Thursday, November 1, 2012

Khamal Counts His Blessings

Only about 12 per cent of the 300,000 persons in the United States walking around with Arteriovenous Malformations ever suffer a symptom from them.
“I don’t remember everything about that day, but before practice I remember I felt fine,” said Khamal Brown. 
Very occasionally, says Dr. Margot Putukian, the Director of Athletic Medicine at Princeton, an athletic exertion such as weight lifting can bring on a headache and a discovery of an AVM.  But Brown had no clue when, three quarters of the way through practice on October 9, the starting sophomore cornerback suddenly had no memory of his assignment during a special teams drill.  
“What did we just do?” he asked first Tom Moak, then Mandela Sheaffer, who, concerned, walked Brown off the field and over to the medical staff.
“He had a deteriorated mental status, memory issues,” said Dr. Putukian. “Based on how commonly you see concussions in football, we made the assumption of a concussion, but the typical protocol includes evaluating for a more serious brain injury as well. We decided to transport him off the field.”
Brown, holding his head, left on a cart, most of the offensive players working on the adjacent field not even seeing him go.  In the training room, he vomited, grew sleepy, and spoke making less and less sense, so Dr. Putukian decided to bypass the emergency room at Princeton Hospital and have him transported directly to the Bristol Myers Squibb Trauma Center at Capital Health Regional Center in Trenton.
Khamal was in the ambulance when she called his father, Kevin, in Atlanta.
“I had heard from Dr. P before when Kevin had had nicks, scrapes, whatever,” recalls Kevin. “So when she calls during my daughter’s soccer practice and first asks how I’m doing, I thought, ‘hmmm, love you, but when you call there is something wrong with my boy.’”
“She said, ‘I just sent him off to the hospital with a head injury, wish I could tell you more but we really don’t’ know.’ By the time I got home, Dr. (Mandy) Binning from Capital Health Regional was calling to get consent to put a bolt in his head to drain the blood and fluid.”
The AVM, which is an abnormal tangle of arteries and/or veins, had hemorrhaged.  
“Hard to say,” says Dr. Putukian, when asked just how much time Dr. Binning, a neurological surgeon, had to relieve the pressure before Khamal suffered permanent disability or became the 1 per cent of AVM patients who die.  But time was of the essence and the time and place of his episode serendipitous.
“This was something he probably was born with and that had been there all his life,” said Dr. Putukian. “There is no sense that it is related in any way to participating in football.
“It could have happened in his sleep, in his dorm room, anywhere. So we are very fortunate it happened when and where it did, that his teammates recognized it and brought him to me and that he was treated appropriately and quickly.”
Before he boarded a 9:30 flight that night to Philadelphia, Kevin Brown had been told by Dr. Binning that his son was in stable condition. But when a doctor is telling you your child’s head suddenly is bleeding internally, how much do you hear? And how long can two hours seem?
“On the plane I’m thinking I just hope when I get there he is still alive,” said Kevin.
Tom Moak ’13, two years ahead of Brown at Atlanta’s Westminster School and his mentor as a Princeton freshman, was on his way to the hospital when he got a voice mail from Kevin that his son was on his way to surgery.  “So it was much worse than I thought,” recalled Moak, who drove to Philadelphia to meet the plane and take Kevin to Trenton and his son.
“When I walked in he was awake and knew who I was,” said Dad. “He didn’t know dates or the kinds of things that change, but he knew who I was and that just put a big smile on my face.”
The next day a procedure confirmed the AV Malformation and suggested from among several treatment options that it be completely removed.
A week to let the symptoms settle down left seven days for Khamal to ask the same four questions of doctors, his father and his mother, Kina Herron, who had flown in from Atlanta the next day.  
Khamal Brown
“He kept asking because he couldn’t remember the answers,” said Kevin. “He wanted to know would he die, would he play football again and can he still get his Princeton degree? And then he would ask ‘who do we play next?’ as if he was going to be out there.
“I was just happy he was alive and asking. But it did get me choked up for him to ask (about football).”
For that one, the Browns were told that first, the procedure, and then only time, would tell. 
“If there was a re-accumulation of pressure and fluid when they took the drain out, it would have required a shunt, which is a way to alleviate the pressure,” said Dr. Putukian. “A shunt is too unstable, would not have allowed him to participate in contact sports.”
Dr. Binning wouldn’t know whether the shunt was needed until she went in, leaving a long week shortened only by a steady flow of two-at-a-time visiting teammates assuring Khamal that however much they missed him, they were quite capable of beating Brown without him.
If they did, the recipient of the game-ball would be a no-brainer, you will pardon the expression. The hard part was winning the game.  The pressure had already been relieved in Khamal’s head, but now who was going to do that for Moak, the designated courier of the precious cargo.
“Friday night I’m thinking ‘what if we don’t win, what would I say?” he said.  “So when I walked into the room with my parents and he had the biggest smile on his face, that was about the most relieving thing I have ever been a part of.
“It was a great moment for me and a great moment for him, too.”
Because the hospital televisions don’t carry the NBC Sports Network, Khamal and Kevin had listened to the 19-0 win on the radio.  “Thought they were going to have to soundproof the room to be honest with you,” said Kevin. “He was pretty hyped.
“Actually we learned afterwards that stimulus might not have been that good for him. He was pretty drained afterwards.  Had we known that . . . . hey, it’s hard to say because it’s your kid in that bed. I probably would have let him watch it anyway because it meant that much to him.”
Dr. Binning removed the malformation four days later without having to install a shunt.  Spirits soared, Khamal could stop asking about it now and great medical minds could move on to more complex diagnoses, like Princeton’s chances of coming back from 24 points down in the fourth quarter to beat Harvard. 
Hey, it wasn’t brain surgery. The Tigers did it because they never stopped believing.
“That game we could get on the laptop (ESPN3),” said Kevin but three days after Khamal’s operation, he dozed off after only 10 minutes.  
“I was jumping when we were coming back but I wasn’t screaming, not even when Roman (Wilson) caught the touchdown,” said Dad.  “I jumped out of the chair though and I ‘m sure he heard me because he woke up.
“I told him what had happened. He asked ‘why didn’t you wake me?’  I told him ‘Because your head is killing you.’”
Moak walked in about 90 minutes later with another game ball. “THE Gameball caught by Roman,” said Khamal. “Awesome.”
Three days later, before he could open his own sporting goods store, he was released from the hospital and two days after that was a visitor at practice.
“It’s been a stressful two weeks,” said Moak. “About the best thing you could ask for is to see him healthy and happy and on the road to a good recovery.”
Kevin stayed on the other side of the field, not certain he could control his emotions as his son interacted with his teammates.
“It might have been the last time he saw the seniors,” said Kevin. “Although I did promise to try to get him here for a bonfire if we beat Yale.”
Flying being forbidden in case something went wrong in mid-air, the next day Khamal and his mother and father drove back to Atlanta. Kevin mapped out a route with a hospital every 10 feet or so, just in case. Dr. Binning will check Khamal in six weeks, to be followed by an MRI in April and an angiograph in October. 
Because he had exceeded playing 30 per cent of this season by one game, Khamal, by NCAA rules, can’t get his sophomore year of eligibility back. But it is more than just a longshot that he could play football for Princeton again in 2014 and 2015.
He wants to try a two-course load next semester at either Georgia Tech or Emory, both schools whose libraries employ Kevin as a records manager. As for Khamal’s recovery, whatever the doctors say will go.
“I will take it easy for now and whenever they clear me, I will start doing whatever I can,” Khamal said.  “It’s disappointing I’m not playing now because we’re doing so well but you have to take that with a grain of salt.
“Obviously I feel pretty fortunate that I was around the guys and that they said something to Charlie (Head Athletic Trainer Thompson) and Dr. Putukian. And I’m fortunate I’ll be able to play again.” 
That’s not a lock, but a reasonable expectation.
“He has had surgery both intense and invasive,” said Dr. Putukian.  “It depends on how the brain heals and how the tethering structures around the brain heal.
“They will retake tests, make sure there is no evidence of any other abnormality and then go from there.  
“There is always risk. The neurosurgeons will discuss with him how significant the risk is.  Theoretically, the problem has been corrected and addressed so it should not happen again. The risk would be more related to him having had surgery, which is an invasion of the brain.
“But in speaking to neurosurgeons -- not only Dr. Binning but others -- my understanding is that after 12-18 months they would allow a return to full activity, including contact sports.”
Dad will sign off on football with little hesitation.  “This injury was not trauma related,” he said.  “If Khamal had any football aspirations outside of his Princeton football maybe I would be overly concerned, but for two more years I’m not.  
“This is what he loves. If that wasn’t apparent before, which it was, it’s certainly apparent now.   The bond he has with his teammates, the love he has for the game,  I would hate for him to have to finish out without football.”
There is no such thing as absolute medical clearance, only doctors making recommendations based on what they feel is an acceptable or unacceptable level of risk.  The Princeton football program has had too much practice with such calls over the last four years, starting with Jordan Culbreath’s diagnosis of deadly Aplastic Anemia through Chuck Dibilio’s still mysterious stroke, through Brown’s AVM bleed. 
Odds are the program should be good for 50 years now with nothing worse than orthopedic tears, and Princeton can’t lament its bad luck.  Culbreath is in remission and working in the financial industry in New York, Dibilio plans to return to Princeton next semester with hope of being to the field in the fall. And the Browns, the hard way, learned the power of the community.
“Chuck’s Mom (Dr. Bonnie Ronco) reached out to me by email,” said Kevin. “It was nice to hear something from her. 
“There is no way a parent or parents can get though something like this without prayers, support and thoughts.  
“Your family is a given, we knew that they would be there.  But because of the distance Kina only went to one game last year – Cornell because it was Khamal’s birthday -- and I only saw the Columbia game. So it’s not like we really have connected to the other parents. But the emails, phone calls and texts have been just unbelievable.
“I would like people to know how appreciative we are. His high school teammates who reached out, we have known for a long time. But Princeton, too, has turned out to be family.”