160 Chapter 8
Case Study 8-6: Pediatric Traumatic Brain Injury After a
Hit-and-Run Motor Vehicle Accident
On a beautiful Saturday morning, 6- year- old Collin and his older brother, Travis, hurriedly
finished their breakfast and ran out the door. Collin had wrapped his new baseball glove around
a softball, and overnight, a perfect pocket had been created in the mitt. Travis, a fifth grader, was
going to hit a few ground balls to Collin and show him the finer points of baseball.
For Lindsay and her friends, it had been one of the best sleepovers ever. They had spent the
whole night sharing secrets and giggling about clumsy, awkward boys. The girls knew they were
far more mature than their male peers, and a driver’s license was soon to be the ultimate symbol
of maturity. Fifteen- year- old Lindsay had just received her driver’s permit, allowing her to drive as
long as a licensed driver was pres ent.
She hoped her parents would return from the restaurant they owned in time for her to drive her
best friend home. Although the restaurant didn’t open until 4:00 p.m., there were morning bread
and produce deliveries to be inventoried. Lindsay’s friend offered to call her parents for the ride
home, but on this Saturday morning, the two girls made a bad decision. They thought that just this
once, Lindsay would drive her friend home without a licensed adult in the car. It was a short drive.
No one would be the wiser; besides, she was nearly a legal driver.
Collin was already showing promise as a shortstop; he had the necessary instinct and moves.
Travis threw a ground ball, and Collin scrambled to capture it. After about an hour, Travis thought
it time to hit a few grounders. He tossed the ball above his head, and as it fell he slammed the bat
into it, sending it bouncing to Collin. So far, Collin had caught or stopped each ball. Then Travis
hit a “zinger”; it bounced twice and shot over Collin’s head, between the parked cars, and into the
quiet street. Collin ran after it.
Lindsay carefully backed the family’s second car out of the garage, down the driveway, and
into the street. Just as the driving instructor had taught, she had her hands at 10 and 2 o’clock on
the steering wheel. The two girls talked and laughed as the car came to a complete stop at the first
stop sign. Looking both ways, Lindsay turned right and continued the short journey to her friend’s
house. The car accelerated to the speed limit, and then Lindsay brief ly looked down to change
the radio station. The police report listed the accident as a hit- and- run because the panicked and
distraught girls, screaming and sobbing, had returned home.
Collin lay in the pediatric head trauma unit, with ban dages around his head and tubes coming
from his nose, wrist, and head. The room was dimly lighted, with several instruments humming
and beeping. One instrument attached to Collin’s arm monitored his blood pressure, and the fre-
quency and strength of each heartbeat were displayed above the pressure reading. A pulse oximeter
attached to his index fin ger provided valuable information about respiration and blood oxygen.
The drainage tube attached to his head allowed a red- yellow f luid to fill a small bulb, reducing the
pressure in his brain.
Several days later, Collin’s parents accompanied him to the hospital’s radiology unit for several
diagnostic tests. The magnetic resonance imaging brain scans helped to identify the site of Collin’s
brain injury. The front bumper of Lindsay’s car had damaged primarily the frontal- temporal-
parietal lobes of the left hemi sphere. The pediatric neurologist told Collin’s parents that those
areas are all- impor tant for speech and language. She was extremely pessimistic about his future
ability to talk, walk, and take care of himself.
Five years have passed since Collin ran into the street chasing the errant baseball. The pas-
sage of time has been good for Travis and Lindsay. Travis no longer feels guilty about hitting the
baseball too hard for a 6- year- old child, and Lindsay, with the help of counseling and the kindness
of Collin’s parents, forgave herself for making bad decisions that Saturday morning. Fi nally, the
brain’s remarkable compensation abilities have been very good to Collin.