The Re-education of Dr. Holt
He was a Harvard-trained anesthesiologist who'd been a championship swimmer at West Point. But after his Humvee hit a bomb, the Bethesda man faced his toughest challenge-relearning how to walk, talk and do his job.
Surgeons suctioned out the bone shards that could have severed his spinal cord and rendered him an instant quadriplegic. Shaving down the leg bone from a cadaver, they created a C3 vertebra near the top of the spinal column, used it to replace his shattered C3, then fused it to vertebrae above and below. Beyond that, they could only hope for the best.
A few days later, the Holts flew on a C-17 to Andrews Air Force Base. During the flight, Holt’s temperature soared and he was having trouble breathing. Nashwa packed him in ice and repeatedly suctioned his airway, likely saving his life. Having snapped off one of her 4-inch heels, she limped off the plane at Andrews and boarded an ambulance with her husband.
Holt arrived at Walter Reed with gravel still imbedded in his back, his brain swollen, his face caved in. During his weeks in the hospital’s intensive care unit, he’d undergo surgery to rebuild his face and the roof of his mouth. Seven titanium plates would be fitted into the right side of his face. Frequent CT scans were done to monitor bleeding in his brain. He lost 40 pounds in a matter of weeks.
Holt was diagnosed with a moderate traumatic brain injury (TBI)—one of more than 253,000 members of the U.S. military who have suffered TBI since 2000, according to the Department of Defense.
Doctors wanted to insert a permanent feeding tube, but Nashwa insisted on a temporary device, even though Holt’s facial injuries made its insertion difficult.
“She was a great patient advocate,” Holt says now.
“No, I was the crazy wife,” Nashwa says.
Two months after Holt had gone flying from the Humvee, he could mumble some words and shuffle to the bathroom with help. His transfer to an occupational ward to relearn how to walk and talk, and how to feed and dress himself, should have been cause for celebration. It wasn’t.
“That’s when you realize that you’re going to live, you’re not going to be a quad, but you realize you’re not yourself,” Holt says. “You have modified clothes with Velcro, but it still takes you an hour to get dressed. There is a lot of pride going on, a lot of denial.”
Plus, damage to Holt’s frontal lobe had created disinhibition—a lack of impulse control.
“My wife and doctors would say I needed to stay in bed, but I’d decide I needed a walk,” Holt says. “Security would find me going towards the gate in a hospital gown.”
Even after he was well enough physically to move with Nashwa into Mologne House—a hotel-like residence on the grounds of the old Walter Reed—he struggled. At a Nationals game, he took offense at a couple of men talking during the national anthem, grabbed one and pushed him against a wall. A friend pulled him off.
“There was a lot of family strife,” Holt says. “My wife was being crushed. She suddenly has a big, 200-pound kid who doesn’t listen to anything he’s told.”
Nashwa also realized by now that her husband had been lying during their marriage, telling her that he was building clinics and schools in Afghanistan when, in fact, he was involved in what the military calls “austere and unconventional” operations.
When he started therapy, Holt was given simple tasks, like: Pick up a fork and a knife.
“I’d think that was too easy, but I’d pick up a fork and I couldn’t pick up a knife,” he says. “It was just too much information to absorb.”
It wasn’t until five months after the explosion that he could manage simple tasks like going to the bathroom by himself. But he eventually began to make amazing progress, and it became clear he remembered everything he’d learned in the past, including about medicine. But learning new things took time.
To retrain his brain to concentrate, his speech therapist would ask him questions, then turn on the television and ask him more questions, then add an increasing number of distractions. He played video games and tackled Sudoku puzzles, and turned over playing cards to rhythms set by a metronome.
Neuropsychologists first administered mental acuity tests three months after the explosion. Holt scored well below normal. At nine months, he was borderline. At 12 months, he scored in the normal range. However, his doctors expected more from a West Point graduate with a medical degree and a residency at Harvard.
But my new normal is my old normal, Holt argued.
“I didn’t get in to West Point because I was some academic juggernaut. I got in because of my swimming ability,” he told them. “I graduated third from the bottom of my class in medical school. I got into Harvard because the clinical director liked people from the military because they did what they were told.”
To help ease potential medical board concerns, the neuropsychologist overseeing the mental tests wrote a letter saying that Holt’s exceptional success in life had come from hard work and superior compensation skills, not necessarily from extreme intelligence.
Because of Holt’s experience, his unit has begun testing the learning styles and mental acuity of deploying soldiers to establish a baseline in case of a later brain injury. More units are following suit.
“That’s one of a bunch of reasons it was worth my getting injured,” Holt says.