Susie Stephens, RN, has ridden horses most of her life and loves everything about it. She loves the outdoors, the feeling of freedom, and horses — one in particular, her horse Rohan.
“He’s my best friend,” she said.
On the morning of Sept. 11, 2023, Stephens was riding Rohan up a small embankment near her home in Williamson County when the big horse lost his footing and, in attempting to keep his balance, bucked up his rear end.
Stephens was thrown from his back and hit the ground — hard. She was wearing a helmet but was knocked unconscious by the impact.
It wasn’t just hitting the ground, though. It was the way she hit.
“I landed with my neck flexed on the left-hand side of my face,” she said.
Stephens’ friend Laura Elrod, who was riding alongside her that day, rushed to her side.
After a short period of unconsciousness, Stephens came around and noticed some upper arm numbness.
“I knew I could not touch my chin to my chest, I couldn’t lift my head. I knew I had broken my neck.”
She knew she had broken her neck, not just because of what she could feel in her own body — but because she had treated hundreds of people with broken necks in her 18 years as an Emergency Department nurse at Vanderbilt.
So even though everything happened so quickly, at that moment when she gained consciousness on the ground, she knew.
“Laura, I have a broken neck,” she said. Laura shouted for Stephens’ husband Ed to call 911.
The injury had happened quickly, and the response happened quickly, too.
An EMS crew was on the scene in minutes, and, as she puts it, “They took me lights-and-siren to Vanderbilt.”
She was now a badly injured patient in the same Emergency Department where she once worked.
After numerous evaluations and imaging studies, the definitive diagnosis: “I had a Level 3, unstable, odontoid C2 fracture.” A fracture of the second cervical vertebra in the neck.
Tricky fracture, severe vertigo, and a crown
“They can be pretty tricky fractures,” said Byron Stephens, MD, MSCI, associate professor of Orthopaedic Surgery, who was on a call for emergencies and who treated Stephens (they are not related).
Looking at an injury such as Stephens’ there is one thing that everyone fears.
“If the fracture were to displace — the thing we all fear, even though it’s rare, is spinal cord injury.”
It was such a spinal cord injury that led to the paralysis of actor Christopher Reeve following suffering a broken neck after having been thrown from a horse.
Byron Stephens said that the Orthopaedic Surgical team at Vanderbilt views surgery as a last resort for such injuries — a desire for conservative treatment that was shared by his patient.
“She was very adamantly opposed to surgery,” he said.
Stephens was fitted for a collar to stabilize her neck to allow the injury to heal. In the care of her husband and four children, including daughter Stefani Gianni, who rushed to Nashville from her home in Florida, she went home.
Stephens, who, in addition to her time in the Emergency Department also worked for many years in the Vanderbilt Heart and Vascular Institute and currently works part time for LifeFlight Event Medicine, is very accustomed to being busy — but now she had to learn to stay still.
“I was in a collar for 10 weeks,” she said, and among the side effects of her injury was a vestibular injury that led to eight weeks of severe vertigo.
“I will never look at a ceiling fan the same way again,” she said.
During that time, there was also a much more minor health issue; Stephens had a temporary crown (it somehow stayed in place when she was thrown from a horse) and about three weeks after her injury, she was in the dental chair of Tyler Ames, DMD, assistant professor of Clinical Oral and Maxillofacial Surgery, to have the permanent crown seated. This was at her insistence — she didn’t want to postpone the appointment and was sure to tell Ames that her neck was immobilized and made sure putting in the crown posed no risk.
“She was really gung-ho,” Ames said, with apparent understatement.
Such crown placement is normally routine, but nothing is routine on a patient with a broken neck.
“I was on pins and needles,” Ames said with a laugh. “I was very, very careful — especially when flossing.”
Stephens had been told that her benign postural vertigo can be overcome by walking, which retrains the vestibular system, but, she had also been told from the beginning, retraining the body for even simple things like walking requires physical therapy.
That was the next step.
“It was unbelievable what he did for me”
Flavio Silva, PT, ScD, the clinical coordinator in Physical Therapy, is the person that Stephens credits with restoring her ability to move.
“It was unbelievable what he did for me,” she said. “When the collar came off, I couldn’t turn my head — it was frozen.”
Silva, who has been at VUMC for 18 years, is accustomed to helping patients who have survived severe and life-threatening injuries recover.
“We have access to radiology, labs, everything we need for a safe game plan,” he said. “We have a really good team approach here at Vanderbilt.”
He also knows that part of his job is psychological and motivational, in addition to physical.
“Patients are scared and concerned,” he said. “They wonder if their life is going to be different. Some people think their life is over.”
Stephens had one goal from the day she met Silva: “She said she wanted her life to be back to normal,” he said.
There was a way to go for that to happen, and it was going to have to happen with a tight connection over the course of many weeks.
“You and your PT are going to bond,” Silva said. “That’s a very important part of the recovery process.
“We’re always trying to restore mobility, strength and flexibility,” he added.
Over a period of about three months, Silva brought Stephens from the point of a “frozen” neck (what he called the “phase where [patients] can’t do much”) to a near normal level of activity.
In addition to restoring movement, he restored confidence.
“Flavio was the master of my coming back to life,” Stephens said. When her PT was over, Silva showed Stephens her final X-rays and told her, “Your neck doesn’t even look like you had a fracture.”
Out where a friend is a friend
It all could have ended differently, of course. Stephens has seen it in her time as a nurse; Byron Stephens has seen it in his time as an orthopaedic surgeon; and Silva has seen it in his time as a PT.
“It can be a very dangerous injury,” Byron Stephens said.
“Many people who are thrown from horses with injuries that severe do not survive,” Silva said.
“I wake up every day and wonder why I didn’t die,” Stephens said.
She didn’t and was very grateful for every member of the care team and every one of her co-workers from VHVI and LifeFlight, members of the “horse community,” and others who had checked on her, offered encouragement and love.
But there was that one more thing to do. Get back on Rohan.
She had visited the big horse as soon as she could, and Stephens said she could sense his remorse at her injury. But dropping by and saying hello was not the same thing as going for a ride.
She checked with Byron Stephens and with Silva, who both, after she was healed, told her there was no medical reason to stop doing what she loved.
“Dr. Stephens said, ‘Could it happen again? It could,’” Stephens said. “He also said I could fall down a flight of stairs.”
So, one afternoon, about six months after that terrible day of her accident, Stephens once again took Rohan for a ride.
She now uses an even-more-sophisticated helmet and an air vest that inflates if she falls, similar to the automatic air bags in a car.
She was back in the saddle with her “best friend.”
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When we had concluded the interview for this story, I asked her what she had going on for the rest of the day.
“I’m going to ride Rohan right now,” she said.
