A Crash in California, a bomb blast in Iraq

One evening in San Diego, February 2011, a throng of guests walked out of a nightclub and into the balmy night. The next moment, screaming and carnage - as a taxi inexplicably veered off the street and onto the sidewalk, raking through the disbelieving crowd.

One young mother - Dominique Gambale - sustained the most serious injury. This is her story, and how an orthopaedic surgeon who had served in Iraq called on his wartime experience to make sure Dominique's leg would get another chance.

    Pictures (click to view and enlarge)



Photo Shoot
February 12, 2011
“I was aware of a crowd gathering around me. I heard voices saying: stay with us…”

We were out celebrating Valentine’s Day weekend. My mom was babysitting our two kids and James and I were just leaving the club after a romantic evening of dinner and dancing. We headed down the sidewalk, holding hands, to find a cab. James turned to say something to me, and — in one flashing instant — a cab found us.

Apparently, the driver of the taxi had fallen asleep behind the wheel. His cab veered off the street, onto the sidewalk, plowing into the crowd around us. In all, some 25 people were injured, some seriously. I heard voices crying, “There’s a woman under the car!” That was me.

I recall the impact — and flying through the air — and falling to the sidewalk. I’m told the “falling” sensation was due to my collapsing onto the cement, when the cab driver backed away from the brick wall after pinning me. I heard James calling my name. Someone, a Marine vet, tied a tourniquet on my leg. I started chanting my children’s names. I went into shock.

The next two days are a blur of fleeting impressions. I recall bright lights. I heard a nurse tell the medical staff to cut my dress. I’m thinking, this was one of my favorite outfits! Do you really have to ruin it?

At some point during those early moments in the trauma center, I heard the “amputation” word discussed by the medical staff. I was in and out of consciousness, so I didn’t really “process” what I was hearing. But I did understand, early on, that my leg was in serious jeopardy.

I had two long operations in the first two days — mostly to examine the damage, assess options, and decide on a course of action. On the second day, Dr. Paul Girard took over — the orthopaedic surgeon I now call my “Angel in Disguise.” Dr. Girard treated wounded troops in Iraq, so he was no stranger to “extremity trauma” as I learned my leg injury would be classified. It was Dr. Girard who first determined that my leg was not lost, and who devised the surgical approach to save it. Until then, no one was betting I’d come out of this with two legs.

Those were the first two of nine total surgeries. I was in the hospital for 5 ½ weeks. Dr. Girard led my surgical plan, and the procedures, throughout this period. He continues to supervise all aspects of my progress.

It was months in a wheelchair before I could put even a light weight on my leg. More months on crutches, before I could lean on it. Today, I’m walking short distances with just a cane. A long way from the fitness and activity level I was used to before the crash, but Dr. Girard assures me I’m “ahead of schedule” on recovery performance.

I wouldn’t be truthful if I didn’t own up to some occasional feelings of depression and even anger. But only moments. James and our two children have led my support team. The crash did more than change my life — it severely affected my whole family, as well. They have been so strong.

Today, I see a wonderful physical therapist three days a week for three hours. The other days, I go to the gym, trying to regain the upper body strength I lost from being inactive for so long. The plate in my leg is still very painful and there is still some swelling. It’s been less than a year since the crash, and I’m told my recovery will take two years.

No one is making predictions — except me. It just seems, if I’m going to spend so many hours each day working so hard, I need to have high expectations for where it’s all going.

My goal is to play tennis again.

Dr. Girard knows what I’m training for. He smiles when we talk about it. I know a part of his smile comes from hearing me talk about getting back on the court, in light of all that’s happened. The other part of his smile comes from knowing I’m going to do it.

Thank you, Dr. Paul Girard. How lucky was I to have an orthopaedic surgeon with wartime experience and special insights on how to treat an injury like mine?

Dr. Girard was the right surgeon in the right place at the right time, even if I met him because I happened to be in the wrong place at the wrong time.
February 12, 2011
“I was dazed and couldn’t find Dominique. The scene was chaos.”

Just out of nowhere — the cab slammed into me first and flipped me onto the windshield. My head hit something and I bounced off the hood, onto the ground.

When I gathered my wits and finally located Dominique, it was obvious her leg had been terribly injured. I kept talking to her while pleading for someone to call the paramedics. The police arrived and actually had to use mace to keep the crowd at bay.

When the ambulance finally arrived, the ER team moved everyone away, even me. I had to follow the ambulance in my car. Fortunately, my own injuries were just bad bruises and I could drive okay.

Dominique was awake when I did get to see her, although she doesn’t remember much from those first few hours. I spoke briefly with her first attending surgeon. He said it was “unlikely” her leg could be saved. She had her first operation that same day.

Dr. Paul Girard arrived the next day and got totally involved. His experience as a wartime orthopaedic surgeon in Iraq gave him a special familiarity with traumatic limb injuries. He quickly determined that there was enough healthy tissue to try to save Dominique’s leg. This goal became the surgical focus.

Dominique went through four surgeries in the first five days. All told, she’s had nine surgeries, including some plastic surgery and reconstructive work that utilized muscle tissue from her back, transplanted to her leg. All her surgeons have been amazing.

Dominique’s progress has been so impressive. When she first came home, she had an intravenous antibiotic with a pump device — a pretty scary sight for two young children to see their mom wearing. Only now — 10 months later — is our household returning to normal. I’m so proud of the way our kids have helped their mom, and our family, stay positive from day one of Dominique’s recovery.

Dr. Girard paints her prognosis in terms of a range of potential outcomes. He says it is possible Dominique might return to running and tennis again. But it’s still too early to predict just how complete her ultimate recovery will be. Her dedication to fitness undoubtedly helped her survive the crash. And her zeal for strenuous training now fuels her rehabilitation process.

I only know that with Dr. Girard calling the shots, and with Dominique as his patient, the A-Team is in charge of her recovery.

For all the reasons we have to be grateful to our wounded veterans, it’s time we recognize the surgical advancements they’ve helped make possible.
“Dominique’s leg reminded me of the blast injuries I used to treat In Iraq.”

I saw Dominique’s X-rays before I saw her, so I knew we were dealing with considerable trauma. When I did meet her the day after the crash, it reassured me that she was calm, collected, and able to process what we talked about. The good news was that she had no head injuries, and her vital organs were all OK.

The first surgery I performed was basically to assess her leg’s status. Like the wartime blast injuries I treated in Iraq, there was massive damage. Yet, there seemed to be enough viable tissue with foot circulation to “go for it.” I made the determination that our approach would be to try to save her leg – even though there were lots of uncertainties about just how much of a recovery she could hope for. With her plastic surgeon, we set out to reconstruct her leg.

From the start, we all understood – Dominique included – that amputation would have to remain a possibility if at any time we saw complications. Potentially, those would include a serious infection, or the realization on Dominique’s part that she would actually be more mobile with a prosthesis. We proceeded with guarded optimism.

Throughout their ordeal, I got to know Dominique and James well. What strong people, and what a strong family. Dominique has maintained a great attitude, and James has been by her side the whole time, often traveling the long distance to see her in the hospital two and even three times each day. This devotion has helped them both get through the past year.

No doubt, Dominique’s high level of fitness has served her well. Everyone loses muscle mass if they’re in a hospital bed for more than a few days. Dominique’s was in bed for weeks. Her determination to get up and to start working out again have allowed her to attack her rehab routine with full force. I’m sure her relentless efforts in her therapy – supervised by her outstanding physical therapist – are a key reason she’s come as far as she has.

After nine surgeries, I don’t see any more operations for her. Now, only time will tell how far back she will come. She’s walking now, much sooner than I had projected. Not many people who saw her leg the night of her crash would have believed she’d even keep her limb, let alone walk on it again.

I’m saying it will be at least another year before we have an accurate picture of her total recovery. I know right now she’s still dealing with a lot of pain, and fighting through it.

Anyone else, I’d be doubtful they’d ever run or play tennis again. But this isn’t just anyone – this is Dominique and Team Gambale. Stay tuned.

In Iraq, I saw traumatic extremity injuries every week — sometimes every day. I learned and used surgical methods a stateside physician might not have been able to call on.