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You Gotta Have Heart

Two men shaking hands

Semper Fi — Paul Sander, administrative program director for the Richmond VA’s polytrauma transitional unit, congratulates Marine Sgt. Jose Patino on his hard-fought recovery from a severe brain injury suffered during a training exercise.

With a little help from his friends at the VA Polytrauma Center in Richmond, a seriously injured Marine gets himself back in the driver’s seat

Jose Patino was 14 when he and his family moved from Peru to the United States. A few years later the attacks of 9-11 occurred, and Patino felt he needed to come to the defense of his new country. He joined the Marine Corps.

Fate, it seemed, had drawn him to the kind of work he was born to do. He discovered he was very good at being a Marine. During the next few years he pulled four combat tours in Iraq, where he earned eight medals for his courage. He was a Jar Head’s Jar Head, a born warrior — fearless, cool under fire, impossible to rattle.

Marine Interrupted

Patino loved the Corps so much he decided to make it a career. Soon after returning stateside from Iraq he set his mind to becoming a Marine Corps drill instructor, one of the most physically and emotionally demanding jobs imaginable. He was preparing himself for this challenging new opportunity when, on November 2, 2009, he collapsed half-way through some routine physical training at Camp Pendleton.

His heart had stopped. He was 28.

(Later it was determined that Patino had succumbed to ventricular fibrillation — a potentially lethal abnormality in which the heart muscle abruptly begins generating uncoordinated, ineffective, and scattered contractions that fail to pump any blood.)

Patino’s fellow Marines quickly began performing CPR. When the medics arrived they used a defibrillator to jump-start his dying heart back into some kind of reliable rhythm. But Patino’s heart wasn’t cooperating.

Medics used the defibrillator three more times on the way to the emergency room at Scripps Mercy Hospital in San Diego. Patino was given medication and placed on a ventilator at the hospital, but the damage was already done. For over 30 minutes, his heart had simply not pumped enough blood to his oxygen-starved brain. The result: severe global brain injury.

Patino was transferred to the San Diego Naval Medical Center where they inserted electrodes into his heart to control his unstable heart rhythm. They implanted a device in his chest that would automatically shock his heart every time it began to sputter and fade.

Confused, disoriented and scared, the young marine was not an ideal patient. He was prone to sudden mood swings, some of them violent. They put him on sedatives to control his agitation. Despite this, it sometimes took several nurses to hold him down when he became distraught.

“He just kept looking at the toothbrush. He couldn’t understand what it was, or what it was for.”

— Marta Riquelme, Nurse Case Manager, Richmond VA Polytrauma Transitional Rehabilitation Program

Where Am I?

Medically stabilized but still heavily sedated, Patino was transferred on January 5, 2009, to the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Va.

“Jose had no idea what had happened to him, where he was, or why he was here,” said Dr. Shane Mcnamee, Patino's attending physician at the Richmond VA’s inpatient polytrauma rehabilitation unit. “He was in a fog. He simply didn’t know what was going on. We tried telling him, but he couldn’t retain the information.”

“His short term memory was shot when he first arrived here,” agreed Tom Campbell, Patino’s psychologist at the Richmond VA. “Every day he had to be re-taught everything he’d been shown the day before. He would ask a question over and over, because he couldn’t remember the answer someone had just given him. He had absolutely no ability to hold onto any information from day to day. Naturally, he became increasingly frustrated.”

Marta Riquelme, the nurse case manager and admission coordinator for the Richmond VA Polytrauma Transitional Rehabilitation Program, recalled the first time she met Marine Sergeant Jose Patino.

“My very first interaction with Jose took place while he was still in our inpatient rehabilitation unit,” she explained. “When I came into the room, both his father and his mother were distraught and crying. Their son was holding a toothbrush. He just kept looking at the toothbrush. He couldn’t understand what it was, or what it was for.”

Quitters Never Win, and Winners Never Quit

“Jose’s basic personality and his perseverance were still there,” Mcnamee explained. “He was not a quitter. Slowly but surely, he began focusing on improving his physical condition and recovering his strength. He began giving every activity and every therapy his very best effort.”

Mcnamee said the intensive inpatient program designed for Patino included a hefty emphasis on cognitive re-training. “We focused on guiding him toward independence in all his daily activities, such as grooming and eating,” the doctor explained. “We put him through a structured, step-by-step program to help him rebuild these necessary life skills.”

Throughout the next eight months at the Richmond VA, Patino also received healthy doses of physical therapy, occupational therapy, speech therapy, kinesiotherapy (therapy that focuses on the benefits of physical movement and exercise), vision rehabilitation, psychological counseling, recreational therapy, vocational therapy, and neuropsychology (a sub-specialty of psychology that concentrates on thinking skills and memory).

“Our program’s social worker kept the sergeant’s family continually up-to-date on his progress,” Mcnamee said. “His mother was staying in a Fisher House just several hundred feet away from where he was being treated, so she could see him every day, and also talk with her son’s treatment team every day. But she couldn’t speak any English, so we used an interpreter fluent in Spanish to communicate with her.”

“Everything they do for you over here is good for you. When I first got here, I didn’t understand that.”

— Marine Sgt. Jose Carlos Patino

As time went on, Patino progressed to the point where he could perform most of his basic life activities without assistance, including getting up and getting around on his own.

February 9, 2010, was graduation day for Marine Sgt. Jose Patino. That was the day he said goodbye to his inpatient rehabilitation team and took up residence on the campus of Richmond VA’s Polytrauma Transitional Rehabilitation Program. Here he would begin to master higher-level tasks — things like preparing meals, following a schedule, taking his medication on his own. Even driving.

“Jose was not a happy camper when he arrived here,” observed Dr. Gary Goldberg, the medical director for Polytrauma Transitional Rehab. “In fact, he had only two questions for us: ‘How long do I have to stay at this place, and when can I drive?’

“It was apparent, from the moment he got here, that learning how to drive again was his primary objective,” Goldberg continued. “That was the hill he wanted to take, so we told him we’d help him take it. We told him that if he was patient, cooperated with his transitional rehab treatment team and worked hard at his therapy, we’d do our best to get him driving again.”

But the hill Patino was climbing was a steep one.

“At the time of his admission to transitional, Jose was still having major difficulties with his memory,” explained Paul Sander, administrative program director of the Richmond VA’s Polytrauma Transitional Rehabilitation Program. “This really interfered with his ability to perform the more complex tasks necessary for independent living. He needed a lot of direct supervision from our staff.”

“And he still needed a major anti-psychotic sedative to control his anxiety and behavioral problems,” Goldberg noted. “But the more we worked with him, the more his self-confidence grew, and his self-esteem.”

It’s a Wonderful Life

“As time went on, Jose learned how to use various compensatory strategies,” explained Nurse Case Manager Marta Riquelme. “He kept a notebook. He had a digital watch with alarms to help him stick to his daily schedule of therapies. He worked hard to start to lose some of the weight he’d gained during his hospitalization and began to do intensive physical work-outs every day.

“We took him out into the community for therapeutic outings led by our recreational therapists,” she continued. “Jose also worked with his lead therapist, Dr. Bender, on understanding the nature of his cognitive difficulties and different ways to function in spite of it.”

Neuropsychologist Mark Bender said Patino was particularly adept at using physical activity to manage his stress.

“There was one day when he received some distressing news and wanted to work out,” Bender said. “Unfortunately, at the time he went to the gym, no PT staff were available and, per our policy, patients cannot work out alone. He became quite agitated so I offered to hang out with him while he worked out.

“He spent about 45 minutes in the gym and was extremely appreciative that I stayed with him,” Bender said. “He was always very appreciative whenever anyone helped him out.”

Gradually, Patino was tapered off his medications as his agitation diminished.

Bender said that as the fog in Patino’s head cleared, his sense of humor emerged.

“He has a dry wit, and he’s good at sarcasm,” the psychologist said. “Beginning around the middle of his stay, he had a common response whenever we asked how he was doing. He’d say, ‘It’s a wonderful day, in a wonderful place.’

Polytrauma Transitional Medical Director Gary Goldberg said that throughout his intensive rehab, the determined young Marine continued to keep his primary objective in sight at all times: learning how to drive.

On the Road Again

“Actually, his obsession with driving was a good thing,” Goldberg said. “It became the major focus for our entire treatment program. We developed a checklist of the many different component capacities required for safe driving: good reaction time, good decision-making, an ability to concentrate and anticipate things, an ability to remain composed and focused. We worked gradually through the list until Jose was able to demonstrate competency in each one.

“Eventually, after several months of treatment, Jose was able to take an on-the-road driving test with our driving evaluator,” Goldberg said. “He passed the test. We were all very proud of him that day.”

Polytrauma Transitional Program Director Paul Sander said Patino’s impressive accomplishment gave the young Marine some much needed perspective.

“Early on in the program,” Sander said, “Jose simply didn’t have the memory or cognitive capacity to understand why we were making him ‘jump through all these hoops’ before we would allow him to be tested on the road. He saw therapy as a roadblock, as opposed to a necessary pit stop.”

Patino’s occupational therapist, Melissa Oliver, said she was touched and impressed by Patino’s long journey, which began in anger and confusion, but ended with genuine gratitude –– not to mention a driver’s license.

“After Jose took his driving evaluation and passed,” she said, “he told me he finally understood why everyone had him doing all this ‘therapy stuff.’ He went from ‘I hate you,’ when he first arrived here, to ‘thanks for everything’ when he left us in late August.”

“I started out bad,” Patino agreed. “It was horrible. I didn’t like the rules and regulations. But once I could start thinking again, I realized they were doing these things for a reason. It was for my own safety. They gave me driving classes, and did all these things for me, so I could pass the test. It was awesome. The things they did for me were really good.

“Everything they do for you over here is good for you,” he added. “When I first got here, I didn’t understand that.”

Not only was Patino’s mind functioning again; so were his muscles. He had gotten himself back into fighting shape with his vigorous workouts at the gym.

“We did a stress test recently, and he’s in excellent physical condition,” Goldberg said. “He’s pumped and he’s trim. He’s returning to the Warrior Transition Unit at Camp Lejeune (North Carolina). He’s also expecting a promotion. He’s looking forward to moving up to an E-6, and he’s definitely on track to do that.”

“I think I could pass the Marine Corps physical training,” Patino beamed. “That’s a three-mile run, 100 crunches, and 20 pull-ups.”

“No push-ups?” Goldberg asked.

Patino laughed. “That’s the Army,” he said. “We don’t do push-ups in the Marines.”