BY LINDSEY BURKE | PHOTOS BY LUCIANNA MCINTOSH
Throughout his recovery, Keane had one thing on his mind: getting back in the water.
IT HAPPENED IN AN INSTANT: a sudden impact thrust his body sideways toward the surface, tearing his snorkel and mask from his face. Confused, 13-year-old Keane Webre-Hayes searched around for what hit him.
“I thought my friend was messing with me,” he says. But Keane looked over and saw his diving partner, Noah, yards away. He then looked down to find his wetsuit torn to shreds and his blood filling the water.
Trained as a junior lifeguard, Keane had been aware of his surroundings and had surveyed his dive site for the closest route to safety before going down. He knew a nearby kayak was closer than the shore, so he swam with his uninjured arm to the nearby vessel, screaming to the men inside that he’d been attacked and needed help. The kayakers were the only eyewitnesses of exactly what had attacked Keane—an 11-foot great white shark. A shark of that size can weigh between 1,000 and 1,200 pounds; it attacks its prey by smashing into them at full speed—upward of 30 miles per hour—biting at the same time.
Like Keane, the kayakers had gone out at the crack of dawn for the first day of lobster season; in fact, the water off Beacon’s Beach was filled with divers eager to catch the early crop of California spiny lobster that September morning. Diving 200 yards from Keane was off-duty Encinitas Lifeguard Captain Larry Giles.
“The conditions were great that day,” Giles says. “Very little surf, 25 feet of visibility, overcast, no wind.” The first day of lobster season is traditionally busy for his crew, with so many divers in the water, so Giles had scheduled two additional guards to come in early. A lifeguard sergeant was about a quarter-mile south of Keane when he was alerted that a bystander had called 911. “It was called in as an animal bite,” Giles says, “and 99.9 percent of the time, that means a stingray.” The sergeant made his way up the beach and several free divers waved him over—the first sign that this was something different. Keane’s mother, Ellie, rushed to the scene soon after.
First responders were poised to treat Keane but realized further help was needed. They called for a helicopter rescue while trying to stop the bleeding. His wounds were too severe for a tourniquet, so responders applied firm, consistent pressure until the helicopter arrived. “That was the part that hurt the worst,” says Keane who, despite significant blood loss, never lost consciousness.
“An attack of this nature is what we call a low-frequency, high-risk call,” Giles says. “A lifeguard team is well trained, prepared and equipped similar to an ambulance.” They did everything they could to prevent catastrophic blood loss. “It was truly a significant, unified response between multiple agencies requiring a lot of resources. Our emergency response system worked well and got him to Rady Children’s in time, where they were prepared to handle trauma of this magnitude.”
WHEN THE HELICOPTER landed on the roof of Rady Children’s Hospital-San Diego, the trauma center staff was there waiting. Experts performed a trauma evaluation, which included determining whether the shark had only bitten down on Keane or had taken a bite out of him. He had severe damage to his left upper back and flank that reached the chest wall. The bite had torn his upper back, shoulder, torso, face and ear, but miraculously had missed his jugular, heart, lungs and the nerves that control his arm by millimeters.
“In many cases, patients with injuries as serious as Keane’s would be taken directly into emergency surgery,” says Tim Fairbanks, MD, Rady Children’s chief of pediatric surgery. But Keane remained stable and was instead taken to the Hospital’s pediatric intensive care unit, where he was given a unit of blood to replace what he had lost. His stable condition allowed Rady Children’s preeminent team of surgeons time to assemble and carefully plan their surgical approach. “The expert critical care nurses in the PICU closely monitored Keane and immediately began an array of IV antibiotics to cover the high risk of infection because so little was known about the bacteria present in the shark’s mouth and the ocean water,” says Dana Patrick, RN, BSN, MHA, CENP, director of Critical Care and Emergency Transport at Rady Children’s.
Salil Upasani, MD, was Keane’s orthopedic surgeon. “When I first met Keane he was calm and stable, despite his huge wound. He was still holding his arm and applying pressure to prevent bleeding.” Upon examination, Dr. Upasani discovered that the nerves and blood vessels of Keane’s neck were intact, but his shoulder joint was exposed. His scapula was fractured, his humerus broken; so were the smaller bones surrounding the shoulder.
Though his muscles were severely torn, the shark had gotten away with only small bits of them, so chances were good they could be stitched back together once he was in surgery. Starting from the inside out, Keane’s surgical team operated for five hours, carefully reconstructing his shoulder ball joint, torn rotator cuff and slashed skin. Reconstructive plastic surgery repaired the tissue on his face and left ear, and pieced back together large flaps of skin to close him up.
“They told us it would be more than a 10-hour surgery, but Dr. Fairbanks came out after five and said that everything was going as perfectly as possible,” says Keane’s mother, Ellie. “I remember thinking they weren’t telling us the truth—that they just didn’t want to tell us bad news. But Dr. Fairbanks meant it. The news was incredible; Keane looks amazing.” “Despite the unusual circumstances, Keane’s surgery was very straightforward,” Dr. Fairbanks says. “We had assembled the best surgeons, all the tools and training we needed, and the team is constantly prepared to handle trauma of this magnitude. The Hospital and its donors have prepared the trauma center with everything we need; we were ready before Keane even arrived. This level of preparation made it so everything went precisely as it should. I am so proud of everyone on the trauma team. When someone in this community needs us, we are here for them.”
Keane spent four days recovering from surgery in Rady Children’s PICU, where critical care staff monitored him closely to ensure his fluid levels were appropriate and that his heart and lungs were functioning. As soon as he was able, he began physical therapy.
“Keane is left-hand dominant and immediately wanted to get back out there,” Dr. Upasani says. “He’s a pitcher, a surfer. He was ready to return to the activities he loves.” The first step was to let the fractures heal, and then the muscles. “When muscle is torn and surgically repaired, scar tissue can form. Keane has quite a bit of scar tissue, so focusing on regaining strength in the muscle and properly rehabilitating is likely to take time, but is certainly possible.”
As of this writing, six months after the attack, Keane has regained much of his lost strength. He can paddle and throw a ball, and continues to feel stronger every day. He attends frequent outpatient physical therapy and occupational therapy sessions to rebuild muscle and reduce scar tissue. Regular gym workouts helping him gain strength, as is frequent lap swimming. Keane estimates that his arm has regained 95 percent of its mobility and his muscle is at 70 percent of its original strength.
Residual nerve damage in his cheek made the left side of his mouth partially immobile. “He has kind of a half-smile now,” Ellie says. For her, it’s a frequent reminder of that traumatic day at the beach.
AFTER REGAINING MUCH of his strength, Keane’s first order of business was getting back into the ocean. “I would prefer to move to the desert,” Ellie jokes. But as part of his recovery, trauma specialists at Rady Children’s are helping Keane and his family navigate his desire to return to the ocean, in spite of their fear that another attack is possible. They also are helping Keane and Ellie decide how and when they want to talk about the attack.
“People get bit by dogs all the time,” Keane says. “I just happened to get bit by a shark.” Keane’s gift is in minimizing the trauma, but it’s all Ellie could think about. The incident continues to occupy her mind.
“He didn’t want any gifts for Christmas,” Ellie says. “All he wanted was to get back into the water.” With the help of a trauma counselor, she slowly warmed to the idea. On Christmas Day, Keane took a short swim with the first lifeguard who’d been on the scene the day he was attacked. “I’ve never seen him more overjoyed and liberated than he was in that moment. He’s so brave,” she adds.
Keane’s return to lobster diving evoked an even greater emotional response in Ellie. Accompanied by her counselor, she watched from the beach as Keane took his first dive after the attack—and this time, he surfaced with a lobster. “As much as I never want him in the water again, trauma counseling has helped me understand that if I don’t let him choose his own path, I am altering the trajectory of his life. It’s not easy, but ultimately all I want is for Keane to be happy.”
Healing Beyond the Body
After the physical injuries have healed, deep emotional wounds may still be left behind. That’s why when a child experiences trauma, experts at Rady Children’s are on hand to help stabilize the patient and assist in their continuing treatment.
“We treat the emotional and psychological effects of trauma,” says Chris Walsh, LMFT, director of Clinical Operations for the Chadwick Center for Children and Families. Medical social workers first meet with patients and families while they’re in the Hospital to stabilize any immediate crises they may be in. After this assessment, families may be referred to additional resources in the community, which may include the Chadwick Center. “Our team works with each family to decide exactly what they need or want, and then we provide the appropriate level of education on trauma, support and intervention,” Walsh says.
The staff of the Trauma Counseling Program is primarily composed of licensed clinical social workers, marriage and family therapists, and psychologists with expertise in treating childhood traumatic events. Treatment for chronic pain also is available.
TRAUMA ASSESSMENT PATHWAY
All the families who come to treatment go through a comprehensive assessment using TAP, a model developed by staff at the Chadwick Center. Every family’s unique situation is assessed through clinical interviews, behavioral observation and standardized measures. The TAP model considers culture, strengths, developmental history, family history, trauma history and a wide range of symptoms and behaviors. Using this information, the therapist is able to create a unique client picture that will guide them in selecting the best type of treatment.
EVIDENCE-BASED PRACTICES
Rady Children’s therapists use evidence-based practices — types of treatment that have been proven successful through research reviewed by their peers in the mental health field. Trauma Counseling Program staff are trained and experienced in using evidence-based practices, including trauma-focused cognitive behavioral therapy, child-parent psychotherapy, parent-child interaction therapy and cognitive processing therapy.
Learn more about Rady Children’s comprehensive Trauma Counseling Program.
Published in the 2019 Summer issue of Healthy Kids Magazine