Editor's note: This story contains graphic details that may be disturbing to some readers.
Sunnybrook's trauma department has a world-class reputation. Some of the most critically ill and injured patients from across Ontario – and beyond – find themselves in Sunnybrook's care.
Here, two trauma patients share their stories of determination and survival – and how the team at Sunnybrook helped them stay alive.
Nicole's story: Nicole Moore is a warrior.
This past July, she was among a few hundred Ontarians competing in the Warrior Dash, a 5.5-kilometre obstacle course that includes leaping through fire, darting through metal wreckage and wading through waist-deep mud.
It's hard to believe that little more than a year ago, Nicole was an inpatient at Sunnybrook recovering from a horrific and highly publicized shark attack in Cancun, Mexico.
January 31, 2011: A vacation with friends in Mexico was no excuse for Nicole, an active nurse, to sit back and relax. So, covered in sand after a game of beach volleyball, she headed into the ocean to rinse off. As the Orangeville mother waded into water about waist high, two men on Sea-Doo watercraft shouted at her in Spanish. She wasn't sure what they were saying but decided to get out of the water nonetheless.
"Then I felt a bump," she calmly recounts. "Within seconds of that bump came the first bite."
A shark bit through Nicole's upper left thigh.
It just took the flesh right off, right down to the bone. I am missing two of my quadriceps and two of my hamstrings on the back of my leg."
Nicole knew right away what was happening. "There was just an ocean of red surrounding me."
Despite the massive injury to her leg, she tried to walk to shore. That's when the shark – or perhaps a second shark; it remains unclear – attacked her left arm.
It had my whole arm inside its mouth," Nicole says. "It was hanging off of my arm. I'm looking at this shark and it's trying to pull me down. We are struggling," she says, recalling the moment of the attack.
Nicole smacked the shark square in the nose, a decision based on something she'd heard in her diving training. "It's a very sensitive spot for them." She was able to pull her arm free.
"But I can't walk much further; I don't have a leg to walk on," Nicole recalls of the post-attack moments. "Finally, the men on the Sea-Doos were able to lock fingers with me and gun me to shore."
As she lay battered and bloodied on the beach, Nicole's training as a nurse kicked in. "Given the horrific scene people were looking at, they were just standing around but no one was doing anything," she says. "I looked at my wounds, realized how severe they were and asked for help.
"A man used his bare hands to apply pressure on my leg wound while others around were also scrambling to help. After my leg had pressure on it and someone tied a string around it, I turned my attention to the bite on my arm and knew I was bleeding badly from that wound, as well. I told the young woman who was sitting next to me that I need a tourniquet for my arm. A man pulled the string off his shorts and the woman used it to tie off my arm."
Nicole remained conscious during the whole ordeal. "I can remember all of it. I was completely lucid and awake and alert and not in a panic,"
Nicole was rushed to a Cancun hospital, where surgeons operated on her arm and leg. She remained in intensive care there for nearly a week until she was flown to Sunnybrook.
Back on home soil BUT far from home: Days later at Sunnybrook, the plastic surgery team was horrified by what they found when they pulled back Nicole's bandages. Her wounds were contaminated and rotting. She underwent two emergency surgeries – totalling more than 15 hours – that she says saved her life.
Unfortunately, Nicole and her care team encountered many complications. Her body rejected the skin flap attached to cover the shark bite on her arm. Doctors were unable to save the arm and amputated it above the elbow.
"To get rid of the arm, I felt relieved because it was so painful. There were very few days of tears. I'm very, very grateful to be alive and be there for my kids. Every day was more of a gift."
Nicole stayed at Sunnybrook for nearly two months. It was far for family to visit, but the care was worth it, she says. "Sunnybrook did a fantastic job," she says. "I really feel like I owe them not only my life, but my well-being as well. They contributed immensely to me being at ease."
In spring, 2011, Nicole returned home to her husband Jay and two young daughters to continue her recovery.
Long road to recovery: Nicole's first year of recovery began very well. Her family was adjusting and her condition improved.
"I was able to return to aerobics, get on the stationary bike, go swimming," she says. "I was able to kayak with a pedal kayak and that was fantastic." But in February, 2012, Nicole had another surgery at Sunnybrook and remained in hospital for four weeks.
"They reconstructed my leg again with another skin flap. For the first year of recovery, I had part of my femur exposed because nothing would take due to the wound being down to the bone," she says. "Also, some problems with my stump were prohibiting me from wearing my prosthetic. Unfortunately, the recovery this time has been much more challenging. But, we'll get there."
The prosthetics process is a long and expensive one. "After the surgery, I am able to wear my prosthetic in short bursts, which I love," she says. "It's so fantastic to have that tool. My community has been supportive in helping raise money for this."
Looking ahead: Nicole can't wait to get back to work. She's hopeful that accommodations can be made to allow her to continue as a nurse. "Nursing is so much a part of who I am," she says. "I'm hoping to be back at work this fall."
And she's got some pretty ambitious physical goals for someone still in the midst of recovery: a bike ride with her two girls and downhill skiing this winter. She's working with her physiotherapists and prosthetics team at Sunnybrook to help move forward.
"I'm still working on it. I'm very determined," she says. "And hopefully I'll do a triathlon by 2014. There's no stopping me."
Lenore's story: July 11, 2009: It was Saturday afternoon, just 10 minutes until closing time on Lenore Wirtz's fifth day of work at a women's apparel store in Orangeville. A man came in and began browsing. He'd been in earlier in the day checking out skirts for his girlfriend and returned to purchase one for her, he said.
Suddenly, he lunged at Lenore, grabbed her and forced her into the back stock room.
"I encouraged him to rob the store and take the money instead of hurting me. I told him I wouldn't call the police," she recalls.
He told Lenore to give him all the money in the store and then returned to the stock room. Wrapping a long piece of twine around Lenore's neck, he strangled her until she was unconscious. When she came to, the attacker was straddled on top of her. He pulled a knife from his back pocket. "I guess he decided he'd have to kill me so I couldn't identify him. I got more than 31 stab wounds," the 46-year-old says. "I was conscious."
Lenore tried to fight back. In the struggle, her attacker stabbed his own arm with the knife. When he went to the washroom to tend to his wound, Lenore tried to get away. "I was able to stand up. I was very weak and there was blood everywhere," Lenore says. "I just kept saying to myself, 'I've got to get out. I've got to get out.'" The man realized Lenore was up and trying to get away. He threw her to the ground. She pleaded for her life.
Lenore realized she wouldn't get out of there alive unless she played dead. She slowed down her breathing and watched through her eyelashes as he went through the store, stealing clothing, her purse and her phone. When he was done, he returned to check her near-lifeless body and kicked her to see if she was dead. She lay still. He fled out the back door and left in Lenore's car.
She couldn't see. She could barely move. But she dragged herself to the front of the store, rose to unlock the door and emerged onto the street. There, a passerby found her and called 911.
Airlifted to Sunnybrook: Lenore remained conscious as emergency personnel tended to her on the street. "When I was in the ambulance, I heard them say they were calling the air ambulance to take me to Sunnybrook. When I heard that, I knew it must be really bad. Sleepy little Orangeville doesn't see this stuff. Sunnybrook knows trauma."
The most significant injury was to her left wrist. The attacker had cut it down to the bone. She also had two punctured lungs and a punctured liver. "Eventually the pain was too great and I was screaming in my head but nothing was coming out," Lenore says. "The next day I woke up in critical care."
She underwent two surgeries that first night. Surgeons repaired the wounds to her abdomen and conducted a seven-hour-long surgery to reattach her wrist. While she has limited motor skills and extreme sensitivity in her hand, doctors were able to reconnect all of the nerves and tendons.
"It was a tough time," she says. "But I was so happy to be alive. I don't want to make it sound like it was all happy smiles. It was emotionally difficult to try to understand what the heck had happened. It was a brutal attack and completely random. It wasn't against me, Lenore, as a person."
Each day brought improvements. Lenore remained in hospital for 13 days before returning home to her husband and three daughters. "My three daughters were all going back to school in six weeks," Lenore says. "My middle daughter was heading off to university for her first year. We were trying hard to find a new normal and give her the security and confidence to go and live away from home."
The man who attacked Lenore was convicted of attempted murder and is serving 13 years.
Three years later: Lenore has had two additional surgeries at Sunnybrook in the years since the attack. She underwent two years of hand therapy.
"It was incredible coming back as an outpatient," she says. "It was a long way but I was prepared to do it. I'm so grateful I was able to get that kind of care."
The Wirtz family has now settled into their new normal, Lenore says. "We are all hypersensitive to our safety," she says. "Unfortunately, that's been shattered for my daughters." Each year, they celebrate Mother's Day with high tea at Niagara-on-the-Lake.
Lenore has never returned to the store where the attack took place and memories of the incident and her recovery flood back whenever she sees an air ambulance. "I am so grateful I was taken to Sunnybrook to receive the care we received, me and my family. You can't believe the support we received."