Aneurysm Threatens Baseball Fan’s Life, Saint Luke’s Rallies to Bring Him Home

Ramon Grado doesn’t remember driving home and then sprawling on the living room floor on Jan. 13, 2013. Patty, his wife of 33 years, found him there an hour later, awake and complaining about his headache.

“Ramon rarely got sick, so I knew something was wrong,” Patty said. “He had a hard time swallowing ibuprofen and said his neck hurt. When I couldn’t get him to sit up or move, I got scared.” Patty called her three grown sons, who raced to their parents’ home. They helped carry Ramon to the car so Patty could take him to Saint Luke’s Hospital of Kansas City’s Emergency Department.

Although worst-case scenarios flew threw their minds, none of the Grado family members suspected what was really going on inside Ramon’s head.

The right team

A proud father and grandfather, Ramon worked a fast-paced job as lead warehouseman at Saint Luke’s Hospital.

“I remember leaving work that day,” recalled the then 54-year-old. “The next thing I remember clearly is a nurse standing over me, telling me to be still, that I was recovering from brain surgery.”

At Saint Luke’s Hospital, doctors rushed Ramon to radiology where they performed a computed tomography scan. Within minutes, they discovered a 4 mm irregular cerebral aneurysm—about the size of a red fire ant—had ruptured.

An aneurysm is a weak spot in a blood vessel that expands and weakens even more because of constant pressure from blood flow. They can form anywhere, but most cerebral aneurysms develop along branching points of major arteries deep within the brain.

Ruptured aneurysms are fatal in about 20 percent of patients. If not repaired in time and a second hemorrhage occurs, more than 50 percent of patients will die. With immediate access to the neurological experts at Saint Luke’s Marion Bloch Neuroscience Institute, Ramon was in the best possible place he could be.

Throughout the night, doctors monitored his condition. Leaking blood prevented cerebrospinal fluid from properly circulating. This buildup caused even more pressure against Ramon brain. The team acted quickly to place a catheter into Ramon’s brain to drain the excess fluid. Neurosurgeon Brian Milligan, MD, created a small opening in the front of Ramon’s skull so he could reach the aneurysm. During surgery, the aneurysm ruptured again.

Dr. Milligan controlled the bleeding and successfully placed two small, permanent titanium clips at the base of the aneurysm to keep blood from entering the aneurysm or leaking further.

Time out

Those first weeks in Saint Luke’s ICU are wiped from Ramon’s memory.

“He didn’t understand what was happening. He’d yank out his IVs, insisting he had to return to work,” Patty said. “The nurses were so calm. They moved him to a bed near their desk so they could keep a closer eye on him.”

Disorientation, agitation, and memory loss are common with traumatic brain injury, explained Kimberly Poecker, DO, the physical medicine and rehabilitation physician who oversaw Ramon’s rehabilitation. Ramon also developed vasospasm, a condition in which leaking blood causes nearby healthy vessels to constrict and can cause further brain damage and increased agitation. It occurs in 15 to 20 percent of aneurysm cases and causes brain tissue to become inflamed, which affects memory.

“Ramon couldn’t retain what was happening to him,” explained Dr. Poecker. “Each day we’d ask him, ‘Do you know who I am? Do you know where you are?’ And each day he’d ask, ‘Why am I here?’”

Fortunately, Ramon was on another winning team: The Saint Luke’s Rehabilitation team has advanced training and certification for caring for patients like Ramon who’ve suffered stroke or serious brain injury. In fact, patients begin therapy 24 to 36 hours after experiencing neurological trauma, while they're still in the ICU. As a result, Saint Luke’s ranks above the national average for discharging patients directly home rather than them having to go to another long-term care facility.

Ramon’s biggest challenge was retaining memories. Dr. Poecker and the rehabilitation therapists devised a combination of physical and speech exercises to help Ramon rebuild his cognitive processes. They took him on long walks to improve endurance and test cognitive function by challenging him to find his way back to his room.

Ramon remained in intensive care for a month. In early February the incision site on his forehead became infected and doctors had to remove part of his skull. That part of Ramon’s brain remained covered with skin but unprotected by bone, much like a baby’s soft spot, while a custom-made prosthetic was built. But it didn’t slow Ramon down.

Home run

Rehabilitation continued at the Grados’ home after Ramon was discharged. Doctors warned it could take a year to get back to a normal life.

“Cognitive abilities are often the last to come around,” Dr. Poecker said. “Even if patients are doing well physically, like Ramon, they still tire easily. When the brain is tired, nothing works as well.”

Ramon received home therapy for several weeks. He pushed himself harder than even his therapists preferred.

“I wanted to get back to work, to my motorcycle, and to doing things with my family,” he said. “I’d say ‘Challenge me! Let’s go outside!’ and they’d say, ‘Slow down!’”

Ramon often joked that he has two great loves: his family and baseball—and not always in that order. A huge Royals fan who’d never missed a home opener, he couldn’t imagine being sidelined for the big game. His prosthetic wasn’t yet in place when Ramon and his sons headed for opening day on April 8, 2013, at Kauffman Stadium. The boys stayed on either side of their father, protecting his healing brain from jostling fans and wayward foul balls.

By May, Ramon had progressed so quickly that Dr. Poecker cleared him to return to work in June, just five months after the rupture.

Almost a year later, Ramon’s life is almost completely back to normal. It’s something he celebrated where you expect to find him every spring: the Royals home opener.

“I have my family and baseball,” he said. “Life is wonderful.”