John Keller: Miracle in Progress

When 33-year-old John Keller was first admitted to TIRR Memorial Hermann on March 26, 2008, he was in a vegetative state. Two hospitalizations and less than a year later, on January 29, 2009, he left the rehabilitation hospital walking and talking.

Keller’s road to recovery began on February 17, 2008, when a car struck his motorcycle in McAllen, Texas, and sent him spiraling 150 feet through the air across five lanes of traffic before landing on the pavement. “An eyewitness saw me fly end over end like a helicopter swirling through the air, then hit the pavement on my bottom, fall back and hit my head. I now tell people, ‘I didn’t go to heaven or hell, I just blacked out,’” he wrote in the introduction to his book A Miracle on the Road to Recovery*, which chronicles his return to function over the two years that followed the accident.

On impact, Keller suffered a fractured skull and pelvis and an intracranial hemorrhage resulting in a severe traumatic brain injury (TBI). A neurosurgical team at McAllen Medical Center stopped the bleed. Nine days later, he was transferred to a Houston-area hospital, where he remained in the intensive care unit until his admission to TIRR Memorial Hermann. “The first days after the accident were difficult,” recalls his mother Jan Keller. “John has always been a fighter and strong-willed. We were all fighting for him, and we always believed he would get better. Even though we were devastated when we arrived at TIRR, we knew to keep standing on what we knew God could do instead of what we saw when we looked at him.”

Keller’s diagnosis on admission was severe TBI, autonomic instability and vegetative state or altered consciousness, says physical medicine and rehabilitation specialist Luz Tastard, MD, an attending physician in TIRR Memorial Hermann’s Brain Injury, Spinal Cord Injury and Stroke Program. “Our primary goals for his first admission were to increase his level of arousal, determine whether any conditions or medications were preventing him from waking up and teach his family how to take care of him and help him improve.”

The therapy staff was aggressive in pushing him to advance more, and over time he transitioned to a minimally conscious state. “We are aggressive with all our patients, but there was something in John that made us believe there was more there than met the eye,” says speech therapist Michael Gettleman, MHA, MA, CCC-SLP. “We had a strong sense when we looked in his eyes that he was in there, and that we just needed to work hard to help him get out. All of his therapists noticed it.”

Marcie Roettger, PT, was Keller’s physical therapist for his first three month stay at TIRR Memorial Hermann. “When John couldn’t do everything we asked of him, he’d give us a certain look that let us know that he was getting frustrated with his inability to perform the task. We could tell he was trying to respond. I give extra kudos to his entire family. Their ability to stay positive was infectious to all of us.”

Keller improved, and once he was medically stable, he was discharged for further treatment that included neurosurgery to replace a missing piece of skull with a titanium plate, placement of an intrathecal baclofen pump to manage spasticity and surgery to release his contracted Achilles tendons. He also spent time in the skilled nursing unit at University Place, Memorial Hermann’s senior living community, where he continued aggressive therapy.

“When John was readmitted to TIRR in October 2008, he’d just gotten his baclofen pump, so our initial goals were titrating the pump and aggressive exercise to improve his head and trunk control and to increase his alertness,” says Julie Welch, PT, NCS, his physical therapist during the second stay. “He was starting to be more consistent with visual tracking, and he was making more noise. At first the noises were guttural, so we weren’t sure whether he meant yes or no but he was definitely trying to respond more. As time passed, his ability to respond and perform tasks increased.”

Dr. Tastard began trials of various neurostimulants to help Keller wake up. Botulinum toxin injections relieved contractions in his neck. “He made incredible progress,” she says. “His family was very positive, very loving and very caring. When he had a complication or setback, they said, ‘We know he’s going to work through this. We’re going to keep moving. This is only a small setback.’ They never viewed his injury and rehabilitation as a negative situation. They kept saying that all these things show us we have to work harder to find a solution.”

“It was a long, slow process,” Jan Keller admits. “People would ask us, ‘How long will it take?’ We’d say, ‘With God, a thousand days is like one day. We have to be patient and keep pushing.’ The miracle was that John was hearing us say these things. We pushed and prayed until something happened. He didn’t start putting things together until he started talking and that was 11 months after the accident.”

In January 2009, Keller returned home to continue his recovery with his parents. The following August, he moved back home with his wife April and sons Caden, 4, and Dalton, 2. Today, he uses his blog to reach out to others who need prayer.

“John is basically back to normal,” Dr. Tastard says. “He’s able to be independent in all activities and participate with his wife and kids in their activities. That’s an enormous accomplishment for him. He’s still working to improve his memory and some visual and spatial difficulties.”

Of her son’s experience at TIRR Memorial Hermann Jan Keller says, “They are so positive and so precious and so full of life. When we arrived, we were surprised when they asked, ‘Did you bring his workout clothes? Tomorrow he’ll be up and in therapy.’ They didn’t tell us until much later that John was one of the most severe cases of traumatic brain injury they’d seen. It’s tough to see your son day after day with staples in his head, intubated and unresponsive, but at TIRR they were never discouraged.”

"Keller arrived at the rehabilitation hospital at exactly the right time in his recovery," says Roettger. “We gave him the chance to grow and emerge from a minimally conscious state, which may not have happened had he gone home or to a nursing home. Here, one of our team members would spot something positive – a new way of looking or a certain repeated movement – and we could all build on it.”

“TIRR knew what to do,” Jan Keller says. “They taught us how to look at the blood work and reports so we could track changes and improvements. They discussed everything with us. It was an incredible life-changing experience that deepened our faith.”

"John’s survival alone was miraculous," says Gettleman. “We watched him progress from patient back to husband and father and son and almost everything else he was before the accident. His family’s faith never wavered. They always believed he was going to wake up and be OK. And they called it. His is one of the most remarkable stories I’ve seen in my professional career. When he came to us, he couldn’t even move his eyes and now he’s walking, talking and writing a book. These are the outcomes we dream of as healthcare professionals.”

*A Miracle on the Road to Recovery: A True Story by John Keller with Margie Knight. Word & Spirit Resources, 2010.