United States Department of Veterans Affairs
 Health Care
Surgery and Therapy Help Marine Fight His Way Back from Brain Injury
After surviving a blast that nearly took his life, former Marine Nick Riccio endured surgeries and a variety of therapies and is now a career firefighter in Charleston County, SC.
After surviving a blast that nearly took his life, former Marine Nick Riccio endured surgeries and a variety of therapies and is now a career firefighter in Charleston County, SC.

At 18, he was in Iraq battling his way through Fallujah. When he was 19, he was lying in a bed at Bethesda Naval Hospital desperately trying to recover from a mortar blast that sent shrapnel slicing through his brain.

Francis "Nick" Riccio, a young man who embodies the saying "Once a Marine always a Marine," doesn't remember much of the blast that nearly took his life or the long months of recovery and rehab that followed.

But as he recounts his memorized story with the help of his father, Frank, one realizes what a miracle it is he is even alive.

On June 18, 2004, Riccio's company was hunkered down, resting under a group of palm trees when mortar rounds started flying in. "A round hit the tree right above us and rained down shrapnel," recalled the infantryman. "A piece of shrapnel metal entered the back left side of my head, sliced through my brain, and exited my right temporal lobe."

Miraculously, he survived the hour-long ride back to Baghdad even though his heart stopped twice. The military medical team then performed an emergency craniotomy removing about one-third of his skull to allow the brain room to swell. The skull was implanted in his abdomen to keep the tissue alive.

"If there's a closed head injury like Nick's," explained Dr. Florence Hutchison, the Charleston, SC, VA Medical Center Chief of Staff, "It can be very dangerous if the brain swells too much. It actually cuts off the circulation of the blood to the brain, causing permanent brain injury or death." Fortunately, Riccio's surgery was performed in time.

Real Work Began in Rehab

Hutchison, who attributes Riccio's survival to medical and technological advances like craniotomies and close proximity to military medical care, says as many as 90 percent of service members who are injured in Iraq and Afghanistan survive even when they have severe injuries. That is up from 60 percent during Vietnam."

What the soldiers in Iraq are experiencing is a tremendous amount of concussion injury," said Hutchison. "We're talking things like bomb blasts and artillery shell explosions. And it's happening in this urban environment where medical resources to provide that immediate emergency care are not a huge distance away."

But surviving a blast like the one Riccio experienced is only the first step. Nick's journey took him from Baghdad to Landstuhl Regional Military Medical Center in Germany, to Bethesda Naval Hospital, and then to the Tampa VA Medical Center for more than three months of intensive rehabilitative therapy.

That was when the real work began. "I had to learn everything all over again," Riccio said. His rehabilitation included extensive physical therapy and cognitive rehabilitation therapy at the Tampa, FL, VA, which is equipped with state-of-the-art rehabilitation resources designed specifically to meet the needs of service members returning from Iraq and Afghanistan.

Therapy sessions ranged from learning to walk again to re-learning reasoning skills. Riccio even learned to drive again thanks to the VA. "The VA was great to me when I was an inpatient and here in Charleston where they did my final surgery (to reattach the skull). And now they continue to take care of me," Riccio said.

PTSD was "Rough Journey"

But Nick's rehabilitation wasn't just physical. He also dealt with several readjustment issues along the way. "The readjustment phase in the beginning ... that was very hard," he said quietly.

Riccio had to give up his lifelong career goal of being a Marine, even though the Corps kept him on active duty for more than a year after his injury. He had to learn to deal with anger outbursts, depression and other symptoms of Post-Traumatic Stress Disorder (PTSD).

"It was a rough journey," he said, "but it paid off in the long run." His VA Case Manager, Meredith Miller, says with pride, "Nick's done so phenomenally well. He had a hard time for a while but he's always willing to do what he needs to do to get better and he's more motivated for his family."

Today the 23-year-old is a husband, father of two small children, and a firefighter for Charleston County, South Carolina.

This article was originally written by Tonya C. Lobbestael for the Charleston VA Medical Center's Spring 2009 newsletter.

By Hans Petersen, VA Staff Writer