Nikia’s Second Chance
How dedicated teams of UF Health caregivers brought a teen back from the brink of death
Part I: The Crash
By Douglas Bennett
It was hours before dawn, and Nikia Ingram was in a hurry. Eight more miles to home. Just ahead, Marion County Road 329 bent into a long, unforgiving arc.
Nikia wheeled the car left, anticipating the curve. It wasn’t enough: The right side of the car glanced off a yellow traffic sign and barreled down a berm. The Hyundai splintered 160 feet of four-board farm fence, hurling jagged wooden spears that attacked the sedan. One hit the front end with enough force to impale the car’s battery. Two chunks punched through the windshield, one tearing into the empty passenger seat’s headrest. The other board punctured the glass in front of Nikia. It tore off the top of the steering wheel and kept going.
The car ground to a halt, trapping her in a tangle of metal and plastic. Stunned, Nikia looked down to see a wooden board staked through her torso, pinning her to the seat. The board was next to her heart, throbbing with each heartbeat.
Hours passed in silence, and the cold January air closed in. Around 5 a.m., Nikia saw a car’s headlights approach. The driver, on his way to work, pulled over and called 911.
The 911 Call
Before long, firefighters from a station in nearby Reddick swarmed the scene. Marion County Fire Rescue Lt. Stephen Johnson’s flashlight beam glared back at him from the car’s window. He tilted the light, startled by the demolished steering wheel. Peering harder, he saw a board buried in a young girl’s chest. Her head was slumped, her arms limp. He knocked on the door, hoping to rouse her but certain she was dead.
Slowly, she turned her head to the left and looked up at him.
She’s alive! Focus. I just need to focus on her injuries.
The firefighters worked quickly but deliberately, smashing the back window to reach Nikia with a blanket and neck brace. Then came a crisis: To free her, the board had to be cut away. But their tools — a chainsaw and a hydraulic cutting tool known as the Jaws of Life — were built for brute force, not delicate maneuvers. Johnson clutched Nikia’s left hand and spoke gently.
Everything’s gonna be OK. Stay strong for me. I’m going to get you out and not let you die tonight.
Behind them, another rescue truck rolled up. Improbably, the crew had a reciprocating saw on board. It was not standard equipment, but the firefighters thought it might prove useful someday and they pooled their money and bought one. Today was that day.
Through the gaping wound, Johnson could see into Nikia’s chest cavity. Her every breath was a battle. Johnson grabbed a huge pressure bandage. Two other firefighters swooped in, holding Nikia’s arms and waist. Johnson knew the board would move as they cut. Even the tiniest shift could be deadly. His hands braced the board front and back.
Cut. Just cut right now.
They sawed the splintered wood, leaving a 3-inch by 12-inch chunk in her chest. Finally, they eased her out of the twisted wreck onto a gurney.
By this time, a UF Health ShandsCair trauma helicopter had arrived.
ShandsCair Flight Nurse Daniela Hofacker, R.N., EMT-P, described the injury as “just crazy.’’ The team prepared Nikia for transport, but they had one major problem: the length of board still protruding from Nikia’s back was keeping her from being securely belted in for the rescue trip. Once again, the firefighters would have to use their saw to gently lop off more of the spear through Nikia’s body.
Groggy, Nikia had a hard time sorting out the commotion around her.
When they lifted the helicopter, I felt the air and stuff. Then I was out.
In the helicopter, Hofacker balanced a delicate mix of fluids and medications. They needed Nikia to relax, but not so much that it would disrupt the board. Nikia doesn’t remember it, but she recalls her saying the pain was minimal.
Within minutes, Hofacker and her team were arriving at UF Health Shands Hospital.
It was pretty stressful for us. We got her there, and Shands did the magic.
Patty and Shane Ingram were sound asleep in their Ocala home when Patty’s cell phone rang. It was her sister, who never calls at 6:30 a.m. Patty answered just as her sister hung up. It was probably a misdial, Patty thought. Ten minutes later, her sister’s fiancé called Shane.
Nikia and her cousin had snuck out again, Patty thought.
They searched the house. Shane checked the bedrooms. Nikia’s room was empty. Shane threw open another bedroom door, and their sleepy niece said she knew nothing. Patty looked for her niece’s car, not knowing yet that Nikia had taken it hours earlier to visit her boyfriend.
I remember Shane saying, ‘Do you know where Nikia is?’ And all the air left my body. Where’s my baby?
Patty called her sister, who had already been notified about the crash by authorities who traced the car’s ownership to her. She broke the news to Patty: You need to get to Shands. She’s been in an accident.
Part II: The miracle
n the emergency room, doctors organized a team to treat Nikia’s most urgent issues. Joshua Walker, M.D., and Frederick Moore, M.D., treated her for shock and worked on a plan with anesthesia experts to insert a tube in her airway. Even for Walker, an emergency room veteran, it was a troubling scene. Nikia’s only complaint was being cold. Walker glanced at a colleague, absorbing the other doctor’s worried look. Then, he pressed on.
How could such a thing happen? But at least she’s alert and talking to us.
The urgent calls went out. Thomas Beaver, M.D., the chief of thoracic and cardiovascular surgery, was awakened. Fellow surgeon Mauricio Pipkin, M.D., rushed back to the hospital he had left just three hours earlier.
Nikia lay sedated in an operating room packed with nurses, specialists and technicians. Beaver and his colleagues made a plan, getting a heart-lung bypass machine called an extracorporeal membrane oxygenation, or ECMO, on standby. Then, it was time to operate.
Beaver carefully cut around the protruding wood. The injuries were horrific. The fence rail missed Nikia’s heart but pierced the root of her right lung.
Still, the hunk of wood was also lifesaving. Somehow, it had sealed her blood vessels, preventing a fatal hemorrhage. Beaver worked quickly, stapling the blood vessels feeding Nikia’s lungs. No more than two minutes had passed since his first incision and the removal of the wood.
She didn’t bleed to death. It’s a miracle she could get through this surgery.
Pipkin then took over, noting that most of her right lung was gone and her left lung was failing. Nikia’s airway had a gaping hole. Making a terrible situation even worse, the dirty fence rail had smeared bacteria throughout her chest cavity.
The surgical team devised a bold plan. Instead of placing a drainage tube and leaving a permanent hole in Nikia’s chest, they opted for sequential cleaning. They would pack her chest with iodine-soaked sponges. Every few days, they would swap out the sponges and clean the chest cavity. Eventually, Nikia’s chest would be sterile again.
That is, if she lived.
But first, five hours of difficult surgery loomed. Pipkin took tissue from the wall of the lung’s main passageway, making a flap to close the hole in Nikia’s windpipe. Amid the catastrophic injuries was a godsend: The wood was within an inch of Nikia’s heart. At a slightly different angle or position, she wouldn’t be alive.
When we see a patient with that kind of injury, they are already dead. The fence hit the only spot that would let her live.
The injuries were so gruesome they made Beaver recall his time in Iraq as an Army reservist.
It certainly brought back memories of the trauma we saw over there.
In the waiting room, Patty and Shane paced and waited for any word about Nikia. More than 20 family members kept vigil with them. By early afternoon, there was finally some news. Nikia’s right lung was gone, along with two ribs. A lower rib was dislocated. Her windpipe had been repaired. Pipkin and a colleague were also frank: Nikia’s condition was still fragile. Pipkin recommended putting her on the ECMO device, which would infuse oxygen into Nikia’s blood and let her remaining lung rest and heal.
When Pipkin said it was the only option, Patty didn’t waver.
Then there is no decision. You do what you have to do to save her.
After the first surgery, a team of nurses embraced Nikia’s fight. Nurse Manager Stephanie Queen, R.N., deployed a team, sending nurses from the pediatrics unit into the new UF Health Heart & Vascular Hospital.
Meanwhile, Nikia’s family waited anxiously. Queen, a mother of three herself, said she knew she had to get the relatives to Nikia’s bedside.
I looked at her and thought, there’s no way this girl is going to survive this. If this is going to be her last night alive, I got to get these family members back to see her. Her mother and I really bonded. If this were my child, I had to get back there.
Nikia’s grandmother was especially upset.
I had to get grandma back there. I told her, I need you to hold her hand and touch her. It was a pivotal moment for her family. This was a big deal and we all knew it.
With the ECMO machine keeping Nikia alive, Patty could finally take a moment to breathe.
Everything was looking good. They were sewing her up, we were starting the process of getting out of here. I was thinking, a week or two, we’d be able to go home. I didn’t realize it would be six more weeks.
Part III: Nikia’s new birthday
esiree Machado, M.D., a pediatric cardiac critical care specialist, took over Nikia’s day-to-day care when she was transferred to the Pediatric Cardiac ICU. She worked through many complexities — pain management for broken ribs, ECMO management, heart dysfunction caused by the missing lung, and procedures to clean out her remaining lung.
It didn’t take long for Machado to realize that vital signs didn’t tell the whole story. After the surgery, infection was a constant threat. Every few days, surgeons cleaned Nikia’s lung cavity. They cleared mucus from her remaining lung. Doctors removed Nikia’s breathing tube, but her heart was only pumping to one lung, and it was straining.
By Friday — three days after the crash — Nikia was finally allowed some solid food. She asked for a favorite: pineapple. Eating just a few bites took all day. That Sunday, Nikia started therapy.
It felt like progress, but there were other threats lurking. Every time she sipped water or sucked on an ice chip, some of the liquid leaked into her lung— silent aspiration, the doctors explained. About a week after the crash, her lung collapsed from aspiration. The only option was a feeding tube that went directly into the intestine. That worked for six weeks until her body started rejecting it.
After a while, things seemed to be looking up. Then, four days later, Nikia couldn’t raise her right foot. Doctors found a two-inch blockage in a thigh artery. Before they could operate, a fever appeared. The worry was back for the Ingrams. A few days later, doctors harvested a small piece of vein from Nikia’s leg and repaired the blocked artery. Through it all, Queen marveled at how Nikia persisted.
Everything that could go wrong went wrong for her.
But for every setback, there was often a success. After 25 days, Nikia was strong enough to quit ECMO.
Weeks went by and Patty and Shane willed themselves through a constant bedside vigil, first at the UF Health Heart & Vascular Hospital and then in the Pediatric Cardiac ICU. Over the next 65 days, Patty would leave the hospital just twice, once while Nikia had a five-hour procedure and another time for Chinese food with Shane on Valentine’s Day.
Still, she was far from alone. Shane visited the hospital daily. The Ingrams’ ‘’church family” from Meadowbrook Church in Ocala visited for weekly prayer sessions, along with another minister from a church they had never visited. Patty noticed how Pastor Jason Varnum of Souls Harbor First Pentecostal Church in Belleview always appeared at crucial moments.
It seems as though God knew when to send him.
Relatives helped Shane care for their 4-year-old son, SJ, so Patty could stay at the hospital. Friends and family were a constant presence in the waiting area, even throwing a birthday party for SJ. Talking about those days still brings Patty to tears.
We had so much love, so much support.
Later, Queen would admit she has never seen a patient like Nikia. The teenager didn’t always talk a lot but she never complained.
She had a board through her chest and never once said, ‘I can’t do this.’ She had a will to live unlike anyone I have ever witnessed in my life.
One day, Queen walked into Nikia’s room. She hadn’t seen her in a few days and there she was, on her phone, texting and scrolling. I almost fell over, Queen recalled.
That was the day I knew she might get out of here. Everything changed that day.
Slowly, the wounds closed and Nikia’s airway healed. The left lung was now fully functional. The body adapts to having only one lung, and Nikia can live with one. Combining advanced thoracic surgery with the use of the ECMO life-support system allows UF Health to deliver positive outcomes in even the most challenging cases, Pipkin said. Because of the quality of her care, he added, Nikia’s going to have a normal life.
She’s getting stronger. She’s doing more and more every day. She’s a lucky person.
On April 5, Nikia left UF Health Shands for good.
Part IV: Healing
ome life wasn’t easy at first. Nikia was still on oxygen and alternating between a wheelchair and walker. Each day, Patty and Shane decided who would work and who would stay home. One day, Nikia told her mother she was finished with the walker.
You could just see the strength that she had within to say, ‘I’m not going to do that anymore.’
Three times a week, Nikia receives physical and occupational therapy. There’s a rotating device to strengthen her upper body and resistance bands for arm muscles. It’s tiring, but Nikia said there is progress.
Some days are a lot better than others. One day, I’ll have an attitude. And then other days, I’ll laugh and smile. I want more of those days.
As her body healed, so did the other parts of her life. She caught up on her studies after coming home, blazing through a whole quarter of schoolwork in just a month.
Some wounds are taking longer to get over. She’s still working through the emotional trauma from the crash.
I could kind of feel myself slipping away that night because I was out there for so long. In the hospital at the beginning, there were moments that I thought I wasn’t going to wake up. So every night, I think about how lucky I was. And it’s hard.
At home, memories of the crash were vivid and frequent.
Patty and Nikia talk much more often than they did before the crash. Patty pushes Nikia hard on her recovery, and shrugs off her occasional rebelliousness. Nikia been through a lot, but she’s still a teenager, Patty reminds herself.
Nikia says she has found her silver lining.
Those 65 days together really made us closer. We’re a team now.
When her shoulder and foot issues are resolved, Nikia will be back on the softball field. A new year at North Marion High School has started. She has her eye on nursing, caring for fragile newborns in an intensive care unit.
In late July, Nikia returned to the pediatrics unit for some unfinished business — thanking the nurses and staff who made her whole. The strong hugs came one after the other, affirmations of the resolve of both caregiver and patient. The team’s collective dedication also left an indelible mark on Patty.
Being born and raised in this area, you don’t realize the asset UF Health is to this community. I will be forever grateful and they will have my gratitude for saving my baby.
Just as he had every day at the hospital, Shane Ingram stood close by his daughter. He sees Nikia smile and basks in the moment, profoundly and forever grateful.
She’s come a long way. That’s because of all the prayers. There were so many people reaching out to us through all of this. And the doctors and nurses — it took all of their knowledge and dedication. They made us feel like their family.
Nikia is on the road to a normal teenage life, this time with a higher purpose.
Before the accident, I was going through some things. The accident helped me realize that I could do better — and I’m going to make it through. This is my second chance and I’m going to do it a lot better than I did the first time.
And to the surgeons and medical teams at UF Health who combined to save her life, Nikia had a simple but heartfelt message.
Thank you for not giving up on me.