plete recovery and a bike ride across the United States. I recently invited Doug to Boston to share his story with residents and medical students. In anticipation of this trip, Doug and I reviewed the MRI scan that was performed during his coma, and I shared my astonishment with Doug that the severity of “diffuse axonal injury” on his MRI scan made his recovery seem unlikely. We discussed that there has been only one report in the medical literature of another patient with such severe injury seen on MRI, with lesions on both sides of the brainstem, who attained Doug’s level of functional independence. Yet, what is most compelling to me about Doug’s story is not the rarity of his recovery but the eloquence with which he describes the cognitive and emotional challenges that he faced after emerging from the coma. When he describes his experience to residents and medical students, Doug recalls the confusional state that often follows traumatic coma and explains that he felt as if his life were a dream. He refused to accept that he had spent two weeks in a coma. Instead, he constantly yearned to return to sleep so that he would have another opportunity “to wake up from this nightmare.” When asked to reflect on how his life has changed since the coma, Doug thoughtfully explains that all of his achievements – graduating from college, becoming a middleschool teacher, and dedicating himself to a mission of advocacy – have made him feel prouder of who he is today than he ever did before the coma. The reason is all that he has overcome. As I reflect on Doug’s story and how it has influenced my career path, I am struck by how many questions about traumatic brain injury, and traumatic coma in particular, remain unanswered. Significant advances in functional brain imaging – many of which have occurred in the laboratory of John Detre, professor of neurology and
20 ■ PENN MEDICINE
A Cross-Country Bike Trip to Raise Awareness A survivor of traumatic brain injury makes a return visit to HUP By Gregory Richter
M
ore than five years ago, Doug Markgraf was struck by a pickup truck as he rode his bicycle in a bike lane in West Philadelphia. The impact threw him to the pavement. Although Markgraf was wearing a helmet, he suffered a traumatic brain injury (TBI) and broke his arm in several places. His racing bike and helmet were destroyed. Markgraf spent two weeks in a medically induced coma at the Hospital of the University of Pennsylvania as his caregivers tried to prevent a secondary brain trauma. No one knew if he would ever walk or even talk again. After being transferred to a rehabilitation facility, Markgraf spent much of the next year undergoing inpatient and outpatient rehabilitation. As he grew stronger, he set a new personal goal: to bike across the continental United States as a way to raise awareness and funding for TBI research. Equipped with a tent, food, a smart phone (to update his blog, take photos, and more), and a phone charger that generates electricity as he pedals, Markgraf began his journey in San Francisco
Doug Markgraf on his arrival at HUP.
on June 27, 2011. His overall mission was to talk to people about traumatic brain injury in at least one hospital in every state. It wasn’t always easy. Each night, he struggled to find a place to sleep – in his tent under the stars, on a new friend’s couch, and so on – and to keep the bike stocked with essential items. As he explains, “When the tread on my back tire fell off, I thought, ‘This is such a waste of