The will to recover

Hours after former Virginia swimmer Matt Miller’s bike accident on the Blue Ridge Parkway, his parents, Mike and Nancy Miller, brother Michael, and girlfriend Emily Privette were numb. They looked for every positive sign they could.

If Dr. Stephen Park, director of facial plastic surgery at the University of Virginia hospital, was going to operate on his face, did that mean Matt was going to live?

Doctors did CT scans and X-rays and found that every bone in his face was broken, but that he’d suffered no spinal-cord injuries — in fact, no damage anywhere below the head other than scrapes and bruises and a broken right hand.

Before the surgery, Mike Miller went out to the garage, where he had pulled illegally into the first spot, and decided he’d better make some calls.

His first was to his good friend Jack Brennan, the chairman and former chief executive officer of Vanguard.

The second call was to another close friend — Bill McNabb, current CEO at his company, Vanguard — and a bike enthusiast, who had biked once with Matt the previous summer.

His third call was to his parents. He wasn’t sure how much to tell them. They’re in their 80s and live only two hours from Charlottesville. They wanted to drive up right away, but he told them no.

The Millers wanted answers. They wanted to know whether Matt would live.

But doctors repeatedly told them that first afternoon that 72 hours was the magic number. If Matt’s brain continued to swell like his face, surgeons would need to cut off the top of his skull to give the brain room to expand, according to Jason Sheehan, the neurosurgeon caring for Matt. If this could be avoided and Matt could hang on through Wednesday, his chances of survival would dramatically improve.

“The goal was to keep him alive,” Mike Miller recalled. “But everyone was wondering: Would he have a life worth living?”

Doctors that Sunday afternoon put Matt into a drug-induced coma. The theory was that the brain was taxed enough just trying to repair itself. Performing normal cognitive function — thinking — would be too much strain.

A burr hole was drilled into Matt’s head so a probe could measure blood flow and oxygen in the brain. A feeding tube was inserted through his nose and down into his stomach.

Doctors performed a tracheostomy, opening a hole in his throat to make sure he had a clear airway. During surgery, when Matt would need a machine to breathe for him, staff could hook the ventilator right to his “trache.”

About 8 p.m., Park, the facial surgeon, and his team began the operation.

It lasted six hours.

Nancy Miller fell asleep on the floor of the waiting room, her coat as her pillow. Her husband and older son tried to sleep in chairs.

At 2 a.m. Monday, Park woke the family. He told them that this was one of the worst cases he’d ever seen.

“Your son’s face was like a piece of fine china,” he said, “dropped from 20 feet.”

Park had started reconstruction by lining up the few broken teeth that were left. Then the surgical team tried to realign the jaw and rebuild Matt’s face, using titanium plates and screws. When there was nothing to attach screws to, the doctors just hoped the many tiny pieces of bone would grow around the titanium rods.

“You can’t fix those bones,” Park said. “You just hold it all together and hope they’ll heal.”

The family found one reason to smile. Park told the Millers that during surgery Matt’s pulse was so slow it had triggered alarms. The heart monitor had been set to go off at 50.

“It only took a moment to see he was fine,” said Park, “that he’s some kind of athlete.”

Park also told the Millers that two things had saved Matt’s life: “his helmet and his face.”

“What do you mean his face?” Mike Miller asked.

“His face was his air bag,” Park said.

The face has a “number of air pockets,” Park later explained, “and nobody really knows what they’re doing there. Are they to lighten the skull, to help our voices resonate, or to act as an air bag? When you get a blow, that force is transmitted into the air pocket rather than to what is directly behind it, which is the brain.”

After what they felt was great news from Park, the Millers checked into a motel a few blocks away.

At 7 a.m. the phone rang, waking them, and of course they dreaded the worst.

It was admissions. More forms needed to be signed.

Emily had gone back to her dorm and fallen asleep clutching a teddy bear Matt had given her on their first Valentine’s Day, when both were seniors at Radnor High. When she pushed a button on the bear, which she had done that night, it recited a recorded message in Matt’s voice: “I’m Emily’s and she’s mine.”

Recovering in the ICU

On Monday, compounded by the surgery, Matt’s face was even more distorted. Doctors brought him out of the coma every few hours to check his responsiveness, and Matt tried to pull out his airway and feeding tubes.

Such behavior is a good signal of brain activity, but not good for a patient’s immediate care. Staff put mitts on Matt’s hands and restrained his arms by his side.

The family and Emily visited him in pairs in the intensive-care unit. They talked to him but didn’t know what, if anything, he understood. When doctors lightened the sedatives, sometimes Matt would open his eyes when they spoke, but sometimes not.

“Squeeze my finger,” his mother would say. Sometimes he would. Other times not.

Monday afternoon, Brennan arrived from Philadelphia to comfort his friend. “Jack Brennan basically came down for last rites,” said Mike Miller. They sat outside on a hospital terrace, down the hall from the ICU.

As Monday rolled into Tuesday, still well before the critical 72-hour marker, the Millers began to feel in their guts that Matt was going to live.

But would Matt be Matt? What was the extent of brain injury?”

The force of the collision caused a “shearing” of Matt’s brain; imagine the pulp of an orange being torn away from the peel. As a result, the electrical wiring that connects brain cells had been ripped and bruised. If such wiring had been severed, the brain damage could be permanent and severe.

According to Sheehan, Matt’s neurosurgeon, nerves are encased in insulation. The hope in Matt’s case was that only the insulation was damaged badly, and that the nerves were still intact.

Even in the best of circumstances, recovery normally takes six months to a year, followed by a stay in rehabilitation, Sheehan said.

What struck Emily most about the first two days, even more than Matt’s injuries, was his vulnerability.

Matt had always been in control, so confident about his success at anything he put his mind to. “And he was just laying there,” she recalled, “saliva all over himself. He seemed like a baby, so vulnerable. It was coming through his eyes.”

On Wednesday afternoon, the two men who’d turned Matt on to cycling, along with McNabb, flew down from Philadelphia to visit Matt and the family.

A Vanguard managing director, Tim Buckley, 40, had helped Matt pick out his Look road bike, which Emily had named Black Beauty. Over the summer, Buckley and Chris McIsaac, a Vanguard principal, had invited Matt to ride with them weekdays at 5:30 a.m.

They were amazed that a college student would rise at 5, and even more amazed at just how good he got.

“In a matter of weeks, he accomplished what it had taken me years to accomplish in terms of fitness on the bike,” said McIsaac, 34, who has competed in the Ironman Triathlon — a 2.4-mile swim, 112 miles on the bike, and a 26.2-mile run.

On one of their first rides, Matt crested the nastiest hill right with Buckley, who pointed out that Matt’s thighs were quivering, in spasm.

“It’s going to take a lot more to break me,” Matt had said.

In September, Matt had competed in his first triathlon, the relatively short Sandman Triathlon in Virginia Beach. He finished fourth out of 465 men and was second-fastest on the bike — 26 m.p.h. for 14 miles.

He’d been training for three months.

When McIsaac heard about Matt’s accident, “my heart just dropped,” he said.

“I know intellectually that we were not responsible. This type of stuff just happens. … Nevertheless, there’s this gnawing feeling that you had something to do with it, knowing that you had been a big part of his love affair with cycling.”

The three men, hoping to see Matt but feeling too awkward to ask, sat in the visiting area with the family for a couple of hours, then got up to leave.

“Hey, tell Matt we’re looking forward to seeing him,” Buckley said.

“Do you want to see him?” Mike Miller asked.

Absolutely, they all agreed.

“You sure you can handle it?”

Absolutely.

Only relatives were allowed in the ICU, just two at a time, but the doctors had said it would be good for Matt to hear familiar voices even if it still wasn’t clear what he heard.

“Just follow me and don’t stop,” Mike told them as he led his three colleagues up the elevator, through the ICU doors, and right into Matt’s room.

Mike Miller said to his son, “Matt, some friends are here to see you: Bill McNabb and Tim and Chris.”

Matt’s eyes opened and stayed open.

He clearly recognized them. He reached up, as if trying to give them a hug. But his arms were restrained.

Not knowing what to say, the men started making small talk and, soon, trash talk.

McIsaac told Matt that his pulse during surgery — 42 — was lower than Buckley’s had been during his recent surgery.

Matt gave a thumbs-up.

Then Buckley said, “Hey, Matt, Chris is burning up that the last ride you went on together you dropped him. He thinks he can take you when you get out.”

Matt, passionately, shook his head. As if to say, “No way.”

At that point, Mike Miller simply wept.

He kissed his son on the forehead, then let him rest.

The road to recovery

Four days after losing control of his bicycle and slamming — face-first — into an oncoming car, Miller lay in the ICU at the University of Virginia Medical Center.

Nerves controlling the left side of his face didn’t work, and he couldn’t close his left eye.

His mouth zigzagged like a plunging stock-market table. Every one of his 32 teeth was lost, broken, or compromised.

His jaw was wired shut, and he couldn’t talk.

“He looks like a person who’s had a massive stroke,” recalled Park. “You’re drooling. You’re not smiling. Any number of things make you look visibly deformed. It’s a tough pill to swallow.”

Matt still had no concept of any of this.

Nor would he remember what he typed on an “ICU talk device” that doctors gave him that day, Thursday, Nov. 6:

“Can I go to physics lab?”

Was Matt delirious or serious, or both?

That afternoon, his brother, Michael, heading back to Stanford Law School, told Matt, “I’ll see you at Thanksgiving, no matter where you are.”

Matt remembers thinking, “What are you talking about? Of course, I’ll be home for Thanksgiving.”

This was his first memory since the accident.

By Sunday, a week after he had crashed on an 85-mile triathlon training ride, Matt understood where he was, what had happened. He scribbled on a legal pad:

“I’m going home for Thanksgiving.”

That would be in 18 days.

Not one doctor believed this possible.

The wiring in his brain had been twisted and torn — and the extent of the damage was still unknown.

The surgeons treating Matt assumed he would go from the hospital to a rehab facility to work on the memory and speech impairments, personality changes, and weakness that follow brain injury.

Yet on Tuesday, at Matt’s insistence, his girlfriend since senior year at Radnor High School, Emily Privette, brought a laptop so he could register for spring classes. Matt was in his third year at Virginia.

“I think your expectations are a little unrealistic,” one doctor told Matt.

Emily collapsed into tears.

“That was a reality check,” she said. “Will he be able to go to college, to be a doctor? Will he be at home the rest of his life?”

Matt’s doctors, his parents, even the dean of students, just presumed that he would take incompletes for the fall semester, skip the spring semester, and maybe, by fall 2009, be well enough in mind and body to return to school.

Not Matt. He registered for classes.

That same Tuesday, nine days after his accident, he wrote a note asking his father to swing by his apartment and pick up his books.

“Doctors would come in and he’d be reading and highlighting,” his father recalled. “You could see it in their faces. They were blown away by that.”

Said Matt’s neurosurgeon, Jason Sheehan: “Physics was one of the books he had in the hospital — just a little light reading!”

Matt and Emily

There were troubling signs, too.

At 2 a.m. on Wednesday, Nov. 12, Matt texted Emily to “turn off the stove and put away the groceries.”

In the morning, nurses explained to Emily that Matt often was confused at night. Maybe it was the brain injury, or maybe the narcotics he was taking for pain.

The next night at 1 a.m., Matt texted, “I miss you.” Emily was there in minutes. And for the next two weeks, Emily spent every night in the chair next to his bed and held his hand.

As a 13-year-old, Matt had liked Emily and asked a friend of hers in the orchestra to find out if Emily would go with him to the eighth-grade semiformal. When he got word back that she’d say yes, he asked.

Matt made sure to find Emily for all the slow dances.

Days later, Matt asked Emily to the latest “Star Wars” movie. Emily is the oldest of four, and her mother, she said, made her hold a sign, “Emily’s first date,” and took a photograph. Emily’s sister begged to ride in the car.

Emily hated the embarrassment. “I wasn’t one of those girls who ever since sixth grade had to have a boyfriend,” she explained. And she broke it off.

As Emily recounts it, Matt liked her through most of high school, but she wasn’t interested, and they hardly spoke. Only in their senior year, “as I felt like he lost interest,” Emily recalled, “I got interested again.”

Their first high school date, for pizza, was Dec. 10 of senior year.

At the hospital that first week, Matt’s grandfather had said to Emily that Matt would never look the same.

“I just want my Matt back,” she replied.

“After three years of dating, physical appearance was such a small part of everything I loved about Matt,” Emily said. “And it wasn’t like something was taken away. I still think he looks beautiful. And I know there are many other beautiful parts of him.”

An athlete’s engine

On Nov. 12, 10 days after the crash, UVa swim coach Mark Bernardino brought Matt a present, a T-shirt.

“I’m tired of seeing you in that hospital gown,” said Bernardino, who’d been visiting every day, often twice.

On the shirt was a quote from N.C. State basketball coach Jim Valvano, shortly before he died of cancer:

“Don’t give up, don’t ever give up. How do you go from where you are to where you want to be? I think you have to have an enthusiasm for life. You have to have a dream, a goal, and you have to be willing to work for it.”

That day, Bernardino — Matt’s swim coach before Matt quit to pursue his new love, triathlons — became Matt’s coach again.

Every day they walked, first down halls, then up stairs.

On Nov. 15, Bernardino walked two flights with Matt.

On Nov. 16, two weeks after the accident, Bernardino walked Matt from his sixth-floor hospital room, up two flights to the eighth floor, down eight flights to the first floor, and up six flights back to Matt’s room.

The next day, Bernardino said his calves were “on fire.”

Matt was fine.

“I honestly don’t think very many people could have lived through his trauma,” said Bernardino. “His engine was so powerful, his lungs, his heart, and his mind. I call that the engine of an athlete. They were so tuned, so fit, so ready for battle.

“He thought his battle would be a triathlon. And he found himself unexpectedly in the battle for his life.”

Bernardino could see the hospital staff watching Matt’s recovery in disbelief.

“Matt could feel their joy and excitement at what he was doing medically,” the coach said. “He was making them shake their heads, and he was loving it.”

Positive attitude

Matt was driven, in the way he’d always been driven.

“I have been given so much my whole life,” he later explained, “that when I have to work for something, I work as hard as I possibly can without even considering other options.”

In the hospital, Matt felt grateful to God, who had spared him permanent injury, and to those who prayed for him and pulled for him.

Giving every ounce of his being to getting well and going home was the least he could do.

Doctors loved his attitude.

“Every morning when I was in there to meet him, like 6 a.m., he’d get up, get out of bed, and shake my hand,” said Jared Christophel, a chief resident who checked on Matt’s jaw alignment.

“That attitude does have an effect on outcome.”

If he had any chance of getting out by Thanksgiving, Matt had to build back his strength.

The nutritionist told Matt his mending body needed the calories of a marathoner — 4,000 a day.

But his jaw was wired shut. His primary nourishment was liquid pumped into his stomach through a tube stitched into his nose.

Matt hated that tube.

He made up his mind to suck down as many calories as he could through a straw.

In his second week, Matt began sipping two 440-calorie protein shakes. In bed one morning, he read the ingredients: “trans fat 3g.”

“That’s it,” wrote Matt, who used to bake his own vita-muffins. “No more of these shakes for me.”

He replaced them with orange-flavored Breeze, a juice box with 250 calories and 9 grams of protein — four or five a day.

And each day, his mother, Emily, Bernardino, or friends would bring a Ben & Jerry’s peanut-butter shake.

More surgery

Two weeks after rebuilding Matt’s face, Park saw it had fallen out of alignment. Matt needed surgery again.

There was more.

In the accident, Matt’s jaw, broken and jagged, had slammed into his carotid artery, the primary vessel carrying blood to his brain.

This caused an aneurysm. And it was weakening.

“Imagine a garden hose, and you hit it with a hammer, and the fibers break and it balloons out,” said J. Forrest Calland, Matt’s trauma surgeon.

If the balloon burst, Matt would suffer a major stroke.

Doctors debated which surgery to do first — shore up the artery with a stent, or realign the face.

If they did the face first, the aneurysm might burst.

If they did the stent first, he’d need blood thinners, which would delay his facial repair by six weeks. The jaw would heal out of alignment, forcing complicated, painful surgery later on.

Matt figured his doctors would do the right thing.

“These were the same doctors who’d been saving my life for weeks,” he said. “I had a lot of trust in them.”

Doctors fixed Matt’s face first, in a five-hour operation.

“Seeing Matt lying there afterward, with the swelling and trauma from yet another round of having his face reworked, really brought home the severity of his injuries and what he’s been through,” Matt’s dad, a managing director at Vanguard, e-mailed friend and Vanguard chairman Jack Brennan.

The surgeons put in a stent three days later, on Nov. 21. Matt went back to the ICU.

“We’re no longer optimistic about getting out of here by Thanksgiving, but that’s okay,” Mike Miller e-mailed Brennan. “We’re incredibly grateful to be where we are, and to have made the progress that we’ve made. So makes no difference where we are — we’ll have much to celebrate.”

A nerve problem

With Thanksgiving six days away, doctors tested and found no nerve conductivity in the top half of the left side of Matt’s face.

The nerve was either traumatized or severed.

If severed, the window to repair it would close in days. And repair was still a long shot, not without its own risks.

But without the nerve, Matt would never be able to smile, eat, or speak normally.

For the first time, Matt took a good look in a mirror.

“I look fine, Mom,” he wrote, his jaw still wired shut.

“Well, your smile is a bit off,” she replied, with loving understatement.

“Isn’t my smile fine?” he asked Emily.

“Well, not really,” she said. “It’s OK, though.”

In all honesty, Matt said, his face didn’t look that bad to him, and didn’t upset him.

“It did not seem that important to me,” he recalled. “I had overcome so much, and at the end of the day I was alive. My mind and legs were working. I was living.”

On Monday, Nov. 24, doctors found a bit of conductivity and concluded the nerve might recover on its own.

Leaving the hospital

Thanksgiving was in three days. Matt insisted in notes and text messages that he would be out by then.

He told staff to stop pumping in any nutrition. He’d suck down 3,000 calories a day, and he upped his diet to six juice boxes of Breeze, three cans of high-protein milk, and his peanut-butter shake.

On Wednesday, the day before Thanksgiving, out came the feeding tube, though not his trache tube. Matt had had five operations, and his doctors wanted to leave it in, just in case he needed another.

Matt’s doctors were astonished that he didn’t need rehab. It was “remarkable,” said trauma surgeon Calland.

The Millers would spend Thanksgiving at the family’s duplex at Wintergreen so Matt could be near the hospital.

Matt’s mother, Nancy Miller, an archivist at the University of Pennsylvania who’d spent every day at her son’s side, learned how to clean out the trache tube. She also was given wire cutters and taught how to open his jaw should he choke.

At 9 p.m. Wednesday, when word spread that Matt was leaving, staffers came to see for themselves.

A nurse rolled in a wheelchair.

“I’m walking out of here on my own,” Matt wrote her.

Matt, for the first time, put on the T-shirt Bernardino had given him.

“Don’t give up, don’t ever give up. . . .”

Walking into the November chill, Matt raised a fist in triumph. His brother, Michael, took a photo with his cell phone.

His father, weeping, hugged him and said, “This is the biggest competition you’ve ever won.”

Thanksgiving takeout

The family had made no plans for Thanksgiving, and Wintergreen’s buffet was sold out.

When Mike Miller explained the circumstances, the resort packed up takeout.

Matt, who’d been reading up on blended food, conducted his first experiment.

He blended sweet potatoes with milk and sucked down orange slop through a straw.

He didn’t rinse the blender, so when he mixed turkey with chicken broth, it came out orange. He slurped that down.

Then he blended mashed potatoes with milk.

Finally, he blended pumpkin pie.

“No meal,” he said, “ever tasted so good.”

Sunday: On the road again.