A triathlete’s long road

There was not a cloud in the sky on October 8, 2011, when Colleen Kelly Alexander hopped on her bike for the 10-mile ride from her office in Guilford, Conn., to her home in Clinton. She donned a fluorescent yellow cycling jersey and black helmet with bright yellow stripes, placing her belongings in two neon yellow bags clipped on the back of her bike. It was just after 11:00 a.m. on a Saturday; and Kelly Alexander had wrapped up a meeting with her boss at PeaceJam Northeast, where she was regional manager. A seasoned triathlete, Kelly Alexander, now 37, regularly rode up to 300 miles a week not just to the office, but also as part of her six-day-per-week training schedule. Two weeks previously she had cycled more than 600 miles on a tour for PeaceJam, a nonprofit that encourages teens to commit to change themselves and the world. Kelly Alexander stopped every 100 miles on the tour for speaking engagements at universities about what inspires people to create change in their communities. “Cycling has always been my peace,” she said. “I could get on the bike and the only thing that would be fueling me would be my heart and my mind.”

On this day, however, Kelly Alexander’s peace was shattered. Shortly before noon, as she was riding eastbound on the shoulder of the Boston Post Road in Madison, a 30-ton freight truck rolled through the stop sign at the eastern fork of Neck Road as it turned onto the Post Road. The truck slammed into her, its front and rear tires crushing both her and her bike.

After nearly bleeding to death, flatlining twice, and suffering devastating injuries to her lower body, Kelly Alexander is on the move once again. Her spirit and ability to push past pain have spurred her recovery. She is reclaiming her active lifestyle; although she has not reached her previous level of activity, she participates in rides and other events to call attention to road and cycling safety awareness in Connecticut. A multidisciplinary team of health professionals at Yale-New Haven Hospital (YNHH) have been caring for her for over a year and are still working to restore her function and appearance. Their expertise, along with Kelly Alexander’s determination, is paving the way for a happy ending to a story that could easily have ended differently.

On that autumn day in 2011 a crowd had gathered around the still-conscious Kelly Alexander when Patti Palaia, a paramedic with the Madison Ambulance Association, arrived on the scene. “She was moving everything and talking and breathing, but when I saw the tire track across her abdomen, I knew that was going to be bad,” said Palaia.

Alexander’s lower body was mangled and she was hemorrhaging, but she remained conscious in the ambulance that carried her to YNHH. Palaia kept her alive while EMT Amanda Bernier tried to keep her calm. “I was an EMT years ago,” said Kelly Alexander, “and I knew that if I was screaming I was getting oxygen, my heart was beating, and my brain was alive.” Within minutes of arriving at YNHH, however, she went into cardiac arrest.

Kelly Alexander was dying, said Lewis Kaplan, M.D., associate professor of surgery (trauma), one of the first providers to care for her at the hospital. Her pelvis had been crushed and her skin was torn off the underlying tissue, severing its blood supply from below her left knee up to her pelvis and sacrum (the large bone at the base of her spine), ripping apart large portions of the soft tissue of her lower body. Kaplan and his team twice performed CPR while administering fluids, resuscitation drugs, and massive transfusions of blood products as they sought the source of the bleeding. “She had a lot of injuries and she had time during transport during which they bled, so by the time she got here she was in a very difficult place,” said Kaplan. “The same kind of injuries in a different person would be absolutely life-crippling and it’s not done that to her. She’s like a force of nature.”

A cyclist since childhood

Kelly Alexander’s love of cycling began in Arizona and then Florida, where her father owned a bicycle shop. “I was the little girl who would hang out in the back of the shop with all the mechanics,” she says. Seven years ago, after neurosurgery to treat a malformation in her cerebellum, she added swimming and running to her exercise regimen. Her neurosurgeons had warned her that she might not be able to resume bicycling after her brain surgery. “I took that as a challenge,” she says. “I wanted to start running. I wanted to start swimming.”

She was living in Vermont at the time, working as the executive director of a youth center. She had previously worked at nonprofits after studying business administration and human resources management at the University of Vermont. In response to the September 11 attacks, however, she joined AmeriCorps (a federal program for adults committed to community service); went back to school to study psychology; and became an EMT. “After 9/11 I felt like I wasn’t making a huge impact,” she says of her decision to seek a new career path. Two years ago she came to Connecticut to work with PeaceJam.

“There were so many things going on.”

In the operating room on that October day, surgeons controlled the hemorrhaging from her left thigh and created soft-tissue coverage to close her wound temporarily and reduce fluid loss from evaporation. Michael Baumgaertner, M.D., professor of orthopaedics and rehabilitation and director of the orthopaedic trauma service, was called in to repair Kelly Alexander’s “open book” pelvic fracture—her pelvis had snapped in two. Any movement of her body would cause her pelvis to slide back and forth on her sacrum, causing more bleeding. “The problem was there were so many other things going on,” Baumgaertner said. “She had all these soft-tissue injuries that really could never be expected to heal without having a skeleton for them to exist on.” Baumgaertner and his team used a special operating table to help position Kelly Alexander’s pelvis. Then, while consulting X-rays, they used fluoroscopic guidance to manipulate her pelvis into its proper position through an incision on her buttocks. Two large screws fixed her pelvis in place.

Kaplan also called on a colorectal surgeon, Vikram Reddy, M.D., Ph.D., assistant professor of surgery (gastrointestinal), to repair Kelly Alexander’s anal sphincter, but she was too badly injured for the face-down position that the reconstructive surgery would have required. Reddy suggested placing a colostomy bag for the time being to avoid infection, with the idea of doing repairs later in the healing process. “This was one of the more severe cases because she was torn in multiple locations,” Reddy said.

After the initial round of surgeries, Kelly Alexander was admitted to the surgical intensive care unit, where she almost bled to death again from damage to an artery in her leg. Kaplan, who was in charge of Kelly Alexander’s critical care and continues to oversee her treatment, described the 48 hours following the accident as a “hemodynamic nightmare” due to the cardiac arrests and traumatic shock that required large-volume fluid resuscitation. The impact from the truck, the massive tissue injury she suffered, and the large volume of blood transfusions she received contributed to a severe acute lung injury that made it difficult for her body to oxygenate her blood and clear carbon dioxide from it.

Meanwhile, it fell to John A. Persing, M.D., the Irving and Silik Polayes Professor of Surgery (plastic) and professor of neurosurgery, to try to save as much tissue as possible. Early on he brought Kelly Alexander into the operating room to clean her wounds and preserve as much soft tissue as he could to maximize the quality of the reconstruction and function that would come later on. Persing used wound VAC, a negative-pressure wound therapy system, to suck out the excess edema fluid and help her wounds contract. This method temporarily closes the wound with a special sealed dressing, optimizes blood flow, and decreases the chances of infection, allowing the wound to shrink much more rapidly than it would otherwise. At first, dressing changes were done in the OR because they would have been too painful for Kelly Alexander to endure awake. Although the dressing changes became somewhat less excruciating as healing progressed, they were still so painful that anesthesiologists had to administer powerful analgesics and sedation.

Intubated and heavily sedated for more than 30 days, Kelly Alexander remembers nothing of that period, although she still suffers from vivid nightmares. Her husband, Sean Alexander, stayed by her side virtually nonstop, leaving only for short periods to go to his job as a postal worker. Although he talked to her, she could only cry in response.

In mid-November, Kelly Alexander was transferred to the acute care wing of Gaylord Specialty Healthcare in Wallingford, Conn., where she underwent several hours of wound care each day and learned to walk again. She was able to go home at the end of December 2011, where she received nursing care and prepared for her next round of surgeries.

Physical activity and social activism

Despite her arduous recovery, Kelly Alexander began to pursue physical activity and social activism once again. “She’s thrown herself into that heart and soul and it’s one of the more adaptive ways of dealing with a truly life-altering set of injuries,” said Kaplan. Kelly Alexander’s first event after the accident was the Madison Shamrock Shuffle in early March; it took her two and a half hours to walk two miles. “I did it in my walker, with my wound VAC and my colostomy bag, but it was either that or lie in bed in pain,” she said. Other events soon followed, including a Mother’s Day 5K event, the Branford Road Race in June, and the 10-mile Shoreline Shuffle in August. In September, she set her sights on the New Haven Road Race. “I had a heart-to-heart with Dr. Baumgaertner and asked if I could try to jog without my walker,” she said. “He said to take it easy, maybe try one mile, and see how it goes.” She jogged the entire 5K event slowly, wearing a shirt to which she had pinned a sign thanking the Yale medical staff for saving her life. The sign was made from the foam dressing that she continues to use to treat her still-open wounds.

Despite her accomplishments, the past 14 months have been grueling. Kelly Alexander is plagued by panic attacks and nightmares and is in constant pain. “I’ve had pain of such heavy magnitude that I wasn’t sure how to move past that on my own,” she said. She relies on her husband for emotional support and says that her doctors have become like her family. She is in touch with them on an almost-daily basis, sending photos of her progress, and checking to make sure they approve her level of physical activity.

Her recuperation at home over the last year has been interrupted by a number of surgeries. Due to the violence of her injuries, there is significant inflammation at the wound sites. As part of the healing process, her body is revved up to a high metabolic state; as a result, bone is laid down in places where it doesn’t belong. Baumgaertner did one surgery to remove excess bone growth around her pubic area and will likely perform another to remove additional bone growth at her hip.

Meanwhile, Persing is still working on Kelly Alexander’s leg as he tries to give the most normal shape possible to her body. He opted not to do skin grafts early on, because grafting would have meant additional scarring and divots. The wound VAC eliminated the need to remove skin from another part of her body, but her leg wound has not yet completely healed. “It’s shrinking, but it’s a slow process because we’re getting to the point where her body has given all it can give easily and now for the last few centimeters it’s much harder to get wound closure,” Persing said. The plan is to slowly expand the new skin that Kelly Alexander grows using saline injections into a modified balloon device, in order to slowly stretch the tissue over her leg and abdomen. She will require several surgeries over the next couple of years to remove scar tissue and put in fatty tissue that’s missing to plump up her thigh. In Kelly Alexander’s case, the addition of fat is not merely a cosmetic procedure; because she is a cyclist, she needs the cushioning that the fat provides. “She typically exceeds expectations because she’s so motivated, so there is potential for significant improvement, but she will have some scars and some asymmetry in her legs,” said Persing.

Because of Kaplan’s role in trauma treatment and critical care, he coordinates Kelly Alexander’s care with his colleagues and still sees her regularly in his elective general surgery clinic. “I’m certain she’ll be left with chronic pain, but I think she’ll muscle through it like she’s muscled through everything else,” he said.

Coping with adversity

As far as she’s come, it’s still difficult for Kelly Alexander to grasp what she’s lost. She cycles and runs, but awkwardly and with a limp. She tears up when recounting the accident; she began driving only last October. She will never cycle alone as she did before. “I’m proud of what I can do now, but it’s not what I could do before,” she said. But she continues to push herself because that’s what she’s always done. “If I was not a conditioned athlete I wouldn’t have survived the accident and I wouldn’t be where I am today.”

Besides her injuries, Kelly Alexander has had to deal with other types of adversity. She lost her job shortly after the accident when PeaceJam closed its Connecticut office. (She is planning to file a lawsuit against the owners of the truck.)

Her experiences have inspired her to advocate for helmets and other bike and motorist safety measures. She also raises money to benefit organizations that have helped her, like the Red Cross and Gaylord Healthcare. In October, she organized Gaylord’s first annual cycling tour, which raised more than $10,000 to buy four adaptive bikes for patients. Her first time cycling on the road was also in October, when she rode with the Madison police department during a safety awareness ride. “Getting out and riding 75 miles or running five miles is the least I can do,” she said. “It’s not about me any more. I’m a product of all these people.”

“There are a lot of unsung heroes in this,” said Kaplan. “Everyone from the Emergency Department technicians, to the nursing staff, to the people in the operating room that ran to get blood played essential roles in her care. If that whole team didn’t work well, she probably wouldn’t have survived this.” Still, those who have treated Kelly Alexander acknowledge that her remarkable recovery is due largely to her strength and perseverance. “When you give people a second chance, some take the ball and run with it,” said Baumgaertner. “Her glass has always been half full and it should be a lesson to all of us.”