Back from the brink of death (video)
Aug. 24, 2013 at 3:24 a.m.
Nicholas Ramirez sits by a large window and stares at his mother in front of him.
It's about 10 a.m., and thanks to the sun rays sneaking through the tightly drawn blinds, the room is bright and warm.
The once-bare white walls - and just about every available space in the room - are filled with newspaper clippings, football memorabilia and dozens of photographs of family and friends. The gravelly vocals of Switchfoot frontman Jon Foreman pour out from a small Bose speaker on a lone night stand.
"Remember, you have so many people thinking about you and people that love you," reads a letter written by University of Texas head coach Mack Brown. "For those of us who can't be there for you in person, know that you are in our hearts."
Ramirez's mother stares back at her son, and despite the smeared black tear marks on her cheeks and glassy look in her eyes, she smiles. She looks in her son's eyes and asks him if his name is Aaron.
He turns his head right.
"Look at me," she continues. "Is your name Niko?"
He turns his head left.
Three months ago, her son crashed his motorcycle and landed headfirst without a helmet in a ditch. Doctors thought Niko wouldn't survive the first 72 hours.
Finding his voice
Niko can't speak.
He can barely move.
But he's alive.
The 21-year-old from Victoria communicates by either moving his eyes or his head, depending on his strength, toward a red or green cone to answer simple questions.
"This is the hardest part for me," his mother said. "Niko is tough, and I know what he is capable of doing physically, but mentally is where it breaks my heart."
Niko is at the rehabilitation and research center TIRR Memorial Hermann in Houston. He moved there July 8 after spending two months in a coma at San Antonio Military Medical Center and a week at HealthSouth Rehabilitation Institute of San Antonio. His mother never left his side.
Doriann Ramirez is a 10-year veteran purchasing agent at Magic Industries, a store that sells and repairs oil-field equipment in Victoria.
"Our Magic family has been taking care of Niko and I while I'm (at the hospital)," she said.
Niko's father is an operator at Formosa Plastics in Point Comfort, and his Blue Cross Blue Shield insurance helps pay for his son's care.
Niko worked on the oil rigs as a floorhand before his accident.
He was a man's man - with a Tough Mudder bracelet to prove it.
Last year, Niko crossed the finish line of the 13-mile mud run geared toward challenging both the mental and physical strength of competitors.
But his mother looks to a different charm as a symbol of his perseverance: A Philippians 4:13 medallion hanging on a long, silver chain around his neck reminds her that, "(He) can do all things through Christ who strengthens (him)."
Twice a day, Niko sits with his speech language pathologist and works on answering questions using the red and green cones. Recently, he has been able to make choices using the system, such as choosing if he wants orange juice or ice during therapy.
"One of our biggest goals is to establish a yes/no communication system," therapist Emily Ferguson said. "It really opens our communication about his emotions and physical pains."
Using the system, doctors and therapists were able to find out that Niko had discomfort in his right knee, which turned out to be an old football injury.
The therapy isn't fun. It is a lot of hard work, and, at times, it is frustrating for Niko, and he grunts with discomfort.
"I know he hears us," his mother said. "I know he knows what's going on, and I feel in my heart he is having a conversation with us, but the words just aren't coming out. You can see it all over his face when he tries vocalizing. He wants to talk so bad."
The little things
Closing his hands and opening his eyes - those are the small things Niko's mother said she will never again take for granted.
"My son is fighting just to do those small things," she said. "I know how hard it is."
Because Niko fractured his skull and has bruising all over his brain, it is a fight for him to move his arms, bend his knees and even give a thumbs-up - although he tries.
"Part of his brain has difficulty communicating with the other and also the rest of the body," Dr. Sunil Kothari said. "Because the brain injury is diffuse, his whole body is affected."
Kothari, an assistant professor of physical medication and rehabilitation at Baylor College of Medicine, met Niko in August.
Niko's recovery at TIRR involves several hours of daily speech, physical and occupational therapy.
"The therapy - it's a long process," his doctor said. "This phase is just the beginning."
Part of the therapy involves Niko being harnessed and dangled above a treadmill, and four technicians hold various limbs to stimulate movement in his body.
On average, patients at TIRR receive three to four hours of therapy per day and a maximum of up to six hours a day, according to the hospital's fact sheet. Niko receives the maximum amount of therapy.
Because Niko's brain is misfiring messages to his muscles, he suffers extreme pain, said Patrice Graham, who has a doctorate in physical therapy.
The treadmill, she said, breaks that pattern, saying that Niko has improved his use of his extremities and his ability to follow commands since starting rehab.
His mother recalls how proud she was the first time she saw her son on the machine. "I hadn't seen my son stand since May 25, and when he got on there, he looked at me as if he were saying, 'I can do this mom,' and that look just brought a sense of relief that can't be matched."
About 5:30 p.m. May 26, the Department of Public Safety responded to a 911 call of a motorcycle accident involving a man who was not breathing.
Ramirez and a friend had been riding in the 3000 block of Burroughsville Road when the friend slowed his 2008 Suzuki all-terrain vehicle. Ramirez didn't see his friend reduce his speed and struck the right wheel of the vehicle, flipped over his motorcycle several times and landed headfirst in a ditch 4 feet away, according to a DPS crash report.
Ramirez fractured his skull. The fracture ran the entire length of his head, and his brain was exposed, his mother said.
"I didn't understand it," she said. "Niko always wears a helmet. What was different this day?"
Ramirez was transported to San Antonio in an ambulance later that day, and all his mother remembers is a doctor telling her, "We're going to do surgery. We don't think he is going to make it. We are going to fight for your son."
She was numb.
Two weeks before his accident, Ramirez told his mother that if he were ever on life support, she was not to bring him back. So, at the 72-hour mark when the doctors asked her about donating Niko's organs and removing the ventilator, she knew what she had to do.
"But I needed an MRI first," she said. "I needed something Niko's brothers and sisters could see physically, so that they could let him go peacefully."
At the time, she whispered in her son's ear, "It's time for you to show these people a miracle."
It was at that moment that Ramirez showed purposeful movement by reacting to a doctor pinching his shoulder.
There was no MRI.
Niko didn't need one. The purposeful movement proved that he was fighting for his life.
"You know when you run so much, and it feels that you aren't getting anywhere?" his mother said. "That's how I felt when I was running to the waiting room to tell my family. All I remember is saying, 'He's going to live. He's going to live.'"
After the accident, the Ramirez family reached out to the Victoria community and asked for prayers.
"I'm just trying to get all of Victoria to lift him up," his brother, Michael Ramirez, said then.
More than 100 people gathered at a family ranch and prayed for him. "It was just amazing how the community came together," said Celeste Ramirez, Niko's sister.
People all around the world have reached out to Niko, his mother said.
"Live your life," she advises those following her son's story. "There is nothing that you can't do. And if you think you can't do something, look at Niko. Niko would love to be doing a lot of things right now, but he can't."
Niko has a long road ahead of him. Doctors are waiting for two pieces of bone made in Germany to arrive, so they can close the areas of his skull that needed to be removed for swelling. They also will put a shunt in his head to remove fluid on the brain.
"No one who has had a brain injury as severe as Niko ever gets back to 100 percent," Kothari said. "He is always going to face issues as a result of this brain injury. How far he gets is something we cannot say for sure, but there is almost no chance that he can return to a full level of functioning."
However, Ramirez's age and the fact that he is already showing progress in therapy both play well to his recovery, his doctor said.
"He shows signs. He is aware, answering questions, and all of those things are very promising signs," he said. "The longer you go without some of these skills coming back, the more confident you can be that they won't come back."
His doctor estimated Niko will be at TIRR for another two to six weeks after his surgery and then go to a post-acute brain injury center.
Post-acute care is tailored to a patient's individual goals and offers advanced therapy, Kothari said.
As far as expectations, Niko's mother said she has none.
"He wasn't supposed to make the ride to the hospital," she said. "He wasn't supposed to make it through the 72 hours.
"I know Niko will be walking. I know he will be talking. I know he will be eating. To what extent, I don't know yet. I don't know what God has in store for us."