Who gets hit by a tram, Mr Polak?
Michael Gleeson | November 22, 2008
GRAHAM Polak remembers the after-match function but not the match. He remembers the water he drank at the MCG that night, but not the quick glass of wine he shared with Cleve Hughes before stepping out the door of his flat. He saw the first tram but not the second. But he remembers neither.
His next memory is of Trent Croad and another mate, Murray Silver, standing before him in Epworth hospital. It was weeks later. He had had dozens of conversations before that with teammates, family, and doctors in the hospital but he recollected little even immediately afterwards. This post-traumatic amnesia is to be expected when you get hit by a tram.
It was late on June 28 when Polak and Hughes jogged across the four lanes of Dandenong Road to the avenue of trees that divides the arterial road, planning to get to a taxi on the other side, where Jordan McMahon and his girlfriend were waiting. He didn't make it.
"Jordy reckons I was nearly across and I saw the one tram coming but by the time I saw the other one coming it was probably a bit too late and I started to run for it, apparently, and nearly got past it and it just clipped me on the side and smashed me. They think it was the rear-view mirror that hit me," Polak said this week.
He was spun like a top. In an odd coincidence, walking past was a friend of his manager who was also trained in emergency first aid. He put Polak into the correct position and called an ambulance, which arrived within minutes, quickly followed by a MICA (intensive care) unit.
Polak was quickly given oxygen and put on a spine board and loaded into the back of the ambulance. But there was a hold up in leaving the scene when a piece of machinery in the ambulance failed. En route to the Alfred, Polak was upset and agitated, kicking and tugging at his face-mask.
Fortunately, an intensive care ambulance with two trained staff was available that night, for they were able to do what a regular-staffed ambulance could not and induce a coma there.
"We induced the coma in the ambulance because we wanted to protect his airway and by paralysing and sedating him with drugs it stops further movement and that protects the brain from further swelling," MICA paramedic Mark Eddey said.
Moments earlier, driving in the opposite direction, was neurosurgeon John McMahon, who had finished work at the Alfred and saw Polak being treated on the tracks. He did not stop. Despite being a brain surgeon he figures unless he has a scalpel and an operating theatre he is of no more use than any other bystander. But it would not take long for him to become involved. He was phoned by the hospital's registrar to consult soon after arriving home.
Tests confirmed Polak had sustained a severe brain injury. On a clinical scale of three to 15, in which 15 is normal and three is dead, Polak was a seven.
Within 15 minutes of arrival at hospital he had been given a CAT scan that revealed tiny petechial haemorrhages around the brain. Effectively, surgeon McMahon felt, Polak had been hit and violently spun so that the brain had sloshed in his skull so aggressively that many of the neurones connecting the inner and outer parts of the brain had sheared. He did not have a skull fracture or a single large haemorrhage, so it was doubtful his head hit the tram or the ground.
"This is a global, very severe brain injury that people take months to years to recover from, and some do not recover and may end up in a nursing home," McMahon said.
It was decided to put Polak in intensive care and closely observe him for brain swelling, but not to insert a monitor to the brain to test for swelling. Inserting this monitor would have seriously affected Polak's ability to play football again, but the decision not to insert it was a clinical one, not a footballing one.
The brain scan also revealed another haemorrhage in the right thalamus and internal capsule that McMahon feared could have caused weakness in his left side. He has since not experienced this.
"He did far better than we would ever have expected of someone with petechial haemorrhages," McMahon said. "He is on the lucky end of the scale when we take into account his initial neurological condition. The initial thing was this guy is probably not going to die because he is moving his arms at the scene - that is a good sign - but with him he still had a severe head injury, he still had these petechial haemorrhages which could represent something quite bad for prognosis."
Less than a week after the accident, Polak was transferred to the Epworth Hospital. For weeks more he swam in a fog of post-traumatic amnesia. He was up and out of bed within days of his accident and had some awareness but was not cognisant of all around him. Richmond coach Terry Wallace came to visit and Polak began doing sit-ups in his hospital bed; others came and he knew to tell jokes to some and not others, but could not recall afterwards any who had been there.
"He was gradually waking from his coma. It's not like Hollywood where you wake up and you are pleasantly confused but you cannot remember your wife. It's a gradual process and not a very nice process," Epworth physio Gavin Williams said.
Polak presumed he had been in a car accident. He asked about the other car, about his own car and would point to the gravel marks and bruising on his legs and say, "Look at the exhaust burns", his girlfriend Alyce said. On another occasion he turned to Alyce and asked determinedly, "How long was I trapped in the car?" as though pleading with her to break a secret.
He was told it was a tram, not a car. His mind was muddy but he could barely believe it. Even now he finds it difficult to consider.
"Who gets hit by a tram? I just thought it was silly getting hit by a tram - things that don't swerve or don't do anything, just go on straight lines, and I still got cleaned up by one. How stupid am I getting hit by one of those?" he laughed ruefully this week.
The process of rehabilitation under associate professor John Olver at the Epworth has been painstaking, slowly seeking to return Polak's balance and short-term memory, which remain the worst affected.
"They reckon it is going to get better in time, the memory is going to get better, the balance is going to get better, but, myself, I can't see it getting better. Because I can't feel it getting better so I don't know if it is. It probably is, but I can't tell. It is frustrating the poo out of me." he said.
His proudest moment came when he was allowed to run again. Having been held back by Williams until he was certain his balance would cope, it was a tangible sign to Polak that he was advancing.
"Running was the most satisfying thing. To know that I am actually able to run again and didn't have disabilities or anything that would stop me from running was pleasing," he said.
Measuring these baby steps of change, Polak was satisfied this week to be allowed to drive. Having sustained such a serious injury, including some impairment of vision in his left eye, he was finally recovered sufficiently to be re-tested and cleared by the TAC and doctors to resume driving. It was a moment to celebrate.
"Driving again was great because well you know you must be getting better but I had been sitting at home all day and you can't go anywhere, you can't do anything, you can't drive anywhere. It was very frustrating," he said.
He has not drunk alcohol since the incident and is banned by doctors from doing so until he hits the 12-month anniversary of the accident. It will be a moment deserving of a celebratory drink.
He harbours a desire to play senior football again, which is a worthy goal and one the doctors believe is achievable, even if it will take time. He still tires easily, especially later in the day and week, and has troubles with his short-term memory, even needing teammates at times to remind him of drills they have just been instructed to perform.
"I reckon footy is what drove me the most, seeing the boys coming in. Because it was boring, I would come back home here and sit by myself and I couldn't drive and I was bored to death, so I just wanted to get back to the club and be around them and involved," he said.
"I have come a long way from where I was but I have a long way to go. I definitely want to get back to playing. When that is, I'm not sure . . . I will work my way back through. I wouldn't want to go back into the senior team until I am physically well enough to play or jeopardise someone else's spot in the side and I don't want to be in and do stuff-all - I don't want them to lose because of me."
Polak believes the injury has flipped his skills. Renowned for his ability to mark strongly, he is dropping easy chest marks, while his kicking has improved.
"My hands are still hopeless, my left side is a bit shaky, a bit more 'unco' than usual. I was never that good on my left anyway, but my hands are the main thing that annoy me. I have been dropping sitters but they reckon that is nothing, it will improve. But it gets you down," he said.
The plan now is to recommence full-contact training early next year. There is little concern that he would be at risk of a worse brain injury from another knock, rather, more concern that he not be put in that position until such time as his balance and judgement has returned to normal.
Said professor Olver: "There has got to be a certain amount of protection but at the same time people have to live life, and you don't wrap them up in cotton wool."
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