On Black Friday five years ago, Brian Hickey caught the PATCO train to Haddon Township, to meet some old friends at a bar. He still has the round-trip ticket in his wallet. Hickey never made the trip back to Philly that night.
Instead, over the last five years Hickey has journeyed from the edge of death through pain and confusion to a remarkable recovery.
In 2008, Hickey became one of the nearly two million Americans to suffer a traumatic brain injury, according to the Centers for Disease Control. On the bell curve of such injuries, Hickey's was well over to the severe side. He nearly died; he was told his career as a journalist was almost certainly over.
That he didn't die and has returned to a bustling career is a story built on equal parts personal determination and medical science.
Today, Hickey is the community news editor for NewsWorks.org and writes for the national sports blog Deadspin. Before his injury, he worked at various newspapers and served as managing editor of the City Paper.
More than that, Hickey is a full-fledged Philadelphia character, a man with one of the most hilarious Twitter feeds on the planet (@BrianPHickey), a great teller of true crime tales, a Quizzo master par excellence (every other Tuesday night at Billy Murphy's in East Falls) and a voluble fan of Maury Povich, Katy Perry and the FC Barcelona soccer team.
Talking about the night he was hurt, Hickey looks into his wallet at that PATCO ticket: "I can't use this, which kind of pisses me off; $2.60 down the drain - or the rates might have gone up since then."
Hit and run in the night
That night in 2008, after hanging out with his friends for a while, Hickey left the bar around 10. He was walking toward the train station, on a dark street with no sidewalk. That's the last thing he remembers.
A close-by resident heard a thump, and a car speeding off into the night. The young man looked out of his window but didn't see anything. His dog wouldn't stop barking, so he went out to check. He found Hickey bleeding and moaning in the street.
When paramedics arrived, Hickey was conscious, and belligerent: "I was like, 'I'm fine, don't effing touch me. I want to go home, don't take me to the hospital.'" Luckily for Hickey, the paramedics ignored his commands.
Instead, they took him to Cooper University Hospital, where his condition rapidly deteriorated.
Meanwhile, his wife, Angela Hickey, had no idea where he was. She was studying that night, and had fallen asleep early. When she woke up around 3 a.m.and her husband wasn't home, she started to frantically call his cell phone. She got no answer. By dawn, she had alerted Brian's dad, and a few of the friends who had been out with Hickey that evening.
Eventually they learned through an acquaintance who worked at Cooper that Hickey had been admitted there. Just as Angela Hickey ran out of her Philadelphia home to drive to the hospital, police arrived at her doorstep to tell her what she already knew - her husband had been injured.
"I went to the trauma unit, which is a bay of beds, and they told me he was in a fight," said Angela Hickey. "They had no idea what was going on, so it was very confusing at first. We just knew that he was in horrible condition; he was intubated. They were measuring the pressures in his brain continuously."
Using the 'golden hour'
The hospital team knew how important the right kind of care, right away, is for a traumatic brain injury.
That's the first medical advance that helped Brian Hickey survive.
In recent years, the wars in Iraq and Afghanistan, along with the focus on head injuries in sports, have brought increased experience and research funding to the field of brain injuries. Traumatic brain injury is still a contributing factor to a third of all injury-related deaths in the United States, but many people now survive injuries that surely would have been fatal 20 or more years ago.
"Early use of intercranial pressure monitors has been shown to help reduce mortality," explained Brian Kucer, who leads the head injury program at Magee Rehabilitation Hospital in Philadelphia. He says acute care hospitals now follow guidelines set by the Brain Trauma Foundation. The last major revision dates to 2007, the year before Hickey's injury.
"Surgeons are more likely to do early surgery to relieve some of that pressure; the skull does not expand and as the brain swells, it can push up against the skull and cause damage," added Kucer.
Brian Hickey describes his "double crany" as he calls it, more colorfully. "They cut two pieces of my skull out, if they didn't cut that out, my brain would have exploded inside the skull."
The long journey back
After that surgery, Hickey remained in a coma for more than two weeks after the hit and run.
At first, he couldn't talk: "I don't know if I realized I couldn't talk, because when you wake up, it's not like you're all there."
Hickey was taken to Magee Rehabilitation Hospital in Philadelphia where neuropsychologist Todd Lewis remembers evaluating him, and talking to his father and to Angela about an uncertain future. Outcomes are very difficult to predict with people who have suffered a severe traumatic brain injury. Lewis says family members are the most crucial allies in recovery, so he says establishing a good relationship with them is important.
"I believe in always 100 percent honesty, always maintain hope, never take away hope," Lewis said. "But we always talk about today."
An early focus with Hickey was maintaining his safety, Lewis recalled.
Hickey was rambunctious. His right side was paralyzed during the first weeks of his recovery, due to the bleeding in his brain. That didn't stop him from trying to escape out of his zipped-shut safety bed.
"I was trying to do that with a half-paralyzed body and I don't even know if my helmet was on," recalled Hickey. "They tell me I was screaming at nurses overnight, just waking up flipping out."
Lewis says this kind of irrational behavior is fairly typical: "When people suffer a brain injury very often they are impulsive and disinhibited, and people often will do things because of lack of insight and awareness."
Angela Hickey says her husband's anger scared her. He pounded on a little TV inside of his safety bed. He pounded on his wheelchair, using his functioning arm to hit the arm rest with the paralyzed arm.
She remembers that during most of his stay at Magee, her husband had only two modes: angry, or blank; "He was always flat, his affect, there were no emotions, except for anger."
Back to basics
Individualized therapy, refined by decades of practice and research, is the next thing that helped Hickey recover. Hours or speech, physical, occupational and art therapy helped him regain his most basic skills.
"They literally had to teach him what a pencil was, and how to spell pencil," his wife said.
Hickey found the process beyond frustrating at times.
"The one thing that bothered me most, when I broke down emotionally the first time, I wasn't able to write," he recalled. "Half my body was paralyzed, so I couldn't write, and I'm a writer by nature, that's when reality set in that 'Whoa, maybe you're not going to live the life you lived before.'"
The post-injury belligerence aside, Hickey's tough personality was a help. He was determined to get better. He desperately wanted to leave the hospital and go home, so he set small daily goals, often focused on his beloved pet: "My thing was I wanted to be able to throw a ball to Charlie Dawg, so that's what they would keep telling me to do."
Too much, too soon
Hickey was so determined to get out of the hospital, his care team had to slow him down at times.
Lewis says he encounters two types of patients: "One that you have to give a kick in the pants to get them going, and then one that you have to pull back on the reins, if Brian fit into either of those categories, it was truly pulling back on the reins."
Hickey constantly wanted to do too much, too soon. At some point, Lewis asked him to write an article for a Magee publication. Hickey remembers this as a way to get him to write again. Lewis said his reasons for asking Hickey to write something were two-fold.
"Trying to get him to see the improvements he had made, while realizing the work he still had to do," Lewis explained, noting that some patients overestimate how far they have come. "They think 'I could go back to work tomorrow, I could drive tomorrow.'"
Angela Hickey believes that her husband started to improve a lot once he started to connect with the outside world again: "Ironically, one of the best things that we did was to give him his cell phone back, one night I just left his cell phone with him, and he started putting out Facebook messages, even though his messages didn't make sense at first."
On Dec. 21, 2008. he posted: "Brian Hickey gets off an certain trouble."
This was during a time period when people were still referring to themselves in the third person on Facebook.
And that flat emotional state Angela Hickey observed in the early weeks? It began to change: "One day I walked in and he was crying hysterically, listening to the Killers, one of his favorite bands, and that's when I knew."
Moving out and on
In mid-January, Hickey left Magee (a place he now visits regularly, to let the staff know he remembers what they did for him).
His father moved in to help Angela care for him. He rested, read, wrote thank you notes to those who had been there for him.
He wrote a long magazine article about his accident. He started to work again. He was always a list keeper, he says, so he is used to writing stuff down to remember it. He became a father. (Louden, the son whose picture serves as Hickey's Twitter avatar, is 3 and a half years old.)
Today, Hickey says, he is mostly who he was before that car slammed into him.
"I'm the same guy," he said. "I may get frustrated when I can't remember something; I get flustered from time to time." Then he smiles and jokes that you could probably find someone who'd disagree that he hasn't changed.
Like, for example, his wife: "He is not the same, I mean it's not bad that he is not the same, but he has a much shorter fuse, about small things, and he can't remember things."
But that, Angela Hickey says, is such "small stuff" when she thinks back to the first hours after her husband's accident: "Everyone that saw him, they thought that he was done, gone."
The driver who hit Brian Hickey on Black Friday 2008 was never caught.
Brian Hickey keeps the bloody clothes that he wore that night in the trunk of his car - as a small reminder that life can change in an instant.