an ergonomic bike while she lies in bed to keep her muscles from atrophying. She started at 20 reps and worked herself up to 40, doing the exercises at least twice a day. Recently, her hands became more useable and she can feed herself again.
“I guess it’s just my personality,” she said about her determination to improve. “I’ve got this attitude. I think positively and just keep going. I hope I find some silver lining, and I hope I inspire nurses to reinvigorate their careers by seeing what I’m doing.”
As a patient at Mission Hospital, Niedziela has visited all five departments and the staff of 400 she oversees; she celebrated her 29th wedding anniversary on June 18 and rang in 30 years as an employee at the hospital on June 28. She began her nursing career in 1983 as a bedside nurse, then worked her way up to charge nurse, then manager, then director, and into her current position.
Sounded like thunder
Niedziela and her husband, Ken, of San Clemente, were on a trip in Costa Rica with friends when the unimaginable accident happened.
On May 28, the couple had been touring waterfalls and were on their last stop at the La Paz Waterfall Gardens. Another couple was taking photos and they waited for their opportunity to get closer. Suddenly, Ken Niedziela heard what he described as something sounding like thunder. Then he saw a flash, he said, and saw his wife lying on her back. She was less than 4 feet from him and unconscious.
“I yelled for an ambulance and to go get help,” he said, adding that he immediately began performing mouth-to-mouth resuscitation. “I paused after three to four breaths, and her mouth opened and started to fill with blood.”
Two people from the Niedzielas’ tour group ran to help, as did Kevin Nishiyama, a firefighter EMT from the Fairfax Fire and Rescue Department in Virginia, who happened to be visiting the waterfalls.
Nishiyama said he saw the commotion, then saw someone running in with a backboard and saw people in uniforms surrounding Deanne but didn’t want to butt in because he didn’t want to be “that guy.”
But when someone began yelling for a paramedic, he introduced himself and said he could help. Getting her to the parking lot meant climbing up and down slippery, narrow steps and walking along a narrow gorge that “didn’t leave a lot of room for error.”
“I tightened up the straps and took the lead on getting her out,” he said. “I knew she was in pretty bad shape. I asked her to wiggle her toes and move her hands to get a general gauge of what was going on. She was definitely in an emergent situation and it was important to get her to a trauma center as soon as possible.”
Once down at the parking lot, they met up with a Costa Rica Red Cross truck that had only a driver. Nishiyama put her in the back and looked through medical supplies to make her more comfortable, also checking to make sure she didn’t have any other injuries or broken bones.
What scared Ken Niedziela the most, he said, was what happened next.
“I told them we need to go to a hospital in San Jose and it turned out we went to an urgent care-type facility,” said Ken, a former Orange County Register editor. “After a 45-minute drive along a bumpy road, they wheeled her in on a stretcher to only a nurse that was on duty.”
While in the clinic, Ken got a text saying a private ambulance was on the way to take them to Hospital Metropolitano Lindora in San Jose. In the end, it would take six hours to finally get Deanne to the appropriate team of specialists to give her a fighting chance to survive.
Dr. Brian Hwang, a neurosurgeon at Mission Hospital who six days later took over her care after she was medically evacuated from Costa Rica, said the measures that the Costa Rican team of doctors and nurses undertook in the first 12 hours likely saved her life.
“She had a devastating and tenuous injury and a great possibility she could have lost her life as a direct result of it,” Hwang said. “Her head fell off her spine due to the impact and as a result, her neck had a complete mechanical failure and her spinal cord was compressed.
“If you don’t put the spine back into alignment and take pressure off the spinal cord, we’re talking within a 12-hour period; the spinal cord would die. If it does, you lose all your function below the injury. The spinal cord controls all nerves that run your body. If you lose the ability to move everything below the neck, you lose the ability to breathe.”
Hwang’s assessment – and from reading the medical records later – was that Deanne was going into shock and respiratory failure. In the end, Dr. Andrés Gamboa did nine hours of surgery, working on the front and back of her body because everything had been crushed by the 5-foot, 100-pound limb.
“Looking at the outcome, I know they did a good job,” Hwang said. “It set her up for success.”
Returning home
On June 3, after monumental efforts from people all over – including from many that didn’t know Deanne – $100,000 was raised through a GoFundMe account to pay for a medevac flight back to Orange County. The cost was nearly six figures, the couple said.
For Deanne, it was a goal she worried might never happen.
“I didn’t believe it until I saw the whites of the eyes of the flight crew,” Deanne said. “I knew I needed to get back here. I knew my team was here, and I needed to get back to evidence-based treatment.”
After landing at John Wayne Airport, she was put in an ambulance to Mission Hospital. When she entered the doors of the hospital, dozens of her staff and others in the hospital lined the hallway to welcome her home in an informal ceremony called a “clap-in.”
“I started crying,” she said, “when I saw their faces and I knew I would be safe.”
Once she was settled in the ICU, doctors and nurses tended to her care while a steady stream of well-wishers came by, leaving cards and posters to show their support.
She had one more surgery to repair her clavicle on the left side where the limb had struck her and, since then, has made some steady progress, according to her doctors, who say most people with spinal cord injuries don’t see real improvements for up to six months.
“It’s important to stimulate the muscles so that when the spinal cord comes to life, she’s set up to regain her abilities,” Hwang said. “I’ve seen a lot of good things. I’m optimistic she has a double-digit chance to have some ability to walk.”
Among her improvements, he counts that she can breathe on her own after first needing a breathing tube, move her arms and has regained some sensation below the waist.
The part about walking again will be up to Deanne, the health of her body and the power of her mind, Hwang said. But she’s also been provided the best possible path toward her goal.
In just her time at Mission Hospital, and after her clavicle surgery and help with pain management, Deanne was pleased about little things that in the past she took for granted, like the ability to pick up jalapeno chips off a plate, grasping dark chocolate bites from Trader Joe’s and even using a little stick-like device to send text messages.
Recently, she learned she’d be transferred to Craig Hospital in Denver. According to her and her doctors, it’s among the top in the nation for rehabilitation for brain and spinal cord injuries.
Getting there took some cooperation from her staff at Mission.
“I only have an HMO that doesn’t allow out-of-network care, but my team wrote an appeal,” she said, beaming about her departure.
Taking flight
On Monday, July 3, at promptly 8:25 a.m., Deanne was wheeled out of Mission Hospital. Again, about 60 of her staff were there to “clap-out” and cheer as she left the facility. With her husband, she traveled by ambulance to John Wayne Airport again, where they boarded a private plane staffed with a flight paramedic and flight nurse.
“She was super excited,” Ken said on Tuesday, July 4. “This was her goal from day two after her nine-hour surgery in Costa Rica. Craig Hospital was where she wanted to be.”
Once there, a team of 20 – including doctors and nurses – stopped in to assess her needs. Her therapy will include four to six hours every day for at least 90 days, Ken said.
“You can’t be a passive patient and expect to get better,” he said. “You’ve got to do the work.”
And, Deanne has what it takes to be committed, her husband said. Before her injury, she regularly jogged up to 5 miles a day; she also did Pilates.
“She had good core strength but she’s lost all that and gotten weak,” he said. “She’s got to build all that stuff up over time.”
Ken said he believes in his wife’s strength, adding that the couple has had other seemingly insurmountable challenges which they managed to overcome.
In 2001, when Deanne was pregnant with their daughter Alyssa, they found out that the baby had a congenital diaphragmatic hernia – a condition that has a 50% mortality rate among infants. Two days after she was born, they were told she was dying. A chaplain at Children’s Hospital of Orange County had performed the last rites.
Today, Alyssa is healthy and a year away from graduating college at Colorado State University.
“All we could do then was wait and watch and hope the doctors knew what they were doing,” Ken said of his daughter’s situation. “There was nothing I could do then except be there and hope she was fortunate to survive. With Deanne, it’s the same thing. The first hours in Craig Hospital have been a great step. We’re in the best place we can and we don’t know what the future holds.”
Hwang is optimistic. As a former Army Special Forces Green Beret combat medic and later as a doctor in the civilian world, he’s seen his share of major spinal injuries. He believes Deanne’s attitude can make all the difference.
“I’ve never met someone who is so optimistic and strong,” he said. “She knows this will go on for the rest of her life and she will give it one hell of a fight.”
