Life often comes at you fast, and you want to have the peace of mind to know that you're in expert hands in a dire emergency like Holly’s.
On January 25th, 2019, 45-year old Holly Wright experienced a life-changing event. Assaulted by two strangers, she was robbed and shot point-blank. This shotgun attack fractured her left clavicle and caused extensive soft tissue damage to her neck and shoulder. This trauma required an immediate response from experts. This is Holly’s recovery story.
Out of the blue
Holly Wright encountered her worst nightmare in a place she thought she was safe: sitting in her car, right outside her coworker’s house. What was a seemingly routine event — picking up a colleague for work — turned into a whirlwind quickly. Two men approached her vehicle and attempted to rob her. During this altercation, the armed man shot her in the neck without warning. After the assailants left, Holly called 911. Emergency medical dispatch (EMD) Josephy Garmyn provided immediate care instructions on the phone before the ambulance could reach the scene.
“If it was just a few centimeters to the right, the bullet could have hit my jugular,” recalls Holly. “Paramedics couldn’t believe I was awake and talking when they got there. I asked them, ‘You’re taking me to CMC (Carolinas Medical Center), right?’ and they said, ‘Yes honey, you were shot.’”
After Holly arrived at CMC’s F.H. “Sammy” Ross, Jr. Trauma Center — the area’s only Level I trauma center, she was taken to the operating room, where her trauma team repaired her clavicle fracture and cleaned her multiple wounds.
Over the next 8 days, Holly received care from the trauma, orthopedic, and plastic surgery teams. This treatment included a combination of occupational and physical therapy as well as emotional support from pastoral care and Atrium Health’s Trauma Survivors Network (TSN). The TSN plays a critical role in mental health care after traumatic injuries like Holly’s wounds. Recovery is more than a physical trial, but it takes mental stamina and excellent emotional support for the best results.
In the best hands
Holly found herself in excellent hands under the care of her surgery and trauma teams. She particularly credits her primary surgeons, Michael Bosse, MD, her orthopaedic trauma surgeon and Jean-Francois Lefaivre, MD, her plastic surgery specialist.
“Her injury was very complex, potentially life-threatening, and in need of care from surgical teams with advanced trauma training and surgical skills,” says Dr. Bosse. “The care required the coordination and collaboration of multiple specialties in order to achieve the best outcomes. These specialties included trauma surgery, critical care, orthopaedic trauma, plastic surgery, rehabilitation medicine and trauma recovery, and psychosocial support.”
This meant that Holly’s wounds required care from a Level I trauma center. Here the most complex trauma patients are treated. Though Level I and Level II centers can care for most trauma patients, Level I trauma centers are “supercenters” that need to pass strict criteria to qualify.
This tier provides the highest level of surgical care for patients and is expected to be actively engaged in trauma research and education. Level I centers are also fully staffed at all times with all subspecialties, which allows prompt access to precise care for a wide range of emergencies. Atrium Health also has excellent Level II and Level III centers available for less severe trauma patients.
“Her immediate care involved the evaluation for associated injury from the shotgun blast to her shoulder and vital neck structures. Once her airway was secure and bleeding from the wounds controlled, she was taken to the operating room for exploration of the injury to assess tissue damage and remove severely damaged tissues,” says Dr. Bosse, “Following the initial surgery, additional surgeries were needed to reconstruct the damaged shoulder bones, tendons and muscles and to arrange tissues to allow for closure of the wound from the gunshot.”
Plastic surgeon Dr. Lefaivre was in charge of the following reconstructive surgery that closed the hole on Holly’s neck. This made it possible for Holly to participate in physical therapy in Gastonia — with the intention to follow up with more definitive scar tissue management in the coming months.
“There are no words to describe how much I appreciate what my doctors, nurses and other members of my care team did for me. They were just awesome. Attentive. They didn’t hesitate to answer any questions that I or my family had. They were so great.”
In just over one week, Holly was discharged from the hospital and was able to return to her home in Cramerton, N.C.
One step at a time
Holly approached her recovery with the same passion that she took to her work. Strong and determined, she fully engaged with physical therapy for months to maximize her mobility. In spite of losing muscle tissue and having a vertical scar that made her neck tight, she was able to regain significant mobility.
However, in order to make more progress, Dr. Lefaivre recommended a Z-plasty at her follow-up appointment. This surgery would not only improve the appearance of her scar, but it would turn the tight, vertical scar into a more flexible “zig-zag” pattern. This would make her skin less tight by rotating the scar tension line. Holly did what it took to make it happen. She quit smoking in 9 months to greatly reduce the risk of complications. Dr. Lefaivre successfully completed the surgery, which improved her mobility and reduced the tension in her neck.
“She was very involved in her care. Her stepmom was with her on many visits. She had very good support. She was highly motivated and determined, which is an important step to make the recovery more successful,” says Dr. Lefaivre. “Not everyone is like her in terms of the focus on getting well too...If the patient doesn’t believe or doesn’t participate as much as she did, the same positive outcome isn't guaranteed.”
Not just a physical trial
After the physical recovery, there was another battle to fight — a mental one, and Dr. Bosse was prepared to offer the support Holly needed. A traumatic event like a direct, surprise assault can trigger anxiety and episodes of post-traumatic stress disorder (PTSD) at any time, which both need consistent support and treatment.
Dr. Bosse made sure to check on Holly’s total well-being during follow up appointments. As soon as the need arose, he connected her with the care she needed.
“Mental health care is critical to the recovery of the patient. At CMC, we have a program entitled ‘Trauma Survivor Network (TSN)’ that provides inpatient support and post-discharge resources,” says Dr. Bosse.
TSN is a national organization, with 98 chapters around the country, including our chapter at Atrium Health — the only TSN program in the area. It’s a free service offered to both adult and pediatric trauma patients and their families. Through this program, people who have recently become victims of traumatic injuries — including gun shot wounds, traumatic brain injury, spinal cord injury, amputation, and traumatic assault — are paired with others who are further along in their recoveries.to provide a community of support.
“PTSD following major trauma is not uncommon and it needs patient evaluation to determine the presence of PTSD, and if present, the initiation of therapy. There are patient characteristics that enable some patients to recover better than others. Patients with traits called resilience and self-efficacy typically recover better mentally than those without these traits. Holly was remarkable for her high resilience and high self-efficacy,” beams Dr. Bosse.
After over a year of using the Trauma Suvivor’s Network to connect with other trauma survivors, Holly was determined to make sure COVID-19 social distancing wasn’t a barrier to care either. Under Atrium Health’s COVID-Safe initiative to minimize in-person contact with others, Holly and others in TSN attend support meetings through video chat apps to keep the care consistent and safe. This approach to total mind and body wellness is critical to a trauma patient’s complete recovery, so it’s important that patients have access to this resource no matter what.
A sweet reunion
Several months later, Holly wanted to also thank the people who came to her aid at the scene. She reunited with the MEDIC team who transported her to CMC, bringing personally made gift baskets for each person who had a role in saving her life. Honoring the first responders was a touching moment for all — with smiles all around the room.
