I have never become accustomed to the profound nature of many of the injuries and illnesses we see at Marler Clark.  I often find myself saying to the mother, husband, or grandson of somebody who has suffered life-altering injuries that "I wish we never had to meet" . . . my only method of verbalizing the often-overwhelming sadness that I feel in talking to somebody who now must figure out how to live with a gaping hole in their heart.

I’m sure that I said the same thing to Christina Aggas when I received a phone call from her at the office on a Friday night in early 2006.  She explained that she had slipped and fell in October 2005 at a Southern California Carls Jr. restaurant.  Not a big deal most of the time, but Christina happened to be six months pregnant with her and her husband Steve’s third child. 

Though they thought that she had suffered only a scary fall and bruised knee, Christina and Steve decided that it would be wise to get to the hospital and make sure that everything was okay. When they arrived at Kaiser Fontana’s emergency department in Riverside, California, nurses instructed Christina and Steve to go to labor and delivery for observation. 

Christina’s regular obstetrical visit prior to the fall had reflected a healthy fetus and a normal placenta by ultrasound. At the hospital, however, there was one disturbing finding: Christina now had a small tear in her placenta, but it appeared to be stable. The later pathology examination would reveal an “8 x 5 cm ragged tear at the periphery of the placenta."  The obstetrician told Christina that she would have to go on bed-rest for the duration of her pregnancy.

Christina was thus readying for discharge home when her first contraction struck. The obstetrician did not appear to be overly concerned but, not wanting Christina discharged prematurely, he ordered another ultrasound. This procedure revealed a developing placental abruption, or tearing away of the placenta from the wall of the uterus, the consequences of which can be catastrophic—massive hemorrhage with the loss of both the fetus and the mother. Thus, instead of discharge, Christina was rushed to the operating room where she underwent an emergency caesarean section by vertical incision, an act that saved her life as well as the life of her newborn son.

Jacob Aggas thus came into the world at a mere twenty-seven weeks gestation, more than two months early.  He weighed just over two pounds (961 g) at birth.

It would be wonderful to report that Jacob had a normal medical course over the next several months, and that he overcame that problems typically associated with premature birth.  But that is not what happened.  After birth, Jacob was admitted to the neonatal intensive care unit (NICU) at Kaiser Fontana Hospital, where he would remain for the next 70 days. His medical problems on admission included patent ductus arteriosis, bilateral pneumothorax , Respiratory Distress Syndrome, bronchopulmonary displasia , immature retina, gastroesophageal reflux disease (GERD), and most devastatingly, a grade IV brain bleed.

In the NICU, Jacob’s underdeveloped lungs soon collapsed, requiring tubes through the chest wall to inflate the lungs, and he was intubated through the mouth to allow for mechanical respiration, which continued for eighteen days. When taken off ventilator support, Jacob required oxygen via nasal cannula for the following two weeks. During the same period, he underwent placement of a peripherally inserted central catheter (PICC) line into his superior vena cava, several procedures involving extubation and re-intubation through the chest wall and mouth, and he experienced severe bradychardias, infections, anemia, and repeated oxygen desaturations.

Jacob beat all odds and survived the first two months of his life.  He was discharged home shortly after Christmas.  His parents, Steve and Christina, knew they had a tough road ahead with Jacob’s many medical problems; and, as expected, they spent much of the first year of Jacob’s life in and out of hospital emergency rooms.  Jacob suffered from frequent, life-threatening infections at the site of his gastrostomy tube, which was inserted directly into his stomach so that he could be fed by tube.  

We came to be involved in the Aggas family’s life before the true extent of Jacob’s injuries was known.  Bruce Clark and I flew down to California to be with the Aggas family the day after we received their call, and it was clear from the moment that we met him that Jacob was developmentally delayed, particularly in terms of his motor coordination.  

We eventually learned that Jacob’s brain bleed, at birth, had been severe.  (Attached here is our explanation for the pathogenesis of Jacob’s brain bleed and other injuries).  As time passed, Jacob missed many develpmental milestones that otherwise healthy children attain easily.  Though by all accounts a very happy little boy, it became increasingly apparent that Jacob’s muscles simply weren’t receiving the right messages from his brain, resulting in a general lack of physical coordination. 

The diagnosis, of course, was cerebral palsy, and the implications for the lives of every member of the Aggas family were monumental.  Jacob requires round-the-clock care, as he has since the day of his birth.  Fortunately, he is blessed with a mother and father who are as educated about their son’s condition and welfare as most doctors, but the financial costs alone of life-time medical care for Jacob are staggering–estimated to be between 6 and 9 million dollars.

Jacob Aggas turns four years old in October.  He has not yet taken his first step, but I assure you that he is well on his way.  I talked with Christina and Steve recently, and I am thrilled to be able to report that Jacob is as happy as a little boy can be.  Fortunately, we were able to resolve the case, and put sufficient money in trust, that Jacob will have every conceivable medical need met over the course of his lifetime.  I will continue to post updates about the developmental progress of this remarkable young boy over the next few years.