An Air Force veteran suffers a stroke behind the wheel and survives thanks to UF Health TraumaOne.
What was supposed to be a short drive to work June 24, 2016, became a medical emergency for Robert Ayer. The 53-year-old Air Force veteran was driving on Interstate 295 when he had a stroke. Robert crashed his car into the median, coming to rest on an embankment. Fortunately, he didn’t hit anyone else in the collision, but his injuries were life-threatening. Jacksonville Fire and Rescue rushed him to UF Health Jacksonville — the only Level I trauma center in the region — where the UF Health TraumaOne team saved his life and placed him on the road to recovery.
Beyond the Bruises
When Claudia Ayer rushed into the trauma center, her heart pounding, mind spinning and expecting the worst, she was surprised to find her husband sitting upright. Minutes earlier, she received an urgent voicemail from the police informing her of her husband’s single-car accident. A call from UF Health Jacksonville followed.
“A doctor called and said I needed to come fast,” Claudia said. She rushed to be by his side. Externally, he looked fine. Internally, his body was under attack, compromised in key areas needed for survival. Fortunately for Robert, the TraumaOne team is trained to see beyond the surface.
“He was still in shock, contributing to the mindset that he was feeling fine,” said Dunbar Alcindor, MD, a UF Health neurosurgeon.
“My back was hurting really badly and I was aware that I had a stroke,” Robert said.
It was what he wasn’t feeling that could have taken his life. The trauma and emergency medicine team acted quickly to look for any internal complications. Marie Crandall, MD, a UF Health trauma surgeon, was on duty the morning the ambulance arrived with Robert.
“Happily, the initial assessment showed his blood pressure and heart rate were good,” Crandall said.
Crandall wisely sent him for more testing. The results required immediate attention. He had a tear in the colon, a break in the lumbar spine and a blood clot in one of the large vessels in his brain.
Tackling Trauma Together
UF Health Jacksonville’s multidisciplinary teams are trained to save lives. Specialists are on site around the clock to perform procedures at a moment’s notice. In Robert’s case, it was never a matter of how, only a matter of what to address first as everyone jumped into action.
Crandall repaired the bowel perforation while other specialists tackled the blood clot. Although successful, this created the potential for another challenge — brain swelling. By the end of the day, Robert was admitted to the trauma intensive care unit.
“One of the problems with a stroke is you can rapidly develop brain swelling,” said Carlos Arce, MD, a UF Health neurosurgeon.
Robert’s team kept a steadfast watch over him throughout the weekend, noting his decline on Saturday. A decompressive craniotomy is not always necessary, but by Sunday, Arce determined there was a need for more surgery to prevent brain damage.
“As the brain swells, the pressure increases inside the head. If the brain sustains damage, you can die from that,” Arce explained. “We removed a portion of the skull to relieve the pressure, providing much-needed extra space.”
The procedure was a success, but there was still one more medical mountain to climb. Robert’s spinal cord injury, the one problem thought to be a priority upon initial examination, had taken a backseat to the critical issues revealed by the CT scan. Alcindor, who participated in helping with some of the treatment for the stroke, was now ready to address the fractured lumbar spine.
“We felt it was safe enough. We stabilized his spine and replaced the bone flap in his head,” Alcindor said.
The next step was letting Robert recover from his stroke and all the other injuries. The team monitored him for five weeks to ensure he was recovering. The staff kept Claudia informed every step of the way.
“I was always in the loop,” Claudia said. “It’s overwhelming if you’re not in the medical field, but they talked to me in ways I could understand. I always had a voice. I felt like I was part of their team.”
More Than Words
The only one who couldn’t speak was Robert. In the first several weeks, he had an endotracheal tube connecting his nose and mouth to his lungs and later a tracheostomy tube. Since he wasn’t able to talk, he came up with another way to communicate, reminiscent of when they first met.
In the early 1990s, Robert and Claudia’s love story began with the written word. Robert was in the U.S. Air Force and Claudia was in the German Air Force, when he spotted her at a Washington, D.C., nightclub. His first thought was, “Wow, this girl is beautiful.”
For the next several years, they met when their schedules overlapped, and in between, he penned her love letters. Eighteen years after they vowed to stay together “until death do us part” and “in sickness and in health,” he signaled to her to bring him a pen. A white board and a marker became his temporary vocal cords throughout his five weeks at UF Health and after his move to Brooks Rehabilitation.
What felt like a lifetime of silence ended when Claudia answered the phone, expecting to hear Robert’s physical therapist on the other end. He had been at Brooks working on regaining his strength and learning how to walk again.
“Hey babe, it’s me,” the familiar voice said. Hearing his voice for the first time was overwhelming for Claudia. “It was a very emotional moment for both of us,” Robert said.
Robert was talking, working on walking and well on his way to recovering with the same determination he used to tackle every challenge in his life.
“I tried to maintain my positivity throughout the whole thing,” he said. “I was always moving forward. There was never any doubt in my mind that I was going to get better.”
He still has some short-term memory loss, but he is walking, driving and doing daily chores that most people consider mundane.
“Every moment we’ve got on this Earth is precious,” he said. “Don’t take it for granted.”
Steps Toward Success
Robert continues setting goals for the future. He works out three times a week in hopes of passing the physical exam to rejoin his Air Force reserve unit. He also wants to raise awareness and be an advocate for men’s health. The stroke he suffered — the catalyst for everything that followed the June 24, 2016, accident — could have been prevented.
“I went to a cardiologist. I was diagnosed with atrial fibrillation,” he said. “I was given medication, but I didn’t take it seriously.”
On the outside, he looked fine. On the inside, however, he was a tragedy waiting to happen. Robert hopes he can use his experience to help others and encourage at least one person avoid a similar fate.
“Listen to your doctor. Take it seriously,” Robert said. It’s a message he eagerly delivers full of gratitude for the men and women at UF Health Jacksonville who saved his life.
The highly skilled physicians and their medical teams successfully conducted three lifesaving procedures on Robert in a matter of hours. As part of a Level I trauma center, they do this every day. UF Health TraumaOne serves 30 counties in the Northeast Florida and Southeast Georgia region. They care for more than 4,000 patients, like Robert, every year with one goal in mind: saving their lives so that they can reunite with the family and friends who love them.
Editor’s note: Robert Ayer was the patient honoree at the 2018 A Night for Heroes gala, an annual event that benefits UF Health TraumaOne, the region’s only adult and pediatric Level I trauma center.
A Night for Heroes 2018 - Robert Ayer
Marie Crandall, MD, MPH, FACS
Associate Chair, Research; Program Director, General Surgery Residency