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In August 2020, 23-year-old Zoe Messer decided it was time to make a change. She was living in Seattle, but her graphic design and marketing job had gone remote earlier in the year in the wake of COVID-19 restrictions. She decided to move to Salt Lake City, the perfect place to do what she loves the most: explore the outdoors.

Soon enough, Zoe's first Utah ski season arrived, and she was all in. Zoe inherited her love for skiing from her father, despite growing up in Arizona, far from the mountains. On December 5, Zoe headed up to Alta Ski Resort with friends, annual pass in hand and ready to hit the slopes.

Looking back, her memories of the day are spotty. She remembers skiing down one run, but then things go dark. On the next run, she fell behind the group. Thinking she wasn't far behind, Zoe's friends waited for her at the base, but she never came back down.

Zoe had gone off the trail and hit a tree. She was unconscious and almost completely buried in large snowdrifts, invisible to everyone passing by. Hours passed as Zoe's friends searched for her with the help of the Ski Patrol. Someone finally spotted her skis in that patch of trees, and they found her buried in snow. She was immediately airlifted to Ï㽶ÊÓƵ of Utah Health's Level 1 Trauma Center.

"Patients who have low blood pressure and poor oxygen saturations for longer periods of time before they get care tend to have worse outcomes," said Ramesh Grandhi, MD, MS, specialist in neurosurgery and division chief of neurotrauma at Ï㽶ÊÓƵ of Utah Health and associate professor in the at Ï㽶ÊÓƵ of Utah. "But we give everyone a fighting chance. We'll do everything we can."

After reviewing the initial scans, Dr. Grandhi knew that Zoe had a severe traumatic brain injury (TBI). This classification is based on three main criteria to determine the severity of a brain injury: Are the patient's eyes open, can they talk or communicate, and can they follow commands? For Zoe, the answer to all three of those questions was no.

From the moment she crashed, Zoe had some things working in her favor and others working against her. Fortunately, she did not have any severe internal injuries, such as internal bleeding or severe organ damage, but she did have what doctors call polytrauma—multiple injuries to different parts of her body.

A significant challenge with this type of trauma is balancing what treatment is necessary at what time, without affecting the overall recovery. This type of case takes a team of highly trained specialists who work together to coordinate care. Working together with U of U Health Trauma and Acute Care surgeons, Grandhi and the other doctors' priority was to stabilize the damage and prevent further complications.

"She had some significant issues that we had to address, and we weren't comfortable with her going into an operating room right away," Grandhi said. "I had great communication with her orthopedic surgeon, David Rothberg, MD, and my neurosurgery/neurocritical care partner, Sarah Menacho, MD."

Once Zoe was stable, her care team placed a device to measure her intracranial pressure as well as brain tissue oxygenation. Grandhi informed Zoe's family that U of U Health is part of a national clinical trial to determine whether brain tissue oxygenation monitoring can improve patient outcomes after severe TBI. Zoe's parents agreed, knowing that Zoe would want to participate if it meant she could help someone else in the future.

Zoe's team connected at least daily and more often if needed to review the pressure and activity in her brain and began to see improvement, which provided a safe window for Rothberg to stabilize her broken pelvis and hip and fix her sternum, collarbone, left arm, and orbital bone.

By early January—several weeks after she first arrived at U of U Health—Zoe opened her eyes and could follow commands, both great signs that her brain was healing. Most polytrauma/TBI survivors are discharged to a long-term care facility when they no longer need the level of care that a hospital offers, but Zoe did so well in the long-term care facility that doctors decided she could skip inpatient rehabilitation and was discharged home.

Though she was out of the hospital, her physical recovery was difficult. Since she was not quite capable of taking care of herself yet, she went home with her parents to Arizona. On top of having to learn how to walk again, Zoe had third-nerve palsy in her right eye, affecting the up-down and right-left tracking, and would need corrective surgery. Zoe's care team also uncovered a rare congenital heart condition called Wolff-Parkinson-White (WPW) syndrome, where her resting heart rate gets very high, for which she had another operation in the spring.

For Zoe, cognitive recovery was another challenge entirely. The part of her brain that stores short-term memories was significantly impacted in the accident. After waking up from the coma, she could hardly remember things that happened in the last 5 or 10 minutes.

Having gone from what she considered a high point in her life to such a low one, Zoe struggled to give herself grace early on during recovery. She experienced bouts of depression, anxiety, and panic attacks that were new since the accident.

Despite her oftentimes overpowering negative feeling, she continued to fight. Just weeks before the accident, Zoe had received a certificate in teaching meditation, which she has been able to incorporate during her recovery.

"It takes you outside of the four walls of your brain, takes you outside of what has happened to you," Zoe said. "At first, I wanted to just move forward and leave everything behind, but now I want to bring my accident with me as I move forward: all my experiences, everything I've learned, and everyone I've talked to."

She follows up with her trauma team every few months and they've become like an extended family. Grandhi and Zoe were even able to record a podcast together to raise awareness and educate people about TBIs from a patient's perspective. Zoe's advice to survivors is to be as patient with themselves as they possibly can during recovery.

"Dr. Grandhi and my whole team were all so steadfast and calm," she said. "I think that's why I wasn't more worried about what was happening while I was recovering. I just trusted everything they were doing for me."

Because of her unrelenting perseverance, she overcame impossible odds and has made an astonishing recovery. Today, she's hiking and even hitting the slopes (with her surgeon's blessing) once again, learning to live every day to the fullest of her ability in celebration of her second chance.

"I am mending my relationship with myself. I am choosing myself and it feels so good to be back at it," she said. "And it also feels good to know that I still have the support of Dr. Grandhi and his team."