True Grit – Why an Axe to the Head Couldn’t Stop Capt. Trevor Greene
Nearly killed on duty in Afghanistan, Trevor Greene seemed condemned to spend the rest of his days in a coma. Unbreakable determination and his fiancee’s love brought him back to life.
(Photo: Lisa Petkau Photography)
When Capt. Trevor Greene arrived with his platoon in Shinkay, a remote collection of mud huts deep in Afghanistan's Kandahar province, nearly every man and boy in the village turned out to stare. Greene was there to ask residents about the state of their schools, health care and drinking water, in his role as a civil-military co-operation operator. His goal: to determine where the military's resources would make the greatest impact. He and his team had already visited two nearby villages that day, March 4, 2006, and spirits were high as he sat with a group of Shinkay elders and villagers, his helmet removed as a sign of respect.
Suddenly, a young man stepped forward. In one rapid motion, he pulled an axe from his robes and, with the cry, "Allahu akbar!" ("God is greater"), buried it in Greene's head. Sixteen-year-old Abdul Kareem was poised for a second blow when soldiers opened fire, killing him instantly. The villagers scattered, leaving shoes and hats in their wake. Rockets and machine-gun fire exploded around the military medic who worked furiously to keep Greene alive. Capt. Kevin Schamuhn left to radio headquarters as troops quickly brought the situation under control.
"I went back to get his update, fully expecting the medic to tell me Trevor was dead," recalls Schamuhn. Incredibly, "his heart rate was stable and his breathing was stable, but there was a big hole in his head."
Forty-five minutes later, a medivac helicopter carrying Greene pulled away. Shinkay fell silent. The Afghan teenager lay in a dry riverbed, his body riddled with bullets. Nearby, flecking the grass, was the blood and brain matter of the 41-year-old Canadian soldier who had come to help him.
Debbie Lepore told herself not to panic. Greene, her fiancé, lay motionless on a bed in a military hospital in Germany, his head wrapped in a white bandage. He had just had emergency brain surgery and was on full life-support, his breathing and feeding controlled entirely by machines. Lepore knew that his injury - suffered two days earlier and just two months into his first tour in Afghanistan - was serious, but she assumed he would recover. "Most of his body looked okay, and I was trying to be positive," she remembers. "You don't automatically accept that someone is being kept alive. It didn't sink in."
Reality caught up with Lepore about ten days later, when Greene was flown to the Vancouver General Hospital. She was summoned to a waiting room to discuss his prognosis with the attending physician, who explained that her husband-to-be and the father of her young daughter, Grace, would likely never emerge from his coma. The axe had been driven about two centimetres into his brain, damaging his primary motor cortex and severely affecting his primary motor functions, including his ability to speak. Even if Greene did wake up, a stunned Lepore was told, he would be trapped in a vegetative state. He will not be a vegetable, she thought. They might know brains, but they don't know Trevor.
In their five years together before the attack, Lepore had been struck by Greene's determination. An athlete who pushed himself to the extreme (he competed with a rugby team and rowing club), Greene was a journalist by trade and had published two books, including Bad Date in 2001, which explores the issue of prostitution in Vancouver's Downtown Eastside. The book captures his fierce feeling of social responsibility, the quality that ultimately led him to the Canadian Forces and his deployment to Afghanistan. Greene saw rebuilding the war-torn country as the first step towards making a difference in people's lives there.
"Trevor's whole story is about being a champion of the underdog," says Sue Ridout, who produced Peace Warrior, a 2008 documentary about him.
But could a man who, by all accounts, was larger than life - stubborn, driven, addicted to insurmountable goals - overcome a situation in which he had lost a chunk of his brain? "He had a fighting spirit," Lepore explains. "I saw that in him before, and I thought he would do the same again."
In his role as civil-military co-operation officer, Greene attended meetings with village elders throughout Kandahar province. (Photo: Rick Madonick/Getstock.com)
(Photo: Lisa Petkau Photography)
A few weeks after the doctor's prognosis, Lepore was alone with Greene, reading him a letter sent by his friend Brad. Remarking on Brad's unusually neat handwriting, she held the page in front of Greene's motionless face. To Lepore's surprise, his eyes immediately looked at the top-left side of the page and scanned slowly across to the right, returning to the left after completing each line. His eyes worked their way to the bottom of the page, and he read a second page after Lepore flipped over the letter. She asked the doctor, "Can a person in a vegetative state read?" The next day, he confirmed that Greene was no longer in a coma.
The couple began communicating through code - one blink for "yes," two for "no." Soon Greene was answering questions by glancing at responses Lepore wrote on a white board. In this way, she was able to learn whether he was in pain, and where it hurt - essential information she shared with his medical team.
Greene's doctors were impressed, but ultimately pessimistic. His injury was the worst that some of them had ever seen; the fact that he'd survived at all, they reminded Lepore, was a miracle. One doctor encouraged her to admit him to a long-term care facility so she and Grace could move on. But Lepore had a stubborn streak to match Greene's. She insisted he would bounce back.
Working against the couple, however, was nearly 400 years of neuroscience. Until late in the 20th century, doctors believed the brain was a machine made of parts, with each part locked into a specific location, performing a specific task. It's now known that the brain is more adaptable than this, but when Greene was in the hospital, the window of time for repairing the brain was thought to be short. "The standard idea is that most of the recovery is going to happen in a relatively small number of months after the injury," explains Stephen Lindsay, a University of Victoria researcher studying Greene's case. "Once you're six months out, you're supposed to have got as far as you're going to get."
For Greene, the implications were devastating. After all, he needed more than a repair job; he had lost grey matter. After arriving at the Vancouver General Hospital, he survived surgery on his skull and two nearly fatal bouts of pneumonia. Since he'd spent so much time fighting for his life, he was in no condition to do much rehabilitation in those first few critical months. It's no surprise that early on, doctors doubted he would ever speak or walk again.
(Photo: Lisa Petkau Photography)
A few weeks after Greene woke from his coma, his sister Suzanne had arrived for a visit, with Lepore. A nurse approached them. "Watch," she said and placed her finger over the hole in Greene's neck where a tube could be inserted to remove mucus from his lungs. "Who is this?" she asked, pointing at Suzanne. Greene responded: "Hi, Suzy."
Lepore got goosebumps. "That was a very exciting day," she says.
However, the doctors tamped down hope. Greene's recovery was beyond anything they could explain using current science, and they cautioned Lepore that she shouldn't expect any more miracles. Because the axe had damaged Greene's motor cortex, paralysis was a near certainty. The best she could hope for, one doctor said, was that he might be able to lift a finger and thus operate an electric wheelchair.
Bullshit, Lepore thought. She realized that if Greene was ever going to get better, he needed to get out of the hospital.
The military had been pushing to secure a spot for Greene at the Centennial Centre for Mental Health and Brain Injury in Ponoka, Alta., one of the leading rehabilitation centres for brain injuries in Western Canada. Though the doctors at Centennial had serious doubts about his recovery, they accepted Greene for a medication trial. After responding well to the medication, he started a heavy rotation of occupational, speech and physical therapy.
Slowly, things began to turn around - but ironically, the success almost undid Greene. As his cognitive abilities improved, he began to understand the reality of his situation, fully grasping what had happened to him. Soon he was immobilized by post-traumatic stress disorder (PTSD). "It felt like there were rats eating my stomach and heart. I could smell the dust of Afghanistan in my nose," he remembers.
The constant anxiety and depression made it nearly impossible for Greene to participate in his rehabilitation. He threw up in almost every physiotherapy session, conversations were impossible and he was unable to be near a television for fear of viewing news about the war in Afghanistan.
Greene's PTSD shook Lepore. "You can work through physical barriers, but the emotional ones, you really feel in your heart," she says. She struggled to maintain her composure for the sake of their daughter, who had just turned three years old. "It almost ended us," Greene admits.
Through the army, Greene connected with a peer support network, which he contacted regularly. "Ground yourself," one peer counsellor said. "You're not in Afghanistan anymore." Greene eventually realized he had to come to terms with what had happened that day in Shinkay two years earlier. "I was a foreign soldier in uniform. It wasn't personal. I had to forgive him in order to move forward."
(Photo: Lisa Petkau Photography)
After six months in Ponoka - at the height of his PTSD - Lepore was told that Greene was being discharged. The PTSD had slowed his progress and the Centennial Centre doctors took that to mean his recovery had plateaued. But the pair did not accept that Greene had reached the end, so Lepore decided to assemble a new team to help her with his rehabilitation. She fought for an extension from the centre in Ponoka while she secured funding from the military and transformed the garage of their new home in Nanaimo, B.C., into a gym. She sought out physiotherapists and speech therapists and hired a live-in support worker. She then put aside her career as a chartered accountant and, starting in September 2008, she and Greene attacked rehabilitation as if it were a full-time job, a top priority along with caring for their daughter. Every day, after dropping Grace off at school, they spent at least an hour labouring over exercises and stretches designed to strengthen his motor control and muscles.
Lepore confesses her admiration for Greene when she first began to watch him work - the look of utter focus on his face, the sounds of grunting from the almost superhuman effort it took to force his body to do something.
One of things that kept Greene going was his dream of walking his bride down the aisle at their wedding. However, his muscles had tightened up so much that his feet were curled like deformed talons. Then one morning, out of the blue, Greene was contacted by Dr. Norgrove Penny, an orthopedic surgeon from Victoria who had seen Ridout's documentary about Greene the night before. "I can help you," he said. Penny's unusual combination of experience in sports medicine and treating club foot in Uganda made him uniquely qualified to help Greene. He used a technology designed for children's orthopedics called the "Ilizarov apparatus," a brace consisting of steel rings attached to pins that are fastened directly to the patient's bone. Every day, Greene tightened the pins just slightly, which shifted his feet a fraction of a centimetre. Over the course of four months, his feet were slowly pulled back to their natural position.
With his feet straightened, Greene was able to focus on relearning abilities such as moving his upper torso from his hips and holding himself erect, gathering the pieces of the puzzle of walking. Despite the brain damage and the continued skepticism of the medical establishment, he progressed steadily. "Every little movement he did on his own was very exciting," says his physiotherapist, Bonnie Lamley. "It would catch your breath."
Today, Greene's cognitive abilities have nearly entirely returned, and he and Lepore are writing a book about his experience. "I bumped into the medic who saved my life, in Edmonton," Greene says, "He broke down in tears. The last time he had seen me, I was lying on the ground with my brains spilling onto the dirt."
Although he pauses to put words together, his speech is eloquent, employing metaphors and images that once filled his writing. "It's crucial," Greene says, "to get the most out of every minute. Suck the marrow from the bones of life, because you never know when it's going to end."
(Photo: Lisa Petkau Photography)
Why were the doctors so wrong? A hint may lie in a series of studies, starting in the 1960s but only widely accepted for the past couple of decades, that showed the brain can reorganize itself to better carry out what is being demanded of it. In contrast to the long-held belief that the brain is a static machine made up of fixed parts, this theory of "neuroplasticity" paints a picture of a constantly changing brain; if one part is damaged, another can pick up the slack. Greene not only appears to prove this theory but he and Lepore are pushing the brain's plasticity far past the expectations of researchers.
Greene's remarkable gains drew the attention of Ryan D'Arcy, a neuroscientist with the National Research Council. He, along with Stephen Lindsay at the University of Victoria, recently began scanning Greene's brain regularly. The researchers witnessed that parts of his brain are taking over for functions that were lost. After the first brain scan, Greene refined the motor ability of his left hand, and in the second scan the scientists saw that his brain had further reorganized in order to perform this new task. They have since seen similar results with Greene's legs.
Through intensive rehabilitation and sheer will, Greene has reprogrammed his brain. What makes his recovery even more encouraging is that he continues to regain specific motor functions five years after the axe attack. Traditional brain-injury rehabilitation programs are being updated to reflect evidence that after a certain amount of time, a patient's improvements are not necessarily destined to level off. Scans of Greene's brain show that a long-term commitment to rehabilitation may lead to similar results in other patients suffering brain injuries, from stroke victims to children with cerebral palsy.
And perhaps, more importantly, Greene's case can inspire people with brain injuries to have hope beyond what was previously promised by traditional rehabilitation programs. "Trevor and Debbie never accepted that the brain was static," D'Arcy says. "He is one of the early explorers. This is uncharted territory."
On July 24, 2010, a warm and perfectly clear day, Greene stood unassisted at a set of parallel bars in Lepore's sister's backyard. It was a simple and elegant wedding ceremony. Greene, wearing a kilt and a white dress shirt, sat down during the vows to free his hands so he could slide a wedding band onto the finger of his bride, who perched on his lap in front of 130 friends and family.
And what were they celebrating? Lepore's unwavering belief in Greene, his own stubborn determination and their refusal to accept that his recovery had ended. The moment Lepore will never forget, however, was the first dance. Greene was at the parallel bars, Lepore's arms around him. "I remember looking up at Trev. He had the biggest smile on his face." All the guests jumped to their feet and began singing and dancing around the couple at the first line of their song, "I believe in miracles."
One moment Debbie Lepore will never forget - the first dance wither her husband at their wedding. (Photo: Lisa Petkau Photography)