Duluth man enjoys unlikely recovery after emergency surgery removed of part of his skull
DULUTH—The two months David Wolden went without a portion of his skull is something he and his wife, Dorothy, can joke about now.
"Apparently, they put David's bone flap in the freezer somewhere," Dorothy said earlier this month. "He assured us it wasn't in his apartment."
The "he" Dorothy referred to is Dr. John Christos Styliaras, a neurosurgeon at St. Luke's hospital who was sitting across a conference room table from the Woldens, grinning and nodding.
"I promised them I didn't take it home," Styliaras said as all three laughed.
To the uninitiated, the idea of removing a 7 centimeter-by-14 centimeter patch of bone — about the size of a toddler's hand — and storing it in a freezer for a time might seem like something out of science fiction.
In the world of neurosurgery, though, it's something that's done "pretty often," Styliaras said.
It's still a perilous situation for the patient — as it certainly was for David Wolden, now 68, Sept. 14.
Wolden's hard fall from a stool came at a busy time for the couple. David, an Enbridge retiree; and Dorothy, 55, who teaches at Children's Place at the University of Minnesota Duluth; had moved into an apartment in downtown Duluth three days earlier. They had just closed on the sale of their home in Superior. They thought they'd be leaving on a European vacation in five days.
Shortly after noon that Thursday, they were moving some items from their house to their cabin near Lake Minnesuing in Douglas County. Dorothy heard, but didn't see, her husband fall. She found him in the garage, conscious and on all fours, trying to get up, but with blood coming from his nose.
"Like any good Norwegian, 'I'm all right,'" David explained his attitude — although he doesn't really remember anything that happened at the time.
Dorothy knew he wasn't all right. She grabbed a cellphone from his pocket and called 911. At the dispatcher's instructions, she tried to keep her husband lying on his side. He was unconscious by the time a Gold Cross ambulance arrived 20 minutes later.
Dorothy has nothing but praise for the ambulance crew and for the Bennett Volunteer Fire Department crew who also rushed to the scene. Their cabin is in Highland Township, she said, but Bennett first responders were closer.
'I was brutally honest'
At St. Luke's, Styliaras was notified before the ambulance arrived that a patient with a traumatic brain injury was coming in. When he saw his patient and looked at a CAT scan, he knew the situation was dire. He immediately went to introduce himself to Dorothy, and he didn't downplay the gravity.
"My mother told me never to lie," said Styliaras, who grew up in Chicago and in Athens, Greece. "And so I was brutally honest. Because his condition was very, very bad — and the fact that it deteriorated so fast in such a short amount of time."
How bad? The measure that's used for brain damage is the Glasgow Coma Scale, or GCS, which goes from 1 to 15 — the high number being normal. David had a GCS of 4, which at least sounds like it could be worse.
In reality, it couldn't. Styliaras explained it by slapping his hand on the conference table. "This table has a GCS of 3," he said. "So you can see how serious his condition was."
In emergency surgery, Styliaras removed the brain flap on the left side of David's skull. He saw that there was severe damage to the brain, particularly in what's known as Wernicke's area, the part of the brain that controls language development.
David showed no movement on his right side and only a flicker of movement on his left side, so Styliaras didn't know if he would be paralyzed, let alone survive.
It was a close call.
"I feel like maybe 45 minutes later or an hour, you definitely would have died," Styliaras told David. "And if it was ... like 15, 20 minutes, you would have had permanent damage."
David responded: "So I shouldn't complain about only being able to last a half-hour on the treadmill."
'In the best hands'
Dorothy appreciated Styliaras' honesty, she said. She appreciated something else, she told him, becoming tearful at the recollection. "From the beginning, one of the first things you said to me was he's my patient and he's now a member of my family."
Nonetheless, the news was "terrifying," she said.
"David is my best friend," Dorothy said. "It was just such an utter shock, the idea that my partner, my best friend, was maybe going to be significantly changed or gone."
Removing some of David's skull struck her as "extremely bizarre" at the time, she said. But she intuitively trusted Styliaras.
"I just felt like he was in the best hands possible," she said.
The next day, Styliaras had better news to report. David was showing movement, and he was responding to commands. He couldn't speak because a breathing tube still was in place, but all of the signs were encouraging.
The skull flap would remain in a freezer for eight weeks. Reattaching it too quickly could have led to fatal swelling of the brain, Styliaras said. He was discharged from the hospital after four weeks, but had to wear a helmet until the flap was restored.
Styliaras credits David's hard work and a supportive family — siblings and grown children as well as Dorothy — for his almost complete recovery.
David, who ran the Garry Bjorklund Half Marathon in 2017, said he thinks his long-distance running days are probably over. But the avid carpenter has returned to doing projects at the cabin, most recently building a bathroom. At first, Dorothy insisted he not work alone, but later relented.
Styliaras encouraged the return to normalcy.
"I said you healed wonderfully; everything's great," he recalled. "But you can't live your life in fear."
David said the only possible lasting consequence he experiences is occasional struggles coming up with the right word.
"I don't know if that's because I'm 68 or because I have this brain thing," he said. "But I feel great. My health is good."
Given the extent of his injuries, David's near complete recovery was "unlikely," Styliaras said. But helping patients with serious brain injuries is what he likes about his job.
"That's what I love," he said. "Because I'm able to offer this gift of a second chance, not only to one person but to the entire family."