After he suffered a traumatic brain injury in May 2024, doctors said Jacob Smith had a 100 percent chance of an unfavorable outcome. Two years later, Smith is walking, talking and still pursuing his passion, a pursuit connected to the accident that changed his life.
On the day of the accident, Smith was working on one of the many cars he and his cousins collect after work. He was under the vehicle when the supports holding it up broke. Smith’s head was crushed. His cousin, Alex, quickly wrapped it in a hoodie to stop the bleeding before calling 911.
“Alex just wrapped Jacob up in a hoodie and tourniquet and held him in his lap to keep the pressure so that he didn’t bleed out,” said Jacob’s mother, Michelle Patton. “If it wasn’t for Alex’s lifesaving actions for the nine minutes before EMTs got to him, he may not have survived.”
According to Kristen Riley, M.D., Smith’s neurosurgeon and professor in the University of Alabama at Birmingham Marnix E. Heersink School of Medicine Department of Neurosurgery, almost all of his brain was affected.
“Jacob had a large blood clot in the posterior right frontal lobe, the area that controls motor function for the left side of the body,” Riley said. “He also suffered severe trauma to both frontal lobes, deep structures of the brain and left occipital lobe.”
Smith arrived at UAB hospital’s emergency department with severe brain injuries and facial fractures after losing four units of blood at the scene. Jonathan Black, M.D., an associate professor in the Department of Surgery, was working in the trauma bay when he arrived.
“We had to intubate him because he wasn’t breathing on his own,” Black said. “Neurosurgery came and evaluated him and initially told us that he was not going to survive his injuries.”
Soon after arriving, Smith was taken into surgery to reduce pressure on the brain and remove the large blood clot. Doctors estimated a 90 percent mortality rate and a 100 percent chance of a poor or vegetative outcome.
“I did not initially think surgery would be ethical; but after arrival, he began to show some neurologic improvement and move to stimuli, but was still comatose,” Riley said. “At this time, surgery felt reasonable; but we still predicted a poor neurologic outcome.”
Patton received a call from Riley shortly after surgery with news it was successful. For many days post-surgery, Smith was not expected to survive. On Day 9, that changed. Smith began to respond to commands while in a coma, but only to familiar voices from his family.
“He would not do commands for the doctors,” Patton said. “He would only do commands for my sister, my nephew and myself, so I started videotaping it to show the doctors how he would respond.”
Two years after a severe traumatic brain injury caused by a car falling on his head, Jacob Smith is continuing his recovery and making steady progress in rehabilitation with support from his family and the UAB medical team.On that day, after the doctor and nurses were informed, Smith was deemed survivable. He stayed in the intensive care unit for another week before moving to Spain Rehabilitation Center. After two and a half weeks there, Smith woke up.
His eyes were open, but he does not remember anything and was not fully aware until six weeks after the accident. While at Spain Rehabilitation, Smith spent five to six hours every day doing physical, speech, occupational and recreational therapy.
“He built a special bond with his therapists. Jacob was my sensitive, introverted child that didn’t like conflict,” Patton said. “However, when it came to his health and this injury, there was no tapping out.”
Two weeks after beginning therapy, Smith said his first word. He became a patient of Robert Brunner, M.D., medical director of Spain Rehabilitation and Distinguished Professor in the Department of Physical Medicine and Rehabilitation. Brunner noted that one of the biggest impacts that made Smith’s recovery so unique was his motivation to succeed.
“He has always been able to take on challenges in his recovery and find new ways of doing therapy,” Brunner said. “His family’s support and his personal drive to stay consistent and sustain his rehabilitation are what have gotten him to where he is.”
Smith’s motivation stemmed from a desire to continue pursuing his passions in life, including working on cars.
“My passion for fixing up my cars is one of the things that powered me through,” Smith said. “My motto throughout recovery has been that I’m ‘all gas, no brakes’ until I get better.”
Smith began therapy in a wheelchair, unable to speak but able to write. Writing served as his main form of communication early in his recovery, before he regained the ability to speak two weeks into his stay at Spain. After six weeks, he was released on July 9 and continues to return for regular therapy sessions.
“When we first got home, Jacob was completely dependent,” Patton said. “Now, he is walking without a cane. We do carry the cane for certain areas, but he’s walking three times as fast without the cane than he is with it.”
Smith’s left side was paralyzed due to a stroke that occurred in his brain during the accident. His recovery has progressed quickly, a result that may not have been possible without his motivation and young age of 26.
“We were able to get him the surgery with Dr. Riley and her team because he was young,” Black said. “If the same injury happened to an individual 20 years older, they likely would not have survived.”
Two years after the accident, Smith is focused on continuing consistent therapy to regain more control of his left arm and hand, which was predicted to be the last area in which he would regain sensation.
“Therapy is what gets everybody back, so when it’s time for therapy, I am always motivated and ready to get to Spain,” Smith said. “My left arm is still paralyzed. It is starting to activate, not on command yet; but I will get there.”
Smith’s positivity, along with the team at UAB, has contributed to the strong progress in his recovery, according to Patton.
“We are just absolutely indebted to UAB and Spain and all of their help and his whole entire medical team,” Patton said. “I think God placed everybody at the right moment with us, and it’s been absolutely critical in Jacob’s recovery.”