Dr. Kirsty Boyd was six weeks into her medical career when a patient with catastrophic injuries was rushed to The Ottawa Hospital Trauma Centre. Karen Toop had been hit by a snowplow while crossing the street on her way home from work — half her pelvis was missing when she arrived at our hospital. A multi-disciplinary team that included reconstructive plastic surgery, would not only work to save her life and get her back to her family but would also implement a unique idea to drastically improve her quality of life.
From the moment the accident happened, Karen knew her injuries were devastating. She remembers thinking about her five-year-old son at home as she lay helplessly on the road. “I kept thinking ‘I can’t leave him without a mother’.”
Karen lost consciousness briefly and she remembers waking up in the ambulance and speaking to the paramedic. “I asked him to tell my son I love him because I really did think I was going to die. And then he said to me ‘No, no, you tell him’ and I didn’t say anything back.”
“The injury Karen had was the kind of thing we will see once in our career. It’s not a typical day for us to see that kind of an injury.”— Dr. Kirsty Boyd
Ready for the most challenging cases
It was January 23, 2012, when Karen was rushed into our Trauma Centre. Dr. Boyd will never forget the day. “The injury Karen had was the kind of thing we will see once in our career. It’s not a typical day for us to see that kind of an injury.”
Her injuries were devastating. She lost one leg, her left pelvis, and several internal organs. It took the vascular, general, and trauma surgical teams to stabilize her. Two days later, the 40-year-old would be wheeled back into the operating room (OR) for plastic surgery for the first time. “I was very much a small part of a big team of people looking after Karen. Dr. Murray Allen, my mentor who’s now retired, was an integral part of the case. I was relatively new on staff when she came in and was originally consulted by the other surgical services for assistance with her wound care because she had a fairly large soft tissue deficit following her injury,” explains Dr. Boyd.
This was the beginning of a long road to recovery, including multiple surgeries over the many months. Karen spent two-and-a-half months in the Intensive Care Unit. While she recalls some scary moments, she also remembers the healthcare team surrounding her and helping her — each hour, each day. “They were phenomenal. I had this one nurse, Lynne, who was such a strong advocate for me — always looking out, making sure I was as comfortable as I could be — she really helped me.”
Thinking outside the box
Karen’s most significant reconstruction surgery didn’t happen until October 18, 2012. It took months of planning by the plastic surgery team and required combining existing reconstructive techniques in a novel way to rebuild Karen’s pelvis and restore her independence.
Losing a portion of her pelvis in the accident meant Karen couldn’t sit up. “I wasn’t able to sit up more than 20 degrees from my bed. I had to eat like that, and drink like that and do everything from that position,” remembers Karen.
“We explored a lot of options; we reached out to colleagues from all across the country. I mean, this was something that I don’t think had ever been done or described before.”— Dr. Kirsty Boyd
This is when the surgical team started to think outside the box to find a way to give Karen an improved quality of life, and to get her back home to her husband and son. Drs. Allen and Boyd worked closely with Dr. Nancy Dudek from the Rehabilitation Centre, and Dr. Allan Liew from orthopedic surgery, to think of a way to get Karen a new pelvis — what’s called a neo-pelvis.
“Karen lost one leg and part of her pelvis in the accident. The other leg had all kinds of issues including poor blood flow, a loss of sensation, and significant nerve damage to the extent she couldn’t move that leg. While the leg was still attached it wasn’t functional,” explains Dr. Boyd. She adds they spent quite a bit of time in consultation with Karen and her family before the decision was made to amputate.
For Karen, it meant putting her complete trust in her care team. “The lengths they went to save my life were incredible. They asked for input from experts around the world. Everyone came together.”
The role of reconstructive surgery in trauma
The surgery was long and complicated — almost 14 hours. ”We rearranged the bone of her right leg to make a pelvis while keeping the bones attached to their soft tissue. I think origami is a very good description; you’re just rearranging things and moving them into locations close to them,” says Dr. Boyd.
“They were so kind, compassionate, and helpful.”— Karen Toop
It was a unique approach to a complicated case, but Karen’s team saw it as the best chance to help her in the years ahead. “We explored a lot of options; we reached out to colleagues from all across the country. I mean, this was something that I don’t think had ever been done or described before,” explains Dr. Boyd.
The surgical expertise and collaborative effort was transformational for Karen’s future. “After the surgery, I was able to sit up using a chair. I mean that happened slowly. I got the chance to do a lot of physical rehab and I started on the hand bike and doing exercises, weights, and they got me back to the point where I could sit in the chair,” says Karen.
Outstanding compassionate care
In addition to her physical rehab, Karen won’t soon forget the compassionate care she received throughout her recovery. “They were so kind, compassionate, and helpful. The nurses would write out the plans the doctors were making so I could visualize it better. One of my trauma members, Dr. Jacinthe Lampron, baked me a birthday cake, which she said was made with love, and nurses made cupcakes for my birthday.”
“Thank you to the doctors and nurses at The Ottawa Hospital who saved my mom’s life.”— Ryan Toop
Strengthening Karen’s mental health and dealing with the trauma of the accident were also integral parts of her journey “They care for your emotional health through the psychologist, the physiotherapist, the physiotherapist assistants, and my personal support workers — they were all fantastic. It was incredible teamwork and just such giving people.”
Going home to her family
After 11 months in the hospital and nine months at the Rehabilitation Centre, where she learned a whole new way of living, Karen moved into a retirement home until her new, accessible home was ready.
“It was really at the beginning that I knew that I was going to put The Ottawa Hospital in my will, because the hospital gave my son his mother, and that was so powerful.”— Karen Toop
But the most unforgettable part was being reunited with her family. “It was amazing. I can’t describe how happy we all were, to be together again,” she says.
Even more amazing was for her son, Ryan, to have his mom home. Now 14, he’s grateful to have her by his side. “Thank you to the doctors and nurses at The Ottawa Hospital who saved my mom’s life.”
Leaving a gift in her will
The whole experience left Karen enjoying the small things in life, like hugging her family or going to watch Ryan play soccer — things she will never take for granted. It also left her reflecting on those who saved her life and fought so hard to give her a good quality of life. “My accident happened in a flash. You never know when you’ll need the hospital. I went from being able-bodied to losing both my legs, so you know other things happen that maybe aren’t as drastic, but you still need the hospital.”
It’s the specialized team who were ready for Karen when she faced critical injuries, that made her decide to leave a gift in her will to The Ottawa Hospital. “It was really at the beginning that I knew that I was going to put it in my will, because the hospital gave my son his mother, and that was so powerful.”
She believes she’s truly fortunate to have had access to the care she received. “I got world-class healthcare, with the new technology — for example, a VAC (Vacuum-Assisted Closure) dressing. If I didn’t have that, I don’t think I would have survived because I would have gotten too many infections. There was also the hyperbaric chamber. I went there when my wounds weren’t healing and then my wounds healed.”
Karen is also thankful for the care her husband, Harvey, received at The Ottawa Hospital when he became ill — care she witnessed from the perspective of a family member this time. Sadly, Harvey passed away in November 2017.
And so, by leaving a gift in her will, she’s helping patients who will come through the doors in the future and she encourages others to consider doing the same. “It’s important for people in the community to support the hospital, especially when it comes to developing new technology and the new campus that’s going to be built. That’s an incredible endeavor for the hospital, and they need the support of the people in the community to be able to realize these goals.”
For Karen, she feels it’s the least she can do for the team who allowed her to realize her goal of watching her young son grow into a young man.