It was a smooth ride through medical school for Dr. David Jevotovsky, until one New York City morning, an Uber sideswiped him as he was riding his bike through town. Rushed to the emergency room, neurosurgeons repaired his severely injured body and brain. Hear his first-hand account of his road to recovery, supported every step of the way by his family, friends, and medical school classmates.
After suffering a traumatic brain injury as a result of being hit by a car on his bike, Dr. David Jevotovsky had a long road to recovery. Hear him piece together the accounts of his family and friends, and the first hand account of his emergent surgery from the neurosurgeon who treated him.
Dr. Jevotovsky:
From my perspective, I was being told by the nurse, 10 different cake orders. They were very specific. Billy blue frosting, vanilla cake, chocolate, chocolate ganache, , Freddy got a cake with, uh, you know, chocolate, but really needs to switch it to vanilla.And then I'd try to be like, Nurse, I have it. I memorized it. Let me go to Wegman so I can get the cakes and bring them to the party. And I would like try to get it outta the bed and they'd have to hold me down. And the nurse is there. Now my mom's up. It's very confusing to everyone.
And you have to understand that this whole time as they're weaning the sedation, an overarching theme is “ get me out of the hospital.” Home. Home. I want to go home.
Narrator (Rose Reid): “Get me out of the hospital.” An understandable desire for someone stuck in an ICU recovering from a terrible injury, and slowly waking up from a coma. But Dr. David Jevotovsky’s brain… just couldn’t form those words.
Dr. Jevotovsky:
I'm Dr. David Jevotovski. I am a former NYU medical student
now a first year medical resident doing a preliminary year in internal medicine before I return back here to NYU to do a residency in physical medicine and rehabilitation at Rusk.
Narrator: For Sirius XM and NYU Langone Health, this is Vital Signs. I’m your host, Rose Reid.
Dr. Jevotovsky:
I grew up in Rochester, New York, surrounded by all of my family.
So my mom is a person that is a doer. She is so good at doing this and this and this and this and have to get everything done. Everything has to be in order. And I care so much about my family and they are number one. And if you say anything bad about my family, , you are dead to me . Um, and my dad is like an absolute joker and a huge personality, friends with 9 trillion people in the world
My brother is three and a half years older than me, so we were always in different schooling systems cuz he, like, when I was in middle school, he was in high school. When I was in high school, he was in college, et cetera, et cetera. Um, we didn't really become super close until I was in high school. But since then, extremely close.
Narrator: Dr. Jevotovsky’s close knit family was important to him and ultimately led him on his career path
Dr. Jevotovsky:
When I became really interested in medicine was when I was in high school. It was in ninth grade, I learned what cancer was for the first time you hear this word, cancer. Cancer, cancer. And I became really interested in that because I lost my grandfather, who was the very clear patriarch of my family. Like a very important figure to, I lost him to leukemia.
Um, so connecting those dots and understanding, you know, what took this very important person in my family away from me ignited some sort of, I guess underlying passion. And I kept wanting to learn more and more about what else is involved in medicine, what else do I not understand truly. And kind of took off from there and never turned back.
Narrator: He enrolled in the NYU Grossman School of Medicine and easily adjusted to city life.
Dr. Jevotovsky:
So when I moved to New York, I was familiar with the subways, but it wasn't really helpful because NYU is located kind of far off to the east and it's not super easy to get to the subway. Um, but what was very convenient was bike sharing, ride sharing. And it was a great way to kind of combine my interest in staying really active and just, and save money and convenience too. I would use a ride share and just pick up a bike from a station, like a block from my apartment or across from the hospital or wherever I happen to be and drop it off somewhere else. It's great.
I never felt like I was in danger when I was biking. You know, there are designated bike lanes, so I try to stick to, you know, up First Ave down Second Ave. Um, there are like these really set bike lanes that are protected from the cars almost. They have like the, the parked car lane to protect you, which is really nice. And then on the crosstown streets, there are certain streets that have their own lane as well, a little less protected. 'm gonna use, you know, be a little more careful and get to where I need to go. Um, never really felt that unsafe. I mean, I was aware that I was surrounded by cars, but never felt that unsafe.
I would use city bike to get anywhere, but I'd also use it for leisure activities. Like, if I didn't wanna go for a run, I, I could easily bike around Manhattan, which was just, is also beautiful.
Um, so I had actually just finished my, a second year, second half of anatomy class. Um, interestingly enough, it was head and neck anatomy, so the brain and stuff, um, had just finished that, had this free weekend the night before, you know, hung out with some friends and I was like, the next morning I'm gonna wake up. I'm gonna go for this lovely bike ride, gonna switch it up, and this time I'm gonna go and start on the west side instead of the east time. Just change in direction, you know, things look differently when you go in reverse.
Narrator: Just because he was in Medical School, didn’t mean he always made the wisest decisions.
Dr. Jevotovsky:
So you have to understand that I was a, at the time when I started riding these bike shares, I was 22, 23. That's like, peak invincibility complex. Um, where you think, look at me. Nothing can happen to me. So, no, I never once would wear a bike helmet while I was riding. My friends wouldn't. It just seemed normal. When you stand on the street in Manhattan and you look around, few people wear helmets. Um, so I guess I was one of those people.
And that was a big mistake.
I guess I'm, I, I used the bike share for almost two years. Um, from like the moment I moved to New York to when I was on a bike and got hit by a car and then that bike turned into pieces and so, so did I, in a sense.
Narrator: In an instant, Dr. Jevotovsky went from Medical Student to Traumatic Brain Injury Patient
Dr. Jevotovsky:
While I was going on that bike ride, I was crossing from the east side to the west side. One whatever street it was. 20th or 2st. I was hit by a car at the intersection of 21st and 9th. And sustained all sorts of traumatic injuries to my skull, my head, my brain.
I learned that the Uber driver love him, stopped. He called the ambulance who then took me to Bellevue, which is really interesting. I mean, it makes sense that they took me to Bellevue cause it's a level one trauma center. And I had a level one trauma. Um, but that's the place where I as an NYU medical student do the majority of my training. So I was taken to the place where I was learning to be a doctor and be a healthcare provider.
Narrator: When he was brought to Bellevue, he had his cell phone but no other form of identification
Dr. Jevotovsky:
So my med school friends actually got a text message that said, you know, please call Bellevue Emergency Room at this number, um, regarding your friend David And my friends get this text message and are extremely confused.
Um, stop their entire day to come see me in the hospital. And then when they see the, you know, the gravity of what happened in the seriousness of it, they have to then call my parents.
Narrator: He has no memory of the accident, or of much of those first weeks at the hospital. It’s very common for brain trauma patients to synthesize memories as they try to fill in the gaps…
Dr. Jevotovsky:
So I learned, again, I learned all of this stuff thereafter, but I have a very vivid memory in my mind of my mom finding out that I was hit by a car and my dad finding out that I was hit by a car only from third person accounts. But I've created a memory in me, which is certainly traumatic, Um, and gets me pretty emotional when I think about it.
So have a very clear picture of my mom, you know, relaxing outside, living her best, almost retired life, reading a book, and then being called by my medical school friend to say, Hey, David's in a serious accident, you need to come to to New York right now. Um, and then similarly how my father would respond and he's hopping immediately on the plane, uh, which coincidentally one of my other friends was on that plane. And he apparently the whole time was like cracking jokes the whole time when his son's getting neurosurgery was just typical.
Narrator: As his parents were enroute to be with him, his injuries were being assessed by the emergency team
Dr. Placantonakis:
My name is Dr. Demetri Placantonakis. I'm an associate professor of neurosurgery here at NYU. I'm a neurosurgeon scientist, and I work on brain tumors, so I do surgery for brain tumors, and my laboratory works in large part on brain tumors.
I did treat David, um, several years ago when he had that, um, accident. I happened to be on call at Bellevue Hospital, which is the affiliated institution with nyu. Um, and my colleagues or residents called me that day that we had, uh, a severe head injury, a young man who happened to be a medical student at this institution, and he was riding his bike without a helmet and was hit by a car. So, um, David arrived, uh, in the hospital in the emergency room that day, and he was clear that there was severe injury and he required surgical intervention.
My residents, uh, were the first ones to evaluate David when he arrived in the emergency room. And my recollection when they called me is that he was somnolent, which means he was sleepy. And, um, a cat scan indicated accumulation of blood outside of the brain. Um, so it became clear what we needed to do at the time. So we, intubated David, we put a breathing tube in him to protect his airway; to make sure that he takes in his breaths, and we plan to do emergent surgery to evacuate the blood. When blood accumulates around the brain as occurred with David, the blood starts putting pressure on the brain. And compression of the brain can be dangerous. It can be life threatening, it can produce neurologic deficits, it can block blood flow to certain parts of the brain if the blood vessels are compressed.
So the way we do the surgery is we make a, an opening in the skin that's appropriate for the size of the hematoma. We call this the trauma flap. It's a very big area that we open. It's question mark shaped. It starts in front of the ear and it goes back and then it curves back forward along the midline. This allows us to expose much of the brain on that side. So we open the skin and expose the underlying skull, and then we use drills to open a bone window in the skull and expose what's underneath. In the case of epidural hematomas, the blood is accumulated in the space between the skull and the coverings of the brain called the meninges.
One of the issues with David's injury was that, besides the blood, the hematoma that he had outside of his brain, the actual brain tissue itself was a little injured… and there was swelling within the brain. After we finished the surgery and removed the hematoma, we saw on the imaging studies that David's brain was a little swollen. Younger people are a little more susceptible to this. To monitor the swelling, we placed a probe, a small, uh, thin probe within David's brain, and this probe can measure pressure in the brain from the swelling. And for several days, David's pressures were on the higher side. So what we had to do was, for several days, we had to keep him in a coma; a coma induced by us, what we call an iatrogenic coma. Um, and that was to keep the pressures in the brain low.
Dr. Jevotovsky:
Obviously sedation and medically induced comas knocks you out. You want to not be able to move your muscles or anything like that. And I was intubated so I didn't have to breathe, breathe by myself. There was a tube to breathe for me, a ventilator. But you don't want people to be sedated. The sedation was to protect the pressure within my brain because if the pressure gets too, too high, then you risk herniating and dying or having some very severe consequences.
Narrator: It took two weeks for the swelling in his brain to come down. It was time to bring him out of the coma.
Dr. Placantonakis:
Waking up from a coma is complicated a lot of times. But it's not surprising if someone, for example, like David who's been in a coma for about a week because of a severe injury and then starts waking up from the coma is agitated just because your brain is not running on all four cylinders at that time
Dr. Jevotovsky:
I imagine I'm waking up in the hospital, I have no idea where I am. That seems disorienting. Um, so what I've been told is that I've just been, I was like thrashing all, all around and that's very unsafe cuz I have all these lines. I have a tube going to my stomach to feed me. I have a tube down my throat to ventilate me, um, and help me breathe. I have arterial lines and IVs and this and that. Um, so that's not safe.
I would assume that as something like that happens and your nerves are an overdrive in, in a huge like, sympathetic surge of like, holy shit, what's happening to me? My hands flying to the right, my legs kicking. I'm trying to get out of this bed, which is not safe because we don't know if I can walk. All my muscles are atrophied. I think I was just kind of shaking, like having a almost tan temper tantrum within the bed.
Narrator: While Dr. Jevotovsky’s parents were by his side, one important member of his family had not yet arrived.
Dr. Jevotovsky:
So my brother lives in Tel Aviv in Israel. Um, I don't know when he find out, I don't know that, like, I'm sure he told me as well, but I don't have a specific story. Um, but I do know how it, um, how it, um, made it feel, uh, how it made him feel to be stuck across the world when his brother, um, clearly needed him. And now I, I don't whatsoever, you know, blame him or anything. Like, I'm not like, Matt, why weren't you here? Of course not. But it's just a hard thought to reflect on, you know, cuz then he comes and finally sees me when he can. Um, which takes of course longer than coming from Rochester, New York and I'm comatose and or, um, thrashing from side to side as they like wean me outta s sedation. My med school, um, friends had to do like shifts of holding me back. So to have my brother come back to that is certainly without the doubt, the hardest thing to reflect on.
Narrator: Coming out of a coma isn’t as simple as it looks on TV. It can be a confusing, distressing time for brain injury patients.
Dr. Jevotovsky:
So as all of those drugs were being weaned outta my body and the sedation was coming off, I had this weird mixed reality with delirium. Um, I guess I, I have a couple memories to kind of bring that to life that didn't really happen in reality. So, but it, for me, it did seem like reality, which was an interesting thing.
So, okay, we'll set the scene one more time. So I'm in the icu. It's I think 3:00 AM middle of the night. There's a night team, night nurse. My mom is passed out, sleeping in the chair next to me, as she always is. Um, I start talking to myself mumbling about Wegmans, which is a grocery store, started in Rochester, New York, where I'm from., Wegmans is awesome.
From my perspective, I was being told by the nurse, 10 different cake orders. They were very specific. It wa I needed to know who, who the order was for. There was 10 different kids' birthdays. It was a big party. They, their preference of cake, flavor and icing. And I had to repeat it back to her. So my mom is hearing me leading, like Billy blue frosting, vanilla cake, chocolate, chocolate ganache, , Freddy got a cake with, uh, you know, chocolate, but really needs to switch it to vanilla. And like, I had to repeat it all to the nurse. And then I'd try to be like, Nurse, I have it. I memorized it. Let me go to Wegman so I can get the cakes and bring them to the party. And I would like try to get it outta the bed and they'd have to hold me down. And the nurse is there. Now my mom's up. It's very confusing to everyone. But like to me, I'm being told to do a task and I need to then execute, said task.
I'm, I'm talking about cakes and desserts and orders and little and kids and all these things. And you have to understand that this whole time as they're weaning the sedation, an overarching theme is home.
Narrator: After three weeks in the hospital, Dr. Jevotovsky’s body was weak but he was making progress and getting ready to be discharged.
Dr. Jevotovsky:
while I was at Bellevue, they start getting involved with all of the different rehab cos specialties as I like to call them. So rehab, acute rehab, loves to use speech language pathologists, occupational therapists, and physical therapists
I started to have a lot more memories that were fully mine. And in reality, I don't think it was a couple days after I left Bellevue, two or three days after I left Bobby, that I actually gained full control of my, my, my life and my reality in the present tense. Um, but I got from Bellevue in New York City to the Golisano Rehab Center in Rochester for acute rehab. Um, via a medevac, I guess a flight, which was an interesting thing to experience. They brought me right to rehab and there is, when I did, you know, like three hours of rehab a day speech, occupational physical therapy, um, and started to like, regain some of my normal functions of daily living.
So part, part of rehab is going through with the, with the ot, with the occupational therapist. Those like activities of daily living, like hygiene and cleaning yourself. I graduated from being watched by nurses while I was showering to showering by myself, which is a very baby like experience, right? eating I, or they, they taught me, you, they watched me cook for myself. Because a lot of these people that experienced traumatic brain injury, their decision making is altered their understanding of, you know, following, let's say instructions like a recipe can be very altered. So it's important for them to be able to take care of themselves and be able to, to be sure that they can safely provide themselves sustenance in food and not create a fire while they're cooking. Um, and like forget to turn the stove off or something like that. And not, and know not to like cut yourself and like how to protect yourself while when using a knife. All things that are part of the considerations post TBI while rehabbing.
Narrator: After leaving Rehab, Dr. Jevotovsky went to his childhood home to continue outpatient rehabilitation but returning to NYU Medical School was never far from his mind.
Dr. Jevotovsky:
I felt like I was progressing pretty well through all, out, all of rehab in terms of, my mind was coming back very well. I tried to like, relearn or keep up with the medicine that I had learned.
And the real big setback, if anything, was just a emotional, um, grappling of living with your parents when you're 23. But not just being a 23 year old, but feeling like you were a toddler again. You know, I, I had a person that was like essentially watching me when I was sleeping to make sure I wouldn't do anything crazy. Cause my parents were very nervous.
Um, they were, they put cameras in my room and around the house to make sure that if they needed me, that they could see what I was doing. Which was a little creepy. Um, it just was not a fun environment to jump back into when you think you're a fully functioning independent 23 year old to be treated like a baby. And I understand why they did that, but it was difficult.
But the hardest part about that was leaving medical school and watching all my friends keep going with life. And they were progressing and they were going into rotations, which I had not yet done. We were about to start. Um, so getting, they were doing all the things that I was looking forward to. And all my, you know, college friends were hanging out and doing all these things and events. And I was just left at home with my parents, which is nice. It's just not what I was picturing for my life, you know?
I guess there were some days where I would get overwhelmingly sad, I guess not depressed. Um, just like, understandably the situation I was in was frustrating. Um, so I remember one day, you know, I was just laying, I'm like, I'm bored of watching television next to my father right now. Um, like kicked him out of the room and then just like, laid on the phone or laid on the, on the floor, like in pain. I'm not just like a healthy human at that point either. It hurts to put my head on anything. It's like I have a constant headache. It was just frustrating. Um, I don't know. It's, it's hard to talk much more about it other than it sucked.
Narrator: A year after his accident, he returned to Medical School. It wasn’t without it’s challenges.
Dr. Jevotovsky:
An important thing about tbi, about traumatic brain injury is that the person that you are before the brain injury, is not gonna be the exact same person thereafter. Not that, I think that's a crazy concept because, you know, everyone that takes another minute in life, another day in life has some sort of experience that informs them. This just happens to be a very acute experience that really alters your life, but also rewires some of the networks within your brain. So when I got back to school after taking a year off for inpatient rehab, continued to do recovery stuff, um, I was not surprised when my first test was extremely challenging. It was, you know, you take all of the pressures of medical school, amplify them times a million, and my brain is worried about remembering things effectively, concentrating on the task at hand and the test, and just being able to answer each question appropriately. Um, yeah, it was really hard.
Dr. Placantonakis:
So the way David studied and learned new material was different before and after the injury. That's not surprising because there was some injury within the brain. Um, and that changed the way the circuits of the brain worked. But what can happen in compensation is the circuits of the brain are plastic and they can form new connections to, to mediate the function that was lost because of the injury. So the, the answer to a question is why was David's learning and studying different before and after the injury? The answer to that is there was plasticity in his brain that overcame the injury and still allowed him to do the things he was doing before, a differently than before. And he even, he was aware of that.
Dr. Jevotovsky:
I recognized in that moment after that test, that hard test that I needed to approach learning differently. That I, my brain now wasn't working in the way it had before. So I to kind of toss out all of those old strategies and keep testing out new ones. Luckily all my med student friends had already gone through all this. So I had a lot of resources. I had, you know, 20 people's notes, um, to add to mine, which could be resource overload. But I was able to kind of pick and choose and, and create a new system of like distilling information and thinking about what is most important and how to apply the knowledge, like having a true understanding at its base to then apply it more broadly to answer these questions. Um, but I, it was through a lot of trial and error and I think that's what medical school is for anyone. But it was just annoying that I had to do it again in the middle of training… given this accident.
Narrator: His recovery didn’t just transform the way Dr. Jevotvsky learned medicine, it also transformed how he wanted to practice it.
Dr. Jevotovsky:
So I used to wanna be a surgeon, um, just cuz I like doing things and I felt like in building things too. So I thought that would be an interesting combination, uh, you know, moving forward for a career. But when I came back to school and started doing my rotations, I did my surgical rotation and quickly realized that it was not for me. But more importantly, I felt like there wasn't enough me time and time outside of medicine. which to me, after almost losing everything became very important
So I found Physiatry PMNR, which was first exposed to me by, you know, having these doctors guide my rehab. And I saw how they were instrumental to me in my healing at one of, at, at an extremely vulnerable time. So it's like that patient connection with the subject matter ability to do things. It fit.
Narrator: His accident didn't just resonate in his professional life… but also in a very personal way.
Dr. Jevotovsky:
But I think that I'm a better person a thousand percent. If you ask my fiance, would you have dated me pre TBI? She would be the first person to tell you. Absolutely not. Cuz we've known each other for like seven years or, or eight years or something like that. Um, we were friends beforehand, but it was, it is like a different maturity and people sometimes tell, pretty frequently, actually tell me this, that they think I act older than my actual ages. Um, which I would assume is because of this. Like, it made me grow up a lot quicker but I don't know. Different priorities.
Narrator: He’s also found ways to challenge himself physically… and to help others in the process.
Dr. Jevotovsky:
When I was in rehab in Rochester, my uncle came to visit me and he said, David, I'm on my way to New York. I'm about to run the marathon cuz he like does a little bit of the marathon every year, said, Next year you're running with me. I was like, Absolutely not. Uncle lie, you are outta your mind.
But we entered the New York City lottery, Marathon lottery, which again, no chance, no interest in running the marathon whatsoever. Uh, he entered me into it and for some reason they selected me and there's like a, what is a 10% chance you get selected from the New York City Marathon lottery.
But I thought that this would be a good way to, I don't know, a lot of people run for causes. So I was like, Hey, I'm gonna just go and raise some money for brain injury because I don't know recency bias. I interviewed a bunch of different organizations, um, to learn more about them and see if it fit with my goals, but without a doubt, love your brain. Just, it really took my, took all of my attention. Um, the people were just so kind and cool.
Narrator: Just one year after his traumatic brain injury, Dr. Jevotovsky ran and finished the New York City Marathon, raising over $40,000 for the Love Your Brain Foundation. Through the foundation, he found a new community of people who had TBIs... and learned that everyone's recovery is different… with that and his own experience, he carries a unique perspective into his career.
Dr. Jevotovsky:
Um, I, it's, it's hard to say how like, in, in so many words that it, that it affected me, but it, it must because I was a critically ill patient in the middle of my training. Right?
you know, just the other day someone in the hospital was coding and I was part of the team that was helping to resuscitate the, the patient and they were in the ICU and there was a family there that were sobbing and they had to make like a decision whether we were gonna keep doing resuscitate. It was a really intense environment and to just like, have, have empathy and have feelings for, for that family that's there,
So seeing family members that are going through things like that, it's, I just am immediately reminded of my family and what it must be like for them. And, you know, I'm standing there in the middle of a code and I have like a small tear coming down my face.
I think next year it might be a different story when I'm a physiatrist on an acute rehab floor, that might be a little different. Like, who knows how me being a resident in that setting will be different. Um, for people that have just had TBIs or just had a stroke or something very similar.
I hope that I thanked my parents and my family and everyone that was there in any, in my healthcare team in any sort of way. Um, because I do owe so much to these people. Like I said, I don't, I know that I would not have been able to get through it without all these people. Um, I don't know if I've had a specific conversation, um, with all the people I should have.
Producer (off-mic):
You know, they're all gonna listen to this, this episode.
Dr. Jevotovsky:
Thanks mom. Thanks dad.
Thanks Matthew. . Thanks everyone else.
For the Vital Signs podcast, I’m Rose Reid. Join us next time as we bring you the stories of medicine made personal. VO: Vital Signs is a co-production of NYU Langone Health and SiriusXM. The podcast is produced by Jim Bilodeau, Jennifer Hofmann, and Keith King. This episode was written by Jennifer Hofman and sound designed by Jim Bilodeau. SiriusXM’s executive producer is Beth Ameen, in partnership with Allison Clair of NYU Langone Health. Don’t miss a single episode of Vital Signs and subscribe for free wherever you listen to podcasts. To hear more from the world-renowned doctors at NYU Langone Health, tune into Doctor Radio on SiriusXM channel 110. Or listen anytime on the SXM app. To get in touch with our production team, email VitalSigns@siriusxm.com. For the Vital Signs podcast, I’m Rose Reid. Join us next time as we bring you stories of medicine made personal.