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Rochester, MN - Scott Zanoni asks, "Do you know what an axon is?"
He holds his arm up in front of him, splaying his fingers wide to equate the limb with part of the nervous system.
The axon, or body of a nerve cell that routes nerve signals, is like his arm. His fingers, he says, are the nerve connections.
When Scott's car veered into the oncoming lane and struck two others Dec. 11, his brain surged back and forth inside his head, shearing some of his axons and leaving him in a semi-conscious fog for three weeks.
"I woke up and I thought I was dreaming," Scott said. Later he awoke and thought, "What are all these tubes doing on me?"
His ability to explain the complex neurological concept is evidence that Scott Zanoni has made a strong recovery.
"I guess my brain is wiring itself around these places," said Scott, 18.
Brain injuries make learning new information extremely difficult.
But Scott, who graduated from Lourdes High School last week and is headed off to college at the University of Wisconsin-Madison, has come a long way.
He hasn't done it alone. Scott and his family are grateful for the friends, neighbors, Lourdes High School faculty and medical staff at Mayo Clinic's Saint Marys Hospital who have helped him navigate this difficult path.
The accident
The morning of Dec. 11, ice formed on roads throughout southeastern Minnesota, as humid air hit the frozen ground. Scott and his 17-year-old sister, Caitlin, and their 15-year-old neighbor Dan Martin got into the Zanonis' car and headed from their homes on Rochester's west side to Lourdes High School, going eastbound on U.S. 14.
The car skidded into oncoming traffic, was struck by a car, spun around and struck another vehicle.
Caitlin Zanoni, in the passenger seat, and Martin, in the back seat, were shaken up.
But Scott took the brunt of the collision.
"His whole side was crushed in, and they were trying to saw the side of the car off to get him out," Caitlin said, who went into shock.
Because the accident took place on one of Rochester's major commuter routes, the damaged Zanoni family car was an ominous warning to other drivers.
Scott's father, Michael Zanoni, was told by a coworker who had driven by that his car had been in an accident.
"I drove to the accident scene and saw our car, and that's when I started getting pretty nervous -- because it looked pretty bad," Michael Zanoni said.
By that time, all three passengers had been taken to Saint Marys Hospital.
Scott's mother, Mardelle Zanoni, also saw the family car along the road, as well as the Mayo One helicopter.
She headed right for the hospital, where she met Michael, who had already witnessed medical staff trying to calm Scott.
"He was thrashing around pretty good, which I guess is normal for a head injury," Michael said. The medical staff sedated him.
When Mardelle first saw Scott, he was being wheeled unconscious on a gurney toward the intensive care unit, the start of a long and uncertain recovery.
"They said it could be two days when he comes out of it. It could be two weeks. It could be two months," she said.
Caitlin was soon released with a leg brace, and Martin was also released.
But Scott had a long road ahead.
Difficult first weeks
For weeks, Scott slipped in and out of deep sleep with no sign of change.
For a long time he continued to believe he was in the midst of a late-night dream.
"I didn't figure out it wasn't a dream ... I think it was like a couple weeks or like a week later like the fog started to lift," he said.
"And you could almost see it in his eyes," said his mother.
It would be 20 days before he would regain a true sense of consciousness.
In contrast to Scott's worrisome quiet, purposeful action on his behalf filled the hospital waiting rooms, the halls of Lourdes High School and elsewhere.
To support the Zanoni family and Scott, people just started showing up at the hospital -- friends, co-workers, Lourdes staff members.
"Every day when school would get out, the kids would start arriving. So at 2:30 every day, there would be 20 or 30 kids standing there," Michael Zanoni said.
"It's a testament to the kids, I think, and the friends they've made at school. I don't know what we did over the years to deserve all these friends."
When Caitlin returned to Lourdes two days after the accident, the chapel was full.
"People were praying for us all day. It was just so much to hear when you got back," Caitlin said.
Well-wishers set up a "food schedule" for the family, so they didn't have to worry about cooking while Scott worked on recovery.
"The girls took real good care of themselves. We didn't see much of them during the time he was in the hospital," Michael Zanoni said.
Even Scott's sister Hayley, 13, took it upon herself to get Scott's glasses and make sure he wore them so when he did awake, he'd see clearly.
"I remember thinking that you would shut your eyes again if you didn't see everything clearly," Hayley said.
Michael and Mardelle took time away from their jobs to take turns staying at Scott's bedside, so one of them would always be there for him.
"Every night, one of us stayed at the hospital until Scott was released," Mardelle said. With a brain injury, she was told, "you just never know."
"My employer (IBM) said, 'I don't expect to see you the rest of the year. Take whatever time you need,'" Michael Zanoni said.
Mardelle Zanoni works for Rochester Public Schools and needed to immediately suspend her work.
"I just remember my principal saying, 'Don't worry about anything about your job," she said.
Turning the corner
Christmastime spent in a hospital can be a glum. But it turned into a hopeful time for the Zanonis.
"Dec. 26th and 27th he started responding very dramatically, we thought, to verbal commands," Michael Zanoni said. Scott would give the victory sign, or a thumbs up, or would wiggle his toes when asked.
"He wasn't doing any of that for days and days and days," said Scott's father.
Then the milestones kept coming. Scott had his first real food when he was moved to rehabilitation on Dec. 28, nearly three weeks after the crash.
On New Year's Eve, Scott first became truly aware of his surroundings -- he doesn't remember much of the previous three weeks.
"I said what day is it? And they said it's New Year's Eve, and I remember thinking, 'Oh, it's going to be a crappy New Year's for me,'" he said.
When Scott began physical therapy, therapists saw pain in his expression when he did some exercises. It turned out the radius, his right arm bone, was broken. In addition, Scott experienced a slight lung collapse, and a small piece of his spine was chipped.
With brain injuries, Mardelle said, doctors concentrate on the most-important body system first.
There were good days and bad days, but "almost the first two months, there was an improvement every day," Michael Zanoni said.
"I think some of it was how hard he worked in rehab, and he did everything they told him to do," he said.
During walks, Scott would suddenly tire. "Back to the room," he would say.
"He was pointing and gesturing a lot during that first week in rehab, and we forced him to use his speech," Michael Zanoni said.
Sleep was a problem for Scott -- he'd go to bed at 9:30 p.m. and awaken at 3 a.m. He was very restless, so his parents would take him on walks at 3 a.m.
In rehab, doctors limited the number of visitors to Scott, as people with brain injuries can be easily distracted.
"I think one of the nicest things anyone said when we were in the hospital was we know we can't go in to see Scott. So we're just going to keep you company," Mardelle Zanoni said.
The family learned that unpredictability follows brain injury. Will recovery be quick and nearly total, or will the person continue therapy for years but never make progress toward independent living? The Zanonis were told it could be a year before the full extent of Scott's brain injury -- and recovery -- are known.
Returning home
Scott was released from the hospital Jan. 19.
Back at home, he wanted to be treated normally -- he still had work to do.
For instance, family members needed to monitor Scott whenever he climbed the stairs, which frustrated him. Sister Hayley, 13, would wait until he started heading up the stairs, and then walk behind him, trying to protect him without him knowing.
"He had to get that muscle function back," Mardelle said. "He hated that. Loss of independence as an 18-year-old is pretty hard to take."
The family wanted to help him get better, but it was irritating for Scott because the brain injury allowed him to believe he didn't need protection.
"And then we had to explain to him. And then the doctors would have to explain to him," Mardelle said.
At first during his hospital stay, Scott had to eat thickened liquids because of a tracheotomy. Now that he was home, he'd want to eat the home-cooked food quickly. At first, his family had to coach him to eat slower so he wouldn't choke.
He also needed help staying focused, because the brain injury made things a person can usually ignore, like a television, distracting.
But he continued progress. He returned to class at Lourdes Jan. 23, taking one class at first and adding others.
The only visible effect of the crash was a brace on his right hand.
"He started back at school right with the other kids," Mardelle said. "He just flew. We were very amazed -- and we were very happy."
What's up next
Scott has regained an amazing amount of ground, although only time will tell how extensive his recovery is. This summer, he's taking a calculus course at Rochester Community and Technical College to refresh his skills.
His sleep has improved and he is now able to eat regular foods, climb stairs and do most things any other 18-year-old can do. There's very little therapy, unless a problem with function comes up.
Significantly, for Scott, the brain injury means he must avoid further injury. When his music group went to an amusement park over spring break, he had to skip rides to avoid brain trauma.
He also had to quit baseball, which he had played since third grade, and skiing.
"I was kind of bummed," Scott said, although he volunteered to keep score.
Like any other recent high school graduate, he's anxious to get to college and move out on his own. Although he was told he could wait until spring 2008 to start attending college, he decided to start in the fall.
"I don't want to be different," Scott said.
But Scott also wants to help others who have experienced a brain injury.
"If they want to talk about it, or if they need someone to talk to, I would be happy if they would find some way to communicate with me. Because I'd rather somebody who's going through the same type of thing not have to go through it alone," he said.
The family remains hopeful that Scott will also continue moving away from the accident, and moving toward a normal college life of ups and downs.
"We've gotten so much support. It's been amazing," Scott said. "It would have been a lot harder to get through if I didn't have the support."
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