Rachana Tyagi, an assistant professor of surgery and director of pediatric neurosurgery at Robert Wood Johnson Medical School, is a rare talent.
Dusk was beginning to settle over North Plainfield, New Jersey, one day last November, and there was the usual bustle of activity in the home of Marcia Pérez Rivas. She was busy cooking dinner, helping her two younger children with homework, and folding laundry. Moments before, Pérez Rivas had asked her 14-year-old son, Dickson Camilo-Pérez, to run to the grocery store to pick up a few items. A rising star on the cross-country team at North Plainfield High School, he loved to run anywhere.
Pérez Rivas went into a front bedroom to put away the laundry. As she glanced out the window, a blaze of lights caught her eye. An ambulance and several police cars had arrived on the street. Worried about Dickson, she called his cellphone. As it rang and rang, she saw a police officer pick up a cellphone and attempt to answer it. Heart pounding, she ran outside. A person lay motionless in the road.
“I had a feeling it was Dickson, but I couldn’t be sure because his face was hidden by the hood of his sweatshirt,” she says. A speeding car had run a stop sign and hit Dickson, Pérez Rivas learned as the EMTs gently moved her son onto a stretcher and put him in the ambulance. He was conscious and in pain. “I can’t breathe,” he moaned.
Fortunately for the family, Dickson was brought to the Level 1 trauma center at Robert Wood Johnson University Hospital in New Brunswick, where his life was saved by pediatric neurosurgeon Rachana Tyagi. Pérez Rivas never met the diminutive physician before the surgery—just another physician in the emergency department who gently told her to prepare for the worst: her son was in such bad shape that he might not make it.
The results of a CAT scan showed a fractured skull and epidural hematoma, a traumatic brain injury caused by blood accumulating between the skull and the dura mater, the thick membrane covering the brain. This condition is potentially deadly because the blood creates pressure, compressing delicate brain tissue. The fact that Dickson was conscious was not unusual. Classic symptoms of epidural hematoma may include a brief loss of consciousness followed by a period of awareness that can last for several hours before brain function deteriorates. If not treated immediately, increased blood pressure, coma, and brain damage can result. Fifteen to 20 percent of epidural hematomas are fatal.
Tyagi, an assistant professor of surgery and director of the pediatric neurosurgery program at Robert Wood Johnson Medical School, was not on call that day, but her partner summoned her because pediatric neurosurgery is her specialty. “The clot compressing Dickson’s brain was very large,” says Tyagi. “The bleeding comes from a lacerated arterial vessel and the pressure in these vessels is high, coming directly from the heart. We had to act quickly.”
Dickson was brought to the operating room. Once he was sedated, Tyagi made a large incision in his scalp, shaped like a question mark. The skull fracture was visible right away. Small holes were drilled in the skull and connected, and a portion of the bone was lifted. The clot was removed and the blood vessel coagulated to stem the bleeding. It was a straightforward, but life-saving, procedure.
Dickson came through the surgery well but the next week was challenging. He could not walk or talk and spent time in intensive care. He would need extensive physical and occupational therapy. A week after the surgery, he went to Children’s Specialized Hospital, the largest comprehensive pediatric rehabilitation system in the nation, located next to Robert Wood Johnson University Hospital. There, he had full-day rehabilitation to restore function, including walking, speech, cognition, memory, language, and writing.
“Early therapy, including physical exercise and occupational and speech therapy, is an important part of the recovery and helps the brain heal after trauma,” says Tyagi. With occupational therapy, Dickson relearned how to get dressed, brush his teeth, eat, and perform other routine, but essential, tasks.
Tyagi has always been drawn to working with children. She is one of only 245 female neurosurgeons out of roughly 3,600 neurosurgeons in the United States. Neurosurgery training is very long, requiring seven years—even more if fellowship training is sought. Tyagi has done two fellowships: one in pediatric neurosurgery at Cincinnati Children’s Hospital Medical Center, and another in spine surgery at Shriners Hospitals for Children in Philadelphia.
Dickson’s therapy went well and he’s able to do most of the things he did before his injury. He came home from rehab before Christmas, continuing his therapy as an outpatient, and returned to school in February. “Dickson gets frustrated because he’s not able to play sports,” says Pérez Rivas. “I tell him, ‘Be patient!’ But he doesn’t listen. He’s 14.”
Tyagi is very pleased with Dickson’s steady improvement and says he is on his way to a full recovery. “He’ll be running before too long,” she says. •