Discovery 
A Beautiful Mind 
Jan Reid
Cold Case
Did induced hypothermia save the life—and art—of tejano legend Emilio Navaira?
Hugh says: hey this was on house the other night. (March 26th, 2009 at 11:28am)
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Everett’s case was closely followed by the media, and hope arose that hypothermia could be medicine’s newest magic wand. But experts in the field cautioned that Everett’s recovery might have begun before the doctors initiated the cooling, and no clinical study had ever documented hypothermia’s effectiveness in treating spinal cord injuries. Yet hypothermia is known to help protect brain function in victims of cardiac arrest, in patients who are undergoing cardiopulmonary bypass surgery, and in infants who have suffered traumatic births. Memorial Hermann has become a world leader in experiments to extend the treatment to other neuropathologies.
One day last fall, I decided to visit Memorial Hermann. After spending time with Valadka, I met Dr. James Grotta, the co-director of the Mischer Neuroscience Institute, at the University of Texas Health Science Center at Houston. Grotta took me to see a patient that his team had been treating for a stroke. During surgery, the man had gone into cardiac arrest; Grotta was using hypothermia to minimize resultant brain trauma. The patient was wrapped from mid-thigh to collarbone in what resembled a flak jacket, except that the material was translucent plastic. Called Arctic Sun, the device precisely controls body temperature by continuously circulating cold water through the jacket, eliminating the need for intravenous coolants.
The neurologist mused on hypothermia’s broader future as we left the patient. “Do you know how a bear hibernates?” he asked. “Its body adjusts its own temperature to match the temperature of its environment. A biochemist here named Chieng Chi Lee is conducting some very interesting animal research. He’s isolated a protein that enables him to take a rat to a state of extreme frigidity. Except for slight evidence of breathing, the rat looks like it’s dead. But then the man raises the temperature by manipulating this protein, and the rat stirs and gets right up, looks for something to eat. Obviously, it’s going to be a while before we see that tested on humans.”
After his first surgery, Navaira remained stable in his chilled state. But protocol dictates that patients should not be suspended in a hypothermic coma for more than two days. At about 6 a.m. on Tuesday, doctors began to raise his temperature back to normal very slowly, just one quarter of a degree per hour. During this process, Navaira developed a late-blooming contusion on his left temporal lobe, and later that day Valadka felt compelled to operate again. He was reluctant to remove the lobe surgically because it governs speech—and singing. So he took out the screws and plate securing the skull flap, set the fragment aside for sterile safekeeping, and vented the pressure that was roiling the brain tissues. At a press conference afterward, he said, “There is a chance he may not make it. You have to acknowledge that.”
But Navaira continued to hold his own, and by early Wednesday morning the singer’s experience with induced hypothermia was over. That evening, he opened his eyes, murmured a few words, and began to move his legs. It seemed like a miracle.
Did the artificially chilled state save Navaira’s life and preserve his brain function? Valadka was reluctant to draw firm conclusions before seeing the data from all the patients in the study. He had used hypothermia therapy in the interest of doing all he could for an individual patient. And, he told me, “You have to define the outcome you seek. If the standard is mortality, all right. Death has been avoided and life prolonged. But what quality of life defines a favorable outcome? Emilio has done very well, but it’s worrisome that his injury was in the part of the brain that governs speech.” As gently as possible, the doctor was saying that this gifted man might not be able to sing again.
When I spoke with Valadka and Grotta, I thought of the intellectual debate that followed the remarkable recovery of Kevin Everett. Dr. Wise Young, a leading surgeon and neuroscientist at Rutgers University, in New Jersey, wrote in a medical blog that moderate hypothermia does not cool the body enough to help any patients with neurological injuries. “To achieve truly protective effects,” he wrote, “it is necessary to cool the body to 15° C [59 degrees Fahrenheit]. This kind of hypothermia presents its own problems. If the body is kept at 15° C for more than a couple of hours, the cells lose their ionic gradients and become inexcitable . . . It is often hard to restart the heart.”
But the therapy is not just wishful thinking. In the United States and Europe, there have been several studies of hypothermia and brain injury, none more respected and cautious than one reported in the New England Journal of Medicine in 2001. The article’s lead author was Dr. Guy Clifton, a noted neurosurgeon who then practiced at Memorial Hermann. Clifton and his co-authors concluded that hypothermia was not beneficial for victims of severe brain trauma when the target temperature was reached eight or more hours after an injury.
“So why do another study?” I asked Clifton in a phone interview.
“The same data suggested that hypothermia did help when the target temperature was reached four hours after the injury,” he replied.
Many doctors are forging ahead with the treatment in the firm belief that hypothermia is beneficial, and this past December, health officials in New York City announced that its EMS crews would no longer deliver patients to hospitals that were not equipped to administer hypothermia therapy.
In the spotlight of media scrutiny and medical inquiry, Navaira’s recovery has not been untroubled. Nine days after the crash, he required a third procedure, this time to repair a dangerous rupture of a blood vessel in one of his lungs. A month after the wreck, he took his first steps and started speech therapy and physical and occupational rehab. Meanwhile, law enforcement officials in Houston were considering whether to charge him with felony DWI and intoxication assault. Two band members and a passenger have since sued him.
While Navaira was still at Memorial Hermann, one of his teenage sons, Emilio, spoke optimistically about his progress. “Oh, yeah,” he told reporters in San Antonio. “He’s walking around and talking and singing.” In July Navaira was transferred to another rehab program, at the Transitional Learning Center, in Galveston. His brother Raulito told a reporter that he was trying to talk and sing but that he got confused when the words didn’t come out right. In September, with Hurricane Ike churning toward Galveston, doctors at the Transitional Learning Center discharged Navaira to the care of his wife, Maru, and urged evacuation to San Antonio. On September 24, nearly six months to the day after the bus wreck, Maru was driving him home from outpatient therapy when they were hit by a truck. Both were hospitalized with minor injuries.
November brought heartening news: Navaira had won a Latin Grammy for his 2007 album, De Nuevo. But he and Raulito, who accepted the award, had scant time to celebrate. In early December, Navaira woke up to find the left side of his head badly swollen, and recurring weakness on that side of his body had returned. The skull flap that Valadka had twice removed and then restored had become infected. Navaira had successful corrective surgery, but Raulito described the complication as a major setback. Navaira had been running for exercise, but after the surgery he got noticeably weaker, and his confusion worsened. “It’s like starting all over,” Raulito told reporters.
Yet Navaira has survived, and he has a fighting chance to regain his talent, his voice, and the music that has nurtured his career. It seems likely that hypothermia treatment bought Valadka the time he needed to help Navaira turn the first critical corners after the accident. In Houston, Valadka reflected on his patient’s challenge: “I always keep in mind a professor I had in medical school. He kept telling us, ‘Neurological time is not measured in minutes or hours. It’s measured in months and years.’ ”
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