The grisly head injury happened after one wrong step.
Kamel Abdel Rahman was on a construction site in April, checking how the apartment he’s building for his family was progressing, when he slipped and fell onto iron rods on the floor below.
“As I was falling, I thought I would die. But when I landed, I realized I was still alive and didn't even have any pain. I was talking,” Rahman, 46, who lives in Abu Ghosh, a town outside Jerusalem, Israel, told TODAY. (He speaks limited English so his comments were translated by Hadassah Hospital Ein Kerem, where he was treated.)
Rahman’s brother called an ambulance and the fire department. It took an hour to detach the iron rod penetrating his head from the construction site, during which Rahman was “totally functioning” and saw a big crowd watching, he said.
The next thing Rahman remembers is waking up after his surgeries.
So much happened in between.
Dr. Samuel Moscovici, a senior neurosurgeon at Hadassah Hospital Ein Kerem, was in the trauma room when Rahman was rushed to the medical center. By that time, the patient was unconscious and close to cardiorespiratory arrest.
“I remember his face and the rod penetrating his head from side to side. But when you see a patient in this condition, you need to take care of him, to decide on a plan and to manage it,” Moscovici, 39, told TODAY.
“I didn’t think about whether he would survive or not. It is much more simple: I convinced myself that he would survive and we did everything to reach that goal.”
When Moscovici considered all the vital structures that could be damaged by the rod, his first concern was the carotid arteries, which supply blood to the brain. Scans of Rahman’s head revealed the rod — which entered behind his left ear and exited through his right forehead — came within millimeters of the carotid arteries, but passed between them and did not damage them.
It’s the reason Rahman survived, Moscovici said, calling it “very close.” He wasn’t surprised the patient was conscious for a while after the accident, noting people with head trauma can have “lucid intervals” before deteriorating.
When Rahman was stable and doctors understood the exact position of the rod, they removed it during a surgery that took about 15 hours.
But there was a new problem. Rahman’s skull base was completely fragmented and his cerebrospinal fluid was leaking trough his nose and mouth, which could have caused infection, bleeding and death, Moscovici said.
Using a small endoscope inserted through Rahman’s nose, Moscovici implanted tissue from the patient’s leg to close the big hole in his skull base — a procedure known as an endoscopic endonasal approach. That second surgery lasted more than 10 hours.
Rahman spent three weeks in the hospital’s neurosurgical intensive care unit. After slowly being weaned off sedation, he woke up about two weeks after his injury. Moscovici described him as being in “perfect neurological condition,” with no psychological or intellectual changes.
“He’s a very positive and very nice man,” Moscovici said, noting that Rahman also had lots of family support, an important factor in recovery. The patient has an “excellent prognosis, actually he is cured,” the doctor said, adding only two scars are visible: where the rod entered and where it exited his head.
More than a month after his injury, Rahman has returned to his usual routine, including fasting for Ramadan this month.
“I am feeling fine, except for being tired and having some sinus problems and some reduction in my hearing,” he said.
“I get shivers when I look at the scans and realize what has happened to me. I'm very grateful to the team at Hadassah Hospital and to God for surviving such an injury.”