A brain injury sent a Houston

The infant's heart rate plummeted, just as the pediatric neurosurgeon prepared to make an incision in the child's head at Children's Memorial Hermann Hospital.

An injury at a home daycare on Oct. 27 caused blood to pool around 4-month-old Walker Hicks’ brain, and the neurosurgeon, Dr. Stephen Fletcher, needed to cut a piece of his skull to alleviate the swelling.

But Walker went into cardiac arrest on the operating table.

Fletcher immediately started CPR, pressing the palm of his hand against the boy's tiny chest until the anesthesiologists in the room took over in shifts. For 43 minutes, chest compressions kept Walker's blood circulating long enough for Fletcher to remove a fist-sized portion of the skull.

Inside a pulseless, dusky brain worried doctors.

"I thought he was brain dead by the time we finished," Fletcher said.

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Walker needed extensive life support after the surgery. Doctors explained to his shaken parents, Lindsey and Cole Hicks, that he would likely not make it through the night.

As the young couple said goodbye to their only child, Walker started breathing over his ventilator. The improvement gave some hope, but Walker had lost significant motor function. It was unclear if he’d ever move again.

"We need to fight," Lindsey thought to herself. "He has a chance."

Eventually, Walker would become the youngest patient at TIRR Memorial Hermann, the hospital's premier rehabilitation center that just began treating children in December 2020.

Lindsey Hicks, left, watches as her 9-month-old son, Walker Hicks, is carried by anesthesiologist Amy Graham-Carlson to surgery at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

Sandra Resendec, RN, left, and Amy Graham-Carlson, anesthesiologist, right, take 9-month-old Walker Hicks into surgery at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

But his parents wondered, how much of their giggly baby would come back?

Lindsey, a 27-year-old elementary school teacher, received the call from Walker's caregiver around 4 p.m. Oct. 27, just as she was leaving school to pick him up.

There was an accident, the caregiver said. Walker fell out of his car seat inside the home, while the caregiver was preparing him to leave with Lindsey. After Lindsey and Cole arrived, paramedics explained that he was showing signs of a brain bleed. He was not reacting to light, and his pupils were different sizes. Memorial Hermann's Life Flight team would need to retrieve him.

Lindsey and Cole slowly absorbed the gravity of the situation.

"I was kind of in shock," Lindsey said. "I felt helpless."

The parents later said they hold no ill will toward the caregiver and maintain the injury was an accident. They did not want to go into detail about the circumstances around the fall.

"We’re choosing to not dwell on it and to not focus on the nature of it all," Lindsey said. "Because we can't go back and change it."

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The Fort Bend County Sheriff's Office opened an investigation into the case but so far has not filed any charges. The Texas Health and Human Services Commission said it has since cited the caregiver for caring for multiple children in a residential home without the appropriate permit. Through a follow-up inspection in late November, the agency verified that no children were being cared for at the time.

When Walker first arrived at Children's Memorial Hermann, Lindsey and Cole were not allowed to touch him until pediatric investigators ruled out child abuse - a necessary step when any infant is admitted to the hospital with a severe injury. The investigation confirmed they were not involved, but Lindsey and Cole struggled to fight the urge to kiss and hold Walker while a team of medical workers stabilized him.

Based on CT scans, Walker did not have much time.

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Walker Hicks, 9-months-old, is comforted as he lays on an operating table as he is prepared for surgery at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

Lindsey Hicks, left, and her husband, Cole Hicks, talk with Phuong Nguyen, pediatric plastic surgeon, right, about their 9-month-old son, Walker Hicks, after an operation at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

Phuong Nguyen, pediatric plastic surgeon, left, Cassie Hardline, plastic surgery fellow, Stephen Fletcher, pediatric neurosurgeon, and Shivani Bindal, neurosurgery resident, right, are shown during operation on 9-month-old Walker Hicks at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

Cassie Hardline, plastic surgery fellow, left, Phuong Nguyen, pediatric plastic surgeon, and Stephen Fletcher, pediatric neurosurgeon, right, are shown during operation on 9-month-old Walker Hicks at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

A subdural hematoma, or bleeding between the brain and the skull, was pushing his brain to one side. By the end of the emergency surgery, Walker had already sustained two separate brain injuries — one from the initial fall and the other when his heart stopped during the operation.

He continued to fight for oxygen in the pediatric ICU, even with a mechanical ventilator at maximum support. Damage to his liver and kidney, and extensive bleeding, worsened his already grim outlook.

Lindsey and Cole prayed in the waiting room with Cole's father. Dr. Peter Scully, a pediatric critical care specialist, gently explained the situation then delivered a jolt of honesty.

"He is so sick that we expect him to die no matter what we do," he told the couple.

The family cried together. When they went into Walker's room that night, he did not look like their child. Bandages concealed his blonde head. A mask covered his eyes. Tubes and wires spilled out in every direction.

Lindsey and Cole Hicks with their son, Walker Hicks, a few days after his accident.

The parents and the medical staff agreed that if Walker suffered another cardiac arrest, they would not resuscitate him. As they waited for the nightmare to unfold, Walker's right hand flickered with life. He started breathing, weakly, over the ventilator.

"You see it and you think, ‘Is this actually happening?,’ " said Scully.

The effects of traumatic brain injuries are difficult to predict, especially for children, said Dr. Aaron Mohanty, pediatric neurosurgeon at University of Texas Medical Branch. In general, babies who suffer such injuries have a better chance of recovery than adults, because they are still in the early developmental stages.

But the degree to which they regain their motor skills varies widely.

"One thing we are taught as a pediatric neurosurgeon is never give up," Mohanty said. "Ultimately, it may not work out, but you’ll be surprised most of the time what functions you get back."

Days after Walker's surgery, doctors explained to Lindsey and Cole that he could still be paralyzed and rely on a feeding tube for the rest of his life. The parents slept in the ICU night after night, praying for any small sign of progress.

On Halloween, dressed in a fluffy Monkey costume, Walker wiggled his right foot for the first time. On Nov. 2, he opened his eyes. Ten days later, he lifted a toy, then his head, then all his limbs.

Finally, in December, he met the admission criteria for TIRR, which requires patients to be 6 months old and to tolerate at least three hours of rehab per day. There, he was diagnosed with cerebral palsy, a group of disorders that affect movement, balance and posture.

His progress stunned the medical staff there.

"Literally, this kid gives me chills," said Dr. Stacey Hall, a UTHealth physical medicine and rehab specialist at TIRR. "I do feel he's a little a miracle."

Lindsey quit her job to stay with Walker at TIRR, where physical therapists ran him through a kind of baby boot camp. Using toys to encourage him, the staff had Walker hold up his still caved-in head while laying on his stomach. He would sit up, forming a circle with his legs, and push himself off the floor with his weaker left arm.

Walker Hicks before his skull replacement surgery.

Walker Hicks before his skull replacement surgery.

Walker improved enough to return home on Christmas Eve and continue outpatient rehabilitation. As he hit small physical milestones over the next two months, another major step toward normalcy laid ahead: The surgery to reattach the missing piece of his skull - an operation that comes with a unique set of complications — was scheduled for March 25.

The surgeons had one major concern before Walker's operation.

Infants’ skulls grow exponentially, so the piece that the neurosurgeon had removed five months earlier might not fit in Walker's now 9-month-old head.

Dr. Phuong Nguyen, a UTHealth pediatric plastic surgeon at Children's Memorial Hermann, considered the possible strategies as he walked into the operating room.

Phuong Nguyen, pediatric plastic surgeon, left, takes a photo of 9-month-old, Walker Hicks, to show the parents after an operation at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

Cassie Hardline, plastic surgery fellow, left, Phuong Nguyen, pediatric plastic surgeon, Stephen Fletcher, pediatric neurosurgeon, right, are shown during an operation on 9-month-old Walker Hicks at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

Cassie Hardline, plastic surgery fellow, left, Phuong Nguyen, pediatric plastic surgeon, Stephen Fletcher, pediatric neurosurgeon, and Shivani Bindal, neurosurgery resident, right, are shown during an operation on 9-month-old Walker Hicks at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

He and Fletcher, who work in tandem during the operation, could cut the piece of bone into multiple smaller chunks, leaving gaps that would fuse together over time. The second option would be to cut the bone into two pieces, as if pulling apart the slices of bread on a sandwich, and spread them over the missing portion of Walker's skull. The third option: scrape the surrounding bone and use what Nguyen described as "bone dust" to fill the spaces.

Inside the cheerful pediatric OR, where paintings of fish covered the walls, the attending anesthesiologist brushed Walker's nose with her finger and gushed over his rosy cheeks. After the 21-pound infant fell into a numbed sleep, a nurse brought out the pink portion of skull, as thin as a credit card, from the freezer where it was stored at -175 degrees.

A piece of skull from Walker Hicks, 9-months-old, is shown during an operation at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced the piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021 while he was 4-months-old.

Phuong Nguyen, pediatric plastic surgeon, left, Cassie Hardline, plastic surgery fellow, Stephen Fletcher, pediatric neurosurgeon, and Shivani Bindal, neurosurgery resident, right, are shown during operation on 9-month-old Walker Hicks at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

"That's a lot bigger than I was told it was going to be," said Nguyen, sitting on a stool next to Fletcher, hovering over Walker's partly shaved head.

Nguyen made the incision around the edges of the crater on Walker's head and folded back the flap of skin and tissue, revealing the pulsating, reddened membrane that protects the brain and spinal chord.

Fletcher gently placed the missing piece over the gap like a puzzle.

"This thing fits pretty nice," the neurosurgeon said with his southern drawl.

It took two hours for Nguyen and Fletcher, along with a neurosurgical resident and plastic surgery fellow, to reattach the skull by drilling specialized screws into plates that hold the bone together. Only small cuts were necessary to fit the skull into place.

Walker returned home within two days, his messy hair covering his now repaired head.

Walker Hicks before and after his skull replacement surgery.

While much remains unknown about his trajectory, he is catching up in his development every day.

Hall, the rehab specialist, is confident he is going to walk. He is laughing, cooing and babbling with an occasional "dada." He can now sit up on his own, stand with support and eat solid foods. He can also give kisses — a recent development.

Walker still favors his right side, and he's not yet crawling. But the family remains hopeful.

Cole Hicks, left, and his wife, Lindsey Hicks, talk with anesthesiologist Amy Graham-Carlson, right, about their 9-month-old son, Walker Hicks, after his operation at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

Lindsey Hicks, left, watches as her husband, Cole Hicks, and Phuong Nguyen, pediatric plastic surgeon, right, hug after he spoke to them about their 9-month-old son, Walker Hicks, after an operation at Children's Memorial Hermann Hospital Friday, March 25, 2022, in Houston. The operation replaced a piece of his skull that was removed to alleviate the swelling in his brain during an emergency surgery in October 2021.

"We're just being thankful for each of the little victories we have," Lindsey said. "But I mean, Cole has hopes and dreams of being able to play baseball with Walker. And I want Walker to be able to have independence, to be able to have nothing else in his life affected by what happened."

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