Second of three parts.
Four days after losing control of his bicycle and slamming - face-first - into an oncoming car, Matt Miller lay in the ICU at the University of Virginia Medical Center.
Nerves controlling the left side of his face didn't work, and he couldn't close his left eye.
His mouth zigzagged like a plunging stock-market table. Every one of his 32 teeth was lost, broken, or compromised.
His jaw was wired shut, and he couldn't talk.
"He looks like a person who's had a massive stroke," recalled Stephen Park, the surgeon who reconstructed Matt's face with titanium rods and screws. "You're drooling. You're not smiling. Any number of things make you look visibly deformed. It's a tough pill to swallow."
Matt still had no concept of any of this.
Nor would he remember what he typed on an "ICU talk device" that doctors gave him that day, Thursday, Nov. 6:
"Can I go to physics lab?"
Was Matt delirious or serious, or both?
That afternoon, his brother, Michael, heading back to Stanford Law School, told Matt, "I'll see you at Thanksgiving, no matter where you are."
Matt remembers thinking, "What are you talking about? Of course, I'll be home for Thanksgiving."
This was his first memory since the accident.
By Sunday, a week after he had crashed on an 85-mile triathlon training ride, Matt understood where he was, what had happened. He scribbled on a legal pad:
"I'm going home for Thanksgiving."
That would be in 18 days.
Not one doctor believed this possible.
The wiring in his brain had been twisted and torn - and the extent of the damage was still unknown.
The surgeons treating Matt assumed he would go from the hospital to a rehab facility to work on the memory and speech impairments, personality changes, and weakness that follow brain injury.
Yet on Tuesday, at Matt's insistence, his girlfriend since senior year at Radnor High School, Emily Privette, brought a laptop so he could register for spring classes. Matt was in his third year at the University of Virginia.
"I think your expectations are a little unrealistic," one doctor told Matt.
Emily collapsed into tears.
"That was a reality check," she said. "Will he be able to go to college, to be a doctor? Will he be at home the rest of his life?"
Matt's doctors, his parents, even the dean of students, just presumed that he would take incompletes for the fall semester, skip the spring semester, and maybe, by fall 2009, be well enough in mind and body to return to school.
Not Matt. He registered for classes.
That same Tuesday, nine days after his accident, he wrote a note asking his father to swing by his apartment and pick up his books.
"Doctors would come in and he'd be reading and highlighting," his father recalled. "You could see it in their faces. They were blown away by that."
Said Matt's neurosurgeon, Jason Sheehan: "Physics was one of the books he had in the hospital - just a little light reading!"
Matt and Emily
There were troubling signs, too.
At 2 a.m. on Wednesday, Nov. 12, Matt texted Emily to "turn off the stove and put away the groceries."
In the morning, nurses explained to Emily that Matt often was confused at night. Maybe it was the brain injury, or maybe the narcotics he was taking for pain.
The next night at 1 a.m., Matt texted, "I miss you." Emily was there in minutes. And for the next two weeks, Emily spent every night in the chair next to his bed and held his hand.
As a 13-year-old, Matt had liked Emily and asked a friend of hers in the orchestra to find out if Emily would go with him to the eighth-grade semiformal. When he got word back that she'd say yes, he asked.
Matt made sure to find Emily for all the slow dances.
Days later, Matt asked Emily to the latest Star Wars movie. Emily is the oldest of four, and her mother, she said, made her hold a sign, "Emily's first date," and took a photograph. Emily's sister begged to ride in the car.
Emily hated the embarrassment. "I wasn't one of those girls who ever since sixth grade had to have a boyfriend," she explained. And she broke it off.
As Emily recounts it, Matt liked her through most of high school, but she wasn't interested, and they hardly spoke. Only in their senior year, "as I felt like he lost interest," Emily recalled, "I got interested again."
Their first high school date, for pizza, was Dec. 10 of senior year.
At the hospital that first week, Matt's grandfather had said to Emily that Matt would never look the same.
"I just want my Matt back," she replied.
"After three years of dating, physical appearance was such a small part of everything I loved about Matt," Emily said. "And it wasn't like something was taken away. I still think he looks beautiful. And I know there are many other beautiful parts of him."
An athlete's engine
On Nov. 12, 10 days after the crash, the university's swim coach, Mark Bernardino, brought Matt a present, a T-shirt.
"I'm tired of seeing you in that hospital gown," said Bernardino, who'd been visiting every day, often twice.
On the shirt was a quote from North Carolina State basketball coach Jimmy Valvano, shortly before he died of cancer:
Don't give up, don't ever give up. How do you go from where you are to where you want to be? I think you have to have an enthusiasm for life. You have to have a dream, a goal, and you have to be willing to work for it.
That day, Bernardino - Matt's swim coach before Matt quit to pursue his new love, triathlons - became Matt's coach again.
Every day they walked, first down halls, then up stairs.
On Nov. 15, Bernardino walked two flights with Matt.
On Nov. 16, two weeks after the accident, Bernardino walked Matt from his sixth-floor hospital room, up two flights to the eighth floor, down eight flights to the first floor, and up six flights back to Matt's room.
The next day, Bernardino said his calves were "on fire."
Matt was fine.
"I honestly don't think very many people could have lived through his trauma," said Bernardino. "His engine was so powerful, his lungs, his heart, and his mind. I call that the engine of an athlete. They were so tuned, so fit, so ready for battle.
"He thought his battle would be a triathlon. And he found himself unexpectedly in the battle for his life."
Bernardino, who grew up in Drexel Hill and attended Cardinal O'Hara High School, could see the hospital staff watching Matt's recovery in disbelief.
"Matt could feel their joy and excitement at what he was doing medically," the coach said. "He was making them shake their heads, and he was loving it."
Matt was driven, in the way he'd always been driven.
"I have been given so much my whole life," he later explained, "that when I have to work for something, I work as hard as I possibly can without even considering other options."
In the hospital, Matt felt grateful to God, who had spared him permanent injury, and to those who prayed for him and pulled for him.
Giving every ounce of his being to getting well and going home was the least he could do.
Doctors loved his attitude.
"Every morning when I was in there to meet him, like 6 a.m., he'd get up, get out of bed, and shake my hand," said Jared Christophel, a chief resident who checked on Matt's jaw alignment.
"That attitude does have an effect on outcome."
If he had any chance of getting out by Thanksgiving, Matt had to build back his strength.
The nutritionist told Matt his mending body needed the calories of a marathoner - 4,000 a day.
But his jaw was wired shut. His primary nourishment was liquid pumped into his stomach through a tube stitched into his nose.
Matt hated that tube.
He made up his mind to suck down as many calories as he could through a straw.
In his second week, Matt began sipping two 440-calorie protein shakes. In bed one morning, he read the ingredients: "trans fat 3g."
"That's it," wrote Matt, who used to bake his own vita-muffins. "No more of these shakes for me."
He replaced them with orange-flavored Breeze, a juice box with 250 calories and 9 grams of protein - four or five a day.
And each day, his mother, Emily, Bernardino, or friends would bring a Ben & Jerry's peanut-butter shake.
Two weeks after rebuilding Matt's face, Park saw it had fallen out of alignment. Matt needed surgery again.
There was more.
In the accident, Matt's jaw, broken and jagged, had slammed into his carotid artery, the primary vessel carrying blood to his brain.
This caused an aneurysm. And it was weakening.
"Imagine a garden hose, and you hit it with a hammer, and the fibers break and it balloons out," said J. Forrest Calland, Matt's trauma surgeon.
If the balloon burst, Matt would suffer a major stroke.
Doctors debated which surgery to do first - shore up the artery with a stent, or realign the face.
If they did the face first, the aneurysm might burst.
If they did the stent first, he'd need blood thinners, which would delay his facial repair by six weeks. The jaw would heal out of alignment, forcing complicated, painful surgery later on.
Matt figured his doctors would do the right thing.
"These were the same doctors who'd been saving my life for weeks," he said. "I had a lot of trust in them."
Doctors fixed Matt's face first, in a five-hour operation.
"Seeing Matt lying there afterward, with the swelling and trauma from yet another round of having his face reworked, really brought home the severity of his injuries and what he's been through," Matt's dad, a managing director at Vanguard, e-mailed friend and Vanguard chairman Jack Brennan.
The surgeons put in a stent three days later, on Nov. 21. Matt went back to the ICU.
"We're no longer optimistic about getting out of here by Thanksgiving, but that's okay," Mike Miller e-mailed Brennan. "We're incredibly grateful to be where we are, and to have made the progress that we've made. So makes no difference where we are - we'll have much to celebrate."
A nerve problem
With Thanksgiving six days away, doctors tested and found no nerve conductivity in the top half of the left side of Matt's face.
The nerve was either traumatized or severed.
If severed, the window to repair it would close in days. And repair was still a long shot, not without its own risks.
But without the nerve, Matt would never be able to smile, eat, or speak normally.
For the first time, Matt took a good look in a mirror.
"I look fine, Mom," he wrote, his jaw still wired shut.
"Well, your smile is a bit off," she replied, with loving understatement.
"Isn't my smile fine?" he asked Emily.
"Well, not really," she said. "It's OK, though."
In all honesty, Matt said, his face didn't look that bad to him, and didn't upset him.
"It did not seem that important to me," he recalled. "I had overcome so much, and at the end of the day I was alive. My mind and legs were working. I was living."
On Monday, Nov. 24, doctors found a bit of conductivity and concluded the nerve might recover on its own.
Leaving the hospital
Thanksgiving was in three days. Matt insisted in notes and text messages that he would be out by then.
He told staff to stop pumping in any nutrition. He'd suck down 3,000 calories a day, and he upped his diet to six juice boxes of Breeze, three cans of high-protein milk, and his peanut-butter shake.
On Wednesday, the day before Thanksgiving, out came the feeding tube, though not his trache tube. Matt had had five operations, and his doctors wanted to leave it in, just in case he needed another.
Matt's doctors were astonished that he didn't need rehab. It was "remarkable," said trauma surgeon Calland.
The Millers would spend Thanksgiving at the family's duplex at Wintergreen, Va., 45 minutes away, so Matt could be near the hospital.
Matt's mother, Nancy Miller, an archivist at the University of Pennsylvania who'd spent every day at her son's side, learned how to clean out the trache tube. She also was given wire cutters and taught how to open his jaw should he choke.
At 9 p.m. Wednesday, when word spread that Matt was leaving, staffers came to see for themselves.
A nurse rolled in a wheelchair.
"I'm walking out of here on my own," Matt wrote her.
Matt, for the first time, put on the T-shirt Bernardino had given him.
Don't give up, don't ever give up. . . .
Walking into the November chill, Matt raised a fist in triumph. His brother, Michael, took a photo with his cell phone.
His father, weeping, hugged him and said, "This is the biggest competition you've ever won."
The family had made no plans for Thanksgiving, and Wintergreen's buffet was sold out.
When Mike Miller explained the circumstances, the resort packed up takeout.
Matt, who'd been reading up on blended food, conducted his first experiment.
He blended sweet potatoes with milk and sucked down orange slop through a straw.
He didn't rinse the blender, so when he mixed turkey with chicken broth, it came out orange. He slurped that down.
Then he blended mashed potatoes with milk.
Finally, he blended pumpkin pie.
"No meal," he said, "ever tasted so good."EndText