TALLAHASSEE, Fla. – Nurses, anesthesiologists and surgeons were crowded into an operating room at Tallahassee Memorial HealthCare’s main hospital, racing to save the life of a young boy with a knife lodged in his skull. Suddenly, the phone rang, and everything stopped.
“Before you pull the knife, I want him baptized,” the frantic voice on the phone said.
The caller was Gail Brown, the grandmother of the boy who was lying on the operating room table. Brown also happened to be a nurse at the hospital — and she feared the worst.
A hospital chaplain baptized the 20-month-old, and some of those in the operating room whispered a prayer. When the ceremony ended, the surgery commenced.
“I shed a tear,” said Dr. Narlin Beaty, a neurosurgeon at the hospital who led the surgery.
“Honestly, we didn’t know whether he was going to live or die.”
Juan Pedro Nino-Brown survived that surgery in April. Now 2, he loves to laugh and play, and he shows no serious signs of his injury.
His brother, Guillermo Timoteo, who was 8 months old in April, also survived a complex surgery to remove a pair of scissors from his skull. He now seems to be developing just like any other healthy infant and recently celebrated his first birthday.
The medical journey that the boys survived was so significant that their doctors wrote a case report and submitted it to the journal Trauma for review and publication, Beaty said.
“Every day, we see little miracles, and this just happened to be a big one,” he said.
How complex surgeries saved the boys
In the middle of the afternoon of April 24, the boys were rushed to Tallahassee Memorial HealthCare with life-threatening head injuries. Authorities say their mother had attacked them.
Carolyn Brown allegedly stabbed Juan Pedro with the knife and Guillermo Timoteo with the scissors, CNN affiliate WCTV Eyewitness News reported in April.
WCTV reported that, according to arrest documents, Brown told a county worker that she had killed her children. She was taken into custody and transported to the Apalachee Mental Health Center in Tallahassee.
Immediately after Brown said she harmed her children in April, Gadsden County sheriff’s deputies performed a welfare check at Brown’s residence and found the two boys on the floor of a bedroom, according to WCTV.
The boys were in critical condition.
Dr. Joseph Soto, an ear, nose and throat surgeon at Tallahassee Memorial HealthCare, was the on-call physician for facial trauma when the boys arrived at the hospital.
“I’ve taken care of a lot of patients, kids and adults, who have been through a trauma — stabbings, gunshot wounds to the neck — but never have I seen this type of situation with these two boys — two young boys, who were basically defenseless,” Soto said.
“One boy had a pair of scissors through his ear, his left ear. Another boy had a knife through his neck, going up towards his head, in his brain,” Soto said.
“My immediate reaction was how angry I was. I wanted to find who did this,” he said, adding that he did not know details about the incident. “Then I quickly settled down, and I went into ‘doctor mode,’ trying to figure out what we needed to do.”
Soto, Beaty and their colleagues performed angiograms, or X-rays, of both boys to determine how deep the objects were lodged in their heads and what would be needed to remove the objects without causing severe bleeding or additional injury.
“The one thing that gave me hope, when I saw the youngest boy — he had a scissor that was 6½ inches shoved into his ear, to the hilt — and he was sitting there staring at an iPhone that was given to him by our child life specialist,” Beaty said.
“Just like any child who zones out to technology, he was still very much aware,” Beaty said. “Now, his older brother, who had the knife buried in from his jaw up into his brain, he was very much dead when we met him. He was in a deep coma. His pupils were not working. He had no signs of brain stem life.”
Immediately Soto, Beaty and their colleagues performed surgeries on each boy, pulling the scissors out of the younger brother and the knife out of the older brother.
The procedures were not easy.
“When you’re thinking about brain surgery, you either have the left side or the right side. So if you’re going to do a surgery, for example, you’re going to have to either prep the right or left — and in this case, both objects traversed midline. So they were both in the right and the left in both cases, which is unfortunate and unusual,” Beaty said.
“If you perform open surgery from the right, then you don’t have control of everything to the left, and vice versa,” he said.
In order to reach both sides of the boys’ brains, the surgeons inserted a series of catheters into the arteries. Those catheters allowed them to move between both sides and gradually push the objects out of the boys’ brains.
“We would move them from the left to the right as the objects were moved in the boys’ head,” Beaty said, adding that his colleagues and he entered the arteries from the large femoral artery in the leg to then travel to the brain.
The scissors in Guillermo Timoteo’s ear moved an artery that supplies blood to the brain stem and spinal cord, so that artery needed to be repositioned.
As for Juan Pedro, the knife cut his internal and external carotid arteries, which deliver oxygen-rich blood from the heart to the head and brain. Those arteries needed to be closed.
The medical teams used coils and balloons to perform the surgeries without harming any other blood vessels and arteries. The teams relied on 360-degree live X-ray imaging to help guide them through the tiny arteries in the boys’ bodies.
Both surgeries took place April 24, beginning in the late afternoon and ending late that night. The surgeries were successful, and both brothers survived.
‘We are grateful for every day’
“The younger boy definitely is going to have hearing impairment just because of the course of that foreign body that went into his ear,” Soto said.
Yet “when I see these boys and I see how they’re doing, it’s just remarkable that they — in the time I spent with them, which is limited — that they seem to act like normal boys,” he said.
“I hope when people hear about this story, they realize that there can be some pretty bad things that can happen, but you just keep that faith. You keep that hope, and you can still have the happier ending,” he said. “It doesn’t have to be a bad ending.”
Dr. Sanjay Gupta, CNN’s chief medical correspondent and a practicing neurosurgeon, saw radiology images of the boys’ injuries.
Gupta was not involved in their care, but after hearing about their story, he said he was impressed with how the boys’ medical team responded.
“Perhaps the most remarkable part of this story is the judgment and forethought the doctors and nurses had before proceeding with the operation,” Gupta said. “In these situations, the team spent the time to really plan the operation despite the urgency of the moment, and that saved the boys’ lives.”
After the boys were stabilized, they remained at the hospital for about a week. Then, they were transferred to Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, for follow-up treatment and monitoring with specialists.
In a written statement last week, the Nino-Brown family said, “Juan Pedro and Guillermo Timoteo are doing very well, thanks to God and the incredible medical care they’ve received. We are grateful for every day that they continue to grow and heal.”
Soto and Beaty were reunited with the boys in July, when Tallahassee Memorial HealthCare held a special reunion for the boys and their caregivers at the hospital.
“I think it brought closure to a group of people here at Tallahassee Memorial, the community here at Tallahassee Memorial Hospital, that maybe was aching for that closure — to see them succeed,” Beaty said.
Roughly 100 members of the trauma team at the hospital — including physicians, nurses and techs — were involved in the boys’ care.
“We did something collectively as a health care team to save their lives,” Beaty said. “You really felt that we were a team from the beginning to the end.”