A teenage girl, a terrible injury and a will to recover

Samantha Palumbo lay still as a stone. She might as well have been dead.

Above her head, a doctor held a needle. It contained Lidocaine, a local anesthetic. First some numbing, just in case she could feel, and then the doctor would insert a fiber-optic probe into what was left of Sami’s brain.

For nearly a week, Sami Palumbo, 16, had not moved. Her parents and classmates from her school came to Los Angeles County-USC Medical Center and prayed. One by one, the kids shuffled into Sami’s room to say goodbye. When they saw her head, they cried. A thick white bandage covered a hole. Under the bandage, most of the left frontal lobe of Sami’s brain was gone.

On a CT scan, someone had written: “Not compatible with life.”

Now, with the needle full of Lidocaine, the doctor pricked Sami’s scalp. Sami’s left hand shot up. It swiped at the needle and grabbed at the doctor’s hand. Sami’s hand stayed there, clutching and fishing for what had caused the pain.

What was this? the doctor, Azadeh Farin, wondered. A hiccup in the nervous system? Or a conscious movement? Was this hopeless, silent kid trying to say something?

Procedure completed, the doctor walked into the waiting room.

“Your daughter,” she told Sami’s mother, Diana Palumbo, in words that neither would forget, “she just moved.”

What was happening inside Sami’s brain? Was part of it beginning to heal? Were damaged cells beginning to function again? She was ambidextrous, so she was accustomed to calling on more parts of her brain than other people. Was she doing that now? Maybe it was her intelligence. She had been blessed with a high IQ, and maybe she had brainpower in reserve. None of Sami’s doctors knew for sure.

Whatever the cause, Sami had moved. Days became weeks, and weeks piled into months, and Sami’s fortunes rose and fell like the tides. She fell dormant again. Then she twisted her hand. Then she twitched her right eye and opened it. She seemed to see. But then she stared into nothingness again, lost in the grip of her unfathomable injury.

Her father, Sam Palumbo, in his early 70s, wondered what would happen if she remained like this for good. If she did, he thought, maybe God should take her home. At their house, her mother, Diana, 44, collapsed on the floor, went limp and screamed: “Why? Why? Why?” What would become of Sami? What would become of her brain?

She was a sophomore at San Dimas High School. In two more years, her friends -- the kids she had grown up with since kindergarten -- would be gone, off to college or careers. If Sami lived, would she ever be able to go back to class? Or walk, or eat, or bathe, or get into bed by herself, to say nothing of going to the prom, or graduating. . . ?

All her life, Sami had been impatient. She was still shy of 3 years old when she began to speak in sentences. When she was 4, she started competing.

She took an older stepsister’s doll, and they sparred. “You want it back?” Sami said, hands on hips. “Call my lawyer.”

In grade school, her teachers remarked about how Sami envisioned her future and was planning to get there. She couldn’t wait. When she was 13, she begged to go to high school football games. As a bubbly freshman, she was a cheerleader -- on the varsity. Her boyfriend was a football star -- a senior.

By nature, she was a perfectionist. Two hours of studying, first thing when she got home from school. When she was 15, she wrote in her journal: “I put great care into my schoolwork, and my grades are about as perfect as they can be.”

Each day she was up before dawn: curly hair first, then liner around her soft brown eyes, then touches of makeup on her cheeks. Top, pants or skirt: everything pressed, matched. She was beyond cute -- she was extraordinarily pretty.

She entered a beauty pageant, was voted runner-up -- and sulked. About the hardest thing she’d ever done, she told her parents afterward, was to stand up there after the judging with a forced smile, knowing she would not go home the best.

Two months later, she was Miss California Junior National Teenager.

Although she was only a high school sophomore, she signed up for classes at a community college. To get to those classes, and wherever else she wanted to go, she asked her parents for a car.

In March of 2005, just a few days before Sami’s 16th birthday, Diana Palumbo took her daughter to an auto dealer.

Sami fell in love with a gleaming white Toyota Scion coupe.

“My parents. . . said it is worth it to see me happy,” she wrote in her journal. “I get my license [soon].”

At sunset on a warm evening less than a month later, Sami said a quick goodbye to her parents and drove off to meet friends. About a mile from home, she eased the Scion down a hill. She had just finished dinner, and she had not been drinking.

Nobody was sure why -- maybe an animal rushed across the road, maybe she simply lost control -- but her car veered to the right.

Alongside the road was a bridle path. Between the path and the roadway stood a tall fence made of long, straight wooden logs, roughly 5 inches in diameter. Without braking, Sami hit the fence. The logs became spears. Some flew skyward, others sliced into the Scion. The vehicle plowed through 30 feet of fence before it stopped.

When paramedics arrived, they saw glass and blood. A piece of fence had shot through the car. It hit Sami in the head. Much of her face was peeled back. Her jaw hung loosely. Many of her teeth were shattered.

There was a large hole in the top left of her forehead.

The paramedics pried her out of the car and lay her on a stretcher. She was injured so badly they could not guess her age.

In an ambulance that took her to an emergency helicopter, Sami’s blood gushed and her breathing grew raspy, then infrequent.

The paramedics knew that sound: the death rattle.

At County-USC Medical Center, doctors stabilized her. They could not do much more.

CT scans showed devastation inside her skull. The fence had laid siege to every part of her brain, which was as swollen as a sponge. Its surface should have been wavy, undulated, set off from the skull by a small space. Now there were no waves, no undulations, no space between the brain and bone.

Her cerebral cortex, the outer layer of the brain that filters behavior and controls higher thinking, had suffered a massive insult. Her ventricles, the chambers that snake through the brain and carry life-sustaining cerebrospinal fluid, were unrecognizable. The slight separations that set off her lobes and hemispheres were lost in inflammation.

If someone’s essence is the sum of the different parts of personality -- habits, feelings, memories, ways of walking, ways of talking -- and if each of those is linked to a part of the brain, then Sami was in danger of losing her essence.

Ironically, what kept her alive was the hole.

It gave her swollen brain a place to go. Without the hole in her head, her brain would have pushed downward, crushing her brain stem, and because the brain stem controls breathing, she would have asphyxiated.

But she did not. After three weeks, her parents transferred her to Childrens Hospital Los Angeles, then to a small hospital in Orange County. To look at his daughter overwhelmed Sam Palumbo. Usually lighthearted and jovial, he now kept his feelings tight and struggled through his days.

Diana Palumbo quit her job to be with her daughter every minute. She held fatigue at bay, researched Sami’s condition and managed her medical care, constantly peppering doctors with questions.

One day, Sami opened her right eye -- and reacted. She blinked.

Was her brain rewiring? She was young; maybe she could move because her brain was still maturing.

When they finally brought her home, Sami’s parents mounted photographs of her in clear view: in the living room, in the dining room, on a shelf above her bed. Each was a picture from her past. Maybe they would trigger a memory, and maybe the memory would awaken more of her brain.

One evening in February of 2006, Sami rose from her black wheelchair and stood near a window. She touched it with her hands, placed a cheek against the glass and felt its coldness.

The next day, she rose again.

This time she took a step. Then another.

“Three steps, honey,” her mother said, ready to catch her if she fell. “Four, five steps. . . “

Sami was walking, as tentatively as a toddler, but walking. She listed, then caught herself -- and kept going.

”. . . 13 steps. Fourteen. Fifteen! Fifteen steps, baby, 15. You took 15 steps!”

Every day, Sami’s parents helped her into their Ford Expedition and took her to Casa Colina, a rehabilitation facility in Pomona that specializes in people with brain injuries.

She began to engage others, watching, responding with a raised eyebrow, a tiny smile, shoulders that rose slightly or fell.

Part of her brain allowed her left hand to move, so she learned signals: Thumb up, she liked something; thumb down, she didn’t; hand to her mouth, she was hungry. Hand in an upward curve, as if blowing a kiss, meant “thank you.”

One day, she uttered four syllables.

Uh-huh -- yes.

Hunh-unh -- no.

“This girl!” Dr. David Patterson, the medical director, told people. “She has surprised me at every turn.”

When Patterson had first seen her CT scans, he thought she would die, or be a zombie, staring at the wall. “It’s easy to say she won’t get much better, but look at what she’s done so far,” he said now. “Who is to say what her limits will end up being?”

Sami gained a bit of fame. I heard about her from doctors at UCLA Medical Center, so I visited her at home in San Dimas.

Leaning against her mother, she greeted me at the door. She strained to extend a fragile hand. I shook it gently. The right side of her face looked normal, but the left side showed traumatic injury. Her mouth hung open. She did not say a word.

Still, there was something about Sami. She held her focus steady when I explained that I was a reporter, and she listened intently as I spoke at length with her mother. When I said that I was interested in writing about her rehabilitation, she smiled faintly. Then she stuck her left thumb into the air.

We worked out a way to talk.

I would ask a question and offer several possible answers. “If you are feeling cold, show me one finger. If you are tired, put two fingers in the air. If what you are telling me is that you are hungry, three fingers.”

When none of those was right, she held her hand flat and looked at me, brow tense, head cocked a bit. Come on, she seemed to be saying, come on, give me some more, I’m waiting. . .

I realized that if Sami understood a question, she could think her way through to the answer.

It was March 10, 2007, Sami’s 18th birthday.

She sat in her wheelchair, surrounded by family and friends. She wore black pants and a chiffon top. It was hot, but she was draped in a beige blanket. Gone with her left frontal lobe was her ability to control her body temperature. She was freezing.

But, clearly, many things about Sami were not gone.

She was still a stickler for how she looked. She had put on a woolen skullcap, and now she was struggling to raise her hand and use her thin, weak fingers to tuck loose strands of hair under the cap and up behind her ears.

It was hard, caring about her appearance. Her head drooped. Without warning, she would drool, and spittle would dribble down her chin. When she tried to feed herself, she would drop food onto her shirt.

Sometimes it made her want to stay home, so nobody could see.

Over the top of the birthday chatter, her father said: “Sami! Who loves you?” Slowly, she raised her left hand and reached for his nose. She touched it.

Her mother brought out a white cake with candles.

Sami formed her mouth into an oval, tried to gather air into her lungs and tense her stomach muscles to blow them out. But she could not do it.

Her parents stood behind her and blew. “Sami, you are 18. Eighteen, Sami!”

She nodded, but it was clear from our halting conversation that she did not understand. The birthday confused her. She thought she was still 16. It was as if her internal clock had stopped on the day of the accident.

The first time she looked into a mirror after the wreck, she had studied her face, turned slowly and stared at her mother. She held out her hand, upturned awkwardly. What happened to me? How in the world did I get this way?

Her memory was spotty, particularly short-term -- about what she had just done, whom she had just met. She couldn’t recall the accident, or anything that had happened months before or afterward. Those memories were locked away, probably for good.

She simply did not know what had happened to her.

Her mother tried to explain, more than once. Sami could not understand.

But she still liked to live in the moment. At the birthday party, guests regaled her with stories. Sami still loved to laugh.

Another thing had not changed. Sami was still competitive.

In front of her was a tic-tac-toe board. She wanted to play. Trembling with effort, she worked her wooden X into a corner, then looked up at me. OK, your turn.

Twice, I let her win. Then I beat her.

She scowled and stiffened.

We played again. After a few moves, I had a choice. If I filled the middle square, we’d tie. If I filled a corner, she’d win.

“Sami,” I said, “If you were me, which square would you take?”

She peered down, then looked up. Poker-faced, she placed a finger on a corner.

I put down my O.

She won.

Sami raised her left thumb.

A few mornings later, she awoke with a piercing pain. She wailed. Her mother ran to her bedroom. Sami was curled into a ball. She pointed to her head.

At her doctor’s office, she was given a CT scan, and the doctor shivered at what he saw. A bulge: air. Somewhere, her head had sprung a leak. This was an emergency. Air carried germs, and she was not strong enough to fight much against an infection.

She could die.

On March 19, Sami’s parents took her to UCLA Medical Center, where Dr. Jorge Lazareff, a neurosurgeon, and Dr. Henry Kawamoto, a plastic surgeon, would hunt for the leak. If he could, Kawamoto also would try to repair Sami’s face.

I asked her: Was she afraid?

On an answering device, she pushed a green button. A computerized voice said: “Yes.”

I scrubbed up and joined her doctors. By 7:35 a.m., Sami was in an operating room. She had been anesthetized. Kawamoto looked at her latest scan. “Oh, my God,” he said. “That’s a hell of a lot of air.”

He and his assistants lifted the skin on Sami’s forehead. Underneath was the cavern the wooden fence had made. I had to bend over and look about an inch inside before I could see any membrane. It was streaked with thin, purple blood vessels. They pulsed.

Through thick, high-powered glasses, Lazareff studied Sami’s sinus cavity. He pushed back skin and fragments of bone. There it was -- an almond-shaped hole, large enough to stick the end of a pencil through. With a slice of bone from her skull, he patched the hole and sealed it with clear mortar.

Kawamoto peeled back more flesh. A second hole appeared, deeper in her sinus.

The doctors patched it too.

Then Kawamoto took a breath. Slowly, he worked a finger under the skin around Sami’s left eye, touching everything under it, like a contractor surveying land before he starts to build. He was surprised to feel so many cracks.

He and his assistants began cutting and chipping, slicing and sawing. First, they constructed a brow over Sami’s eye. Then, like sculptors, they moved her jaw and her cheekbone. When they finished, her eye was an inch closer to her nose.

Her face was far more balanced.

For now, Kawamoto was finished. Sami had endured enough.

He looked again at her scans and shook his head. “We just don’t see this type of fracture, this devastation, in this part of the face,” he said. “My former professor used to say, ‘It just doesn’t happen.’

“It doesn’t get this far, because the injury she has leaves people dead.”

Weeks went by, then months. In June, San Dimas High School would hold its prom. But Sami’s surgery had depleted her. She was struggling. At Casa Colina, she did poorly in vocabulary and in sequencing events. She moaned and grimaced as therapists tried to get her to unfasten clothespins from the side of a coffee can.

She tried to get out of classes. She looked away when people spoke to her.

One afternoon, she told me she just wanted each day to end, fast. In the huge task of becoming independent, she was having trouble slowing down, considering, waiting. This was the same Sami who couldn’t wait to go to high school, to take college classes, to drive a car.

In time, she made friends with another patient at Casa Colina, and it helped. Then, one day, Sami’s brain made a remarkable leap. She was standing next to her mother, who had lost weight. Sami opened her mouth -- and spoke.

The words came slowly. They sounded bloated, as if her mouth was full. They ran together.

But they were words.

“Mooommmmmiiiiissssskinnnnnny.”

“Mom is skinny,” Diana Palumbo repeated, her voice rising. “Mom is skinny! I heard it. You said words. You spoke, baby. You spoke!”

But then Sami’s friend at Casa Colina returned to her home in Northern California, and Sami grew depressed. She thought of her friends at school, how they were getting ready for the prom -- and how she had to go to therapy instead. How fair was that? With hand gestures, she told me that at night, all alone in her bed, she cried.

Her therapists became frustrated. Some seized on the prom, dangling it like a carrot.

“Hey, no slouching. You can’t slouch like that in your prom dress.” “Pick up your head, no loose neck and [no] head down in a dress.” “Don’t you want to show your stuff? Then come on, let’s go.”

Something clicked. Maybe it was the prom. Sami refocused.

A quiz, for example. Thirty questions. Where is the Empire State Building? Kansas, New York, New Jersey? What is Jupiter? The sun, a star, a planet? What word goes with tonsils? Throat, stomach, spine?

She got every answer right.

How old was she? Sixteen, 17, 18? She put up three fingers: the third choice.

Sami now knew how old she was.

One day, she took 30 steps in a row. Usually, at that point, she moaned. Sometimes she collapsed to the floor. But this time she slowed down, took a breath, caught her balance and gently lowered herself into her wheelchair.

Shoulders up, back straight, she smiled at me. Hey, did you see that?

Nobody could know for sure, but Dr. Patterson, the medical director at Casa Colina, had a hunch: Sami’s brain was adapting. He looked at new CT scans and marveled. The architecture of her brain was still askew, but what was there, inside her head, seemed healthier. He could see undulations on the membrane more clearly.

He could see the lobes very clearly, partitioned as they should be. There were no gray spots. And the ventricles looked good.

“Now this,” he said, “is beginning to look like a brain.”

Patterson spoke cautiously. The odds were heavily against Sami ever living by herself, without help. And in her compromised and weakened condition, tragedy could strike. She could get worse any time, even die.

But, he said, her brain was still developing -- and would not stop until she was about 25.

Moreover, she was becoming ever more engaged, confident. When he told her that she was getting better, she put up her thumb, looked him in the eye and arched her brow.

For weeks, Sami, her mother and Sami’s best friend, Loni Suchanek, a cheerleader soon heading off to college, had planned to shop together for Sami’s prom dress.

On the car ride to Ontario Mills Mall, Loni and Sami’s mother talked about school, who was dating whom, who was going to which college.

Sami slumped.

“What’s wrong?” Diana Palumbo asked. Didn’t she want a prom dress?

Thumb down.

“Don’t you care if you are happy?”

Thumb down.

Her mother kept driving. Once they found prom dresses, maybe Sami would cheer up. They wheeled her into a store.

“Sami, look at this, isn’t it great?”

She glanced, then stared at the ground. Thumb down.

“What about this one? Green? Chiffon? Lace? White?”

She stared into the distance, a petulant teenager, caught in the throes of a meltdown. I’d never seen her this way.

“What’s wrong?” Diana Palumbo asked. “Is this too much?”

Thumb up. Yes.

“So, don’t you want to go to the prom?”

Thumb down. No. Not anymore. No.

Sami’s mother understood. She knew how hard this was. For Sami, the prom could be a great moment, but it also would be an awful reminder of what had been.

When I asked Sami about it, she helped me understand. She felt frustrated, overwhelmed. Part of it was not being able to grow up with her friends. Part of it was her limitations, the way she looked. She was no longer a beauty queen. Now there was her injured eye, her forehead, her mouth. Then there was the drool, the mess she’d make sometimes. And her head -- if only she had the strength to hold it up. . .

She was not sure how the prom would turn out. She was afraid.

Would she go?

She thought about it. Then she decided.

On June 12, it took Sami Palumbo most of the afternoon to get ready.

While her mother put the finishing touches on her simple green dress, her father grew nervous. He took his daughter for a ride in the Expedition. He could not bear to go with her that night. He imagined himself losing his composure, melting into a puddle of tears. Somehow, Sami understood. She reached over and hugged him. Holding her jaw steady with her hand, she kissed him on the cheek.

She looked so different than she had the first time I saw her.

Her soft locks rested neatly at the nape of her neck, and her curled bangs teased the top of her forehead. Since her surgery, her face was so much more symmetrical. Her good eye was open and highlighted by soft mauve makeup. Her parents had told her she looked gorgeous. They were right.

The prom was at an Orange County convention center. Sami insisted on foregoing the wheelchair so she could walk into her prom on her own two feet. The entrance was decorated with blue and gold balloons. Her ankles trembled, but with only a bit of steadying, she stepped down a red carpet. She made it all the way, than sank into her wheelchair.

Friends rushed up. “Oh, girlfriend, you look so beautiful!” “Sami, this is the night we always talked about, remember?” “Sami, can I take a picture of you? You look hot!”

She lit up.

Some of her friends walked away with tears in their eyes. But Sami didn’t notice. She sat and held her mother’s hand and watched young men and women flirt and kiss and sway to the bass-driven music.

She decided she would dance. She wheeled out onto the floor. Her mother helped her stand. She took slight steps, her feet moving to the rhythm of the bass, her body lolling in her mother’s arms. Strobe lights flashed.

I don’t wanna miss one smile

I don’t wanna miss one kiss

I just wanna be with you

Right here with you . . . in this moment

For all the rest of time.

Sami tired quickly. Her head began to droop. Her mother turned the wheelchair to leave, but a woman stopped her. She whispered into Diana Palumbo’s ear. Slowly, Sami’s mother rolled the chair to the front of the dance floor.

Exhausted, caught unaware, Sami scowled. She tried to straighten up.

The dancers drew close and grew quiet. Krystal Buckley, the prom queen, svelte, blond and smiling, walked up.

“I just want to say,” Krystal said, touching her crown, “that this should go to someone so deserving -- and we all know who that is.” She took off her crown. Gently, she placed it on Sami’s head. “It should go to Samantha Palumbo! Samantha, I give you my crown.”

Sami’s friends shouted, hugged and cried. The room thundered with applause. One of her friends jumped up and down, his feet lifting well off the floor.

Sami, her body broken, her brain struggling, tried hard to speak. Straining to hold her head straight, she moved her mouth, but no words came. She took a deep breath and looked at the crowd. Smoothly, steadily, she drew her left hand toward her lips. Then she pushed it delicately outward -- once, twice, slowly blowing tender kisses.

On June 20, Samantha Palumbo walked painstakingly but determinedly up a ramp to a podium at San Dimas High School. In front of the class of 2007, she received an honorary diploma. The class gave her a standing ovation.

kurt.streeter@latimes.com