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Cold case: did induced hypothermia save the life--and art--of tejano legend Emilio Navaira?

Article Excerpt
[ILLUSTRATION OMITTED]

One year ago, at about five a.m. on Easter Sunday, a 26,000-pound bus crashed at high speed into a wedge-shaped traffic barrier near the intersection of Loop 610 and Highway 59, in the Houston suburb of Bellaire. On impact, the driver was hurled headfirst through the exploding windshield toward the crushed barrier and concrete pavement. Remarkably, he sustained no open head wounds of skull fractures--he suffered what trauma experts call a closed-head injury--but he arrived at Memorial Hermann-Texas Medical Center in a coma. A Hispanic man who appeared to be in his mid-forties, he had no identifying paperwork, so the hospital staff gave him a generic name: Julio 1288. Doctors and nurses moved quickly to stanch his bleeding and thread a breathing tube into his trachea. They were too intent on stabilizing him to wonder who he was.

The attending doctor on call that morning was Alex Valadka, a soft-spoken neurosurgeon and the director of neurotrauma services at Memorial Hermann. He studied a CAT scan of Julio 1288's brain and found a large blood clot lying on its surface. The clot was creating intracranial pressure that diminished the flow of blood--and therefore oxygen and glucose--to the brain. This could swiftly initiate a cascade of microscopic disasters, ending in permanent disintegration of brain tissue. The man could plummet into an irreversible vegetative coma, suffer devastating brain damage, or die.

Valadka noted Julio 1288's approximate age, comatose condition, lack of other serious injuries, and, crucially, the short amount of elapsed time between the crash and the man's arrival at the hospital. He then chose to do what only a tiny fraction of neurosurgeons would have done: He initiated an experimental treatment known as hypothermia therapy. (Valadka could do this without explicit permission from the patient because of a federal ethics guideline called waiver of consent, which considers the potential medical benefit and scientific merit of a given treatment.) The therapy involves dramatically lowering a patient's body temperature for a sustained period of time. Major damage from severe head trauma is caused by a rapid, abnormal buildup of fluid between cells. By cooling cells and slowing their activity, hypothermia may greatly reduce the extent of damage.

Through an IV, Julio 1288 was given morphine and antibiotics....

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