this is a true story.
When Anthony Ciaglia was a teenager, he suffered a traumatic brain injury, clinically died three times, and lapsed into a coma. When he awoke, he was a much different person. His brain injury had dramatically affected his personality.
Afflicted by uncontrollable rages, he became bored and housebound. On a whim, he began writing to serial killers and soon was exchanging letters with more than thirty notorious murderers.
This book is not for the squeamish.
It contains uncensored passages lifted from more than three thousand pieces of mail exchanged between Ciaglia and unrepentant serial killers. These letters have been augmented by several hundred hours of telephone conversations that Ciaglia recorded, plus interviews that he conducted in maximum security penitentiaries.
The result is a chilling glimpse into the minds of psychopaths who discuss such aberrant acts as kidnapping, rape, torture, necrophilia, cannibalism, and murder as casually as most of us discuss the weather.
Much of what we know about serial killers comes from accounts written about their crimes and interrogations performed by homicide detectives or forensic psychiatrists. The letters printed here are un- scripted, more reminiscent of chitchat between two buddies who’ve stopped at a bar after work. There are no pretenses, few niceties, and no preening for prosecutors or the public.
What follows is straight from a serial killer’s mind to paper — and it is both terrifying and depraved.
Initially, Ciaglia wrote out of curiosity. What makes a person become a serial killer?
But as he peered deeper into the prisoners’ world, he began to question if he shared many of the same demons as them. Because of the uncontrollable bursts of anger brought on by his brain injury, Ciaglia wondered if he were destined to become a killer.
This book is a story about an average American family whose idyllic lifestyle is shattered by a terrible accident that pushes them to the brink of despair. It’s also the story of a tormented man who eventually found purpose in the most unlikely way — by connecting with monsters.
- Pete Earley, author of The Serial Killer Whisperer
prologue: a typical saturday
Tony Ciaglia felt the familiar butterfly-rush in his stomach as he keyed open his private postbox at the UPS Store on Rainbow Avenue in Las Vegas. He called it his Murder Box.
For the past four years it had been the absolute focus of his life. Some would even say it had saved him.
There were seven new letters inside, each of them fresh installments of a true-crime drama that was playing exclusively in his own living room.
Shuffling the various letters like a deck of playing cards, he walked out into the 105-degree summer heat. He was six feet tall, weighing in at 225—a handsome dude with thick black hair gelled up into an Elvis Presley coif. His girlfriend, Crystal — a petite, exotic Filipino and Portuguese blend — was waiting outside in a BMW sedan.
Joe Roy Methany (Inmate #270896)
Tony welcomed the blast of air-conditioning that struck his unshaven face as he slipped into the passenger’s seat. What he was hoping for was a letter from Joe Roy Metheny, inmate #270896, currently serving two life sentences in a Maryland prison without possibility of parole.
Tony had been pressing Metheny to tell him about unsolved murders.
Metheny’s mail was easy to spot because he always drew a cartoon on the outside of the envelope, just under the return address. The first time Metheny had written, Tony had been surprised that the prisoner’s artwork had made it by prison censors and U.S. Postal Service inspectors.
But after several years of uninterrupted correspondence, he’d concluded that no one really paid attention to Metheny’s childish cartoons. His drawings always featured the antics of a round-faced baby with an oversized head and toothless grin. It was Metheny’s trademark character — a serial killer’s Mickey Mouse.
As Crystal maneuvered the BMW north onto Rainbow Avenue, Tony held up Metheny’s envelope for her to see.
“It’s from Joe,” he announced excitedly, a kid with a candy bar.
“Well, don’t open it yet,” Crystal chided, the mom telling him to wait for after the meal.
Tony had promised his parents, Chris and Al Ciaglia, that he wouldn’t read any of the letters from serial killers unless one of them was present. Although Tony was thirty-two years old, he still lived with his parents, as he had his entire life.
Tony examined the envelope, searching the drawing for a clue. Metheny had used colored pencils to sketch his cartoon baby. A cone-shaped party hat was strapped to its cue-ball head and the infant was clutching a giant burned matchstick in his left hand and a cupcake in his right. A flame flickered from a single candle stuck into brownish pink icing.
A birthday greeting!
“I see it!” he announced to Crystal, who was focusing on traffic.
Metheny was known as the “cannibal killer,” a reference to how he dismembered his victims and served their body parts to unsuspecting diners at a barbecue stand in Maryland.
Metheny always hid some gruesome image cleverly inside his drawings, and now Tony saw it. Metheny’s grinning baby was not clutching a birthday cupcake at all. What he was clutching was a woman’s severed breast. The candle was rising from the graphically erect nipple. It was typical Metheny.
Inside Internet chat rooms and on serial killer websites, Metheny was known as the “cannibal killer” — a reference to how he had dismembered his female victims and served their ground-up body parts to unsuspecting diners at a roadside barbecue stand in Maryland.
He prided himself on being the real Hannibal Lecter — life imitating art — and he had a small cult following on the Web among self-proclaimed devil worshippers and serial killer devotees.
“Do you know how much I could sell this for on the Internet?” Tony asked Crystal. Just as quickly he added, “I never will of course. Joe knows that. I would never do that.”
Reading the Letters: A Family Ritual
Of all the serial killers that Tony corresponded with, Metheny was the most callous and graphic in describing his sexual debauchery. There was a cold-bloodedness about him that astounded Tony’s family. When one of Crystal’s friends died from cystic fibrosis, Tony wrote a short story about how angels had carried her to heaven. He’d sent copies to Metheny and his other serial killer pals. Nearly all of them wrote back and told him that his story was touching.
“Your story brought tears to my eyes,” Metheny wrote sarcastically. “C’mon Tony, you’re going to have to do better than that if you want to make me to cry.”
Tony had been up front with Crystal about his letter writing from the beginning of their now sixteen-month-old relationship. He’d warned her that if she became part of his life, he would share her with them. She’d agreed and he knew from the killers’ written responses that Crystal was a hit. His killer pals especially enjoyed getting photographs of her because she was nineteen, slim, and sexy.
Even his sex life with Crystal was not off-limits. Tony expected the killers to share their most intimate thoughts and he was willing to do the same.
“I’m their escape into the outside world,” Tony had explained to Crystal. “These people depend on me. If I go on a trip and I tell them about it, it’s like they went on that trip, too.”
Tony and Crystal ignored the three barking white Labrador retrievers who greeted them when they entered the art deco–decorated foyer inside his parents’ stucco and red-tile-roofed Spanish-style home.
Al was waiting. Fit and silver-haired, he was in his early sixties and a self-made man. He’d started out selling personal computers when they were first being introduced, then owned two pizza restaurants. Now he operated a Las Vegas mortgage business.
“Read Joe’s first,” Tony said, as the family gathered in the dining room.
The reading of letters had become a family ritual.
Tony’s parents, his younger brother, Joey, and Crystal would congregate around the glasstopped table. During the week, sometimes only Al and Chris would be available to review the six to ten letters that arrived daily. Joey and Crystal would catch up after they got off work. Everyone would discuss the correspondence before Tony would retreat to his bedroom and begin writing responses.
“If you start with Metheny,” said Chris, a thin woman with no-nonsense short hair, “Crystal and I may have to leave.”
“Let’s see how gross he gets,” Al replied, slipping on a pair of silver reading glasses.
A Waste of Good Meat
Al began: “You are always asking me about my murders, well here is one that no one knows about. That’s right, pal. I have never told anyone about this murder.”
Al looked up and quipped, “He certainly knows how to get our attention.”
Starting again, Al read,
I never had to go far to find a victim for most all truck stops across the U.S. had whores working in and around them. This is a story of a young prostitute I killed in October, 1995. She was working the 76 truck stop in Reno, Nevada. I was driving a blue long nose Peterbuilt and I was hooked up to a freezer trailer. That’s a trailer with a freezer. I beat and raped that bitch in the sleeper of the truck that night until I grew tired of her. Then I put my hands on her neck and began squeezing. Her screams of pain slowly dwindled down to mere rasps of agonizing grunts and groans. The sounds she made slowly faded away, never to be heard again. Sweet death had finally come down upon her. Now her body was just a dead carcass, laying in wait for the decompo- sition to start the breaking down of cells.
Al checked Chris but she motioned him to continue. Crystal also nodded. He continued reading.
I layed there with my arms wrapped around her dead body and slept for about three hours. I woke up to my alarm clock going off at 5:30 a.m. I climbed over her and got dressed. I throwed a blanket over her. Then I started the truck up. I got out of the truck, locked the door and headed over to the coffee shop to grab a bite and check the computer for loads heading East. The closest thing I saw available to me that I was looking for was a load of Ranch House salad dressing they wanted taken down to Houston, Texas. The company was located over in Sharps, Nevada, which is only about 25 miles north of the truck stop. I decided to accept the job. I grabbed a coffee to go, and off to the truck I went.
I buried her in about 45 minutes. This industrial park wasn’t very old, so the ground was pretty soft.
I climbed up in the cab, checked everything out and off I go. I got to the warehouse in Sharps that had the load. But there was no one there because it was a Saturday morning. The sign on the door said they opened up at 9 am and it was only 7:45 a.m. So I looked around and there wasn’t a damn soul insight. There wasn’t nothing around this little ass business park so I thought this would be the perfect place to ditch her stinking ass off. I dragged her dead ass out of the truck. I grabbed my little army shovel and off I went to around the back of that warehouse. I found a nice isolated area back there. I buried her in about 45 minutes. This industrial park wasn’t very old, so the ground was pretty soft. And that’s where she is to this day.
Al paused and then continued:
It was not for another two bodies later that I would realize what a waste of all that good meat was only ending up being nothing more than bug and worm food…
Chris shot up from the table. She’d heard enough. “Okay,” she said, exiting, but Crystal remained seated.
I have never shed a tear for those I have killed, nor will I down the road. Those sweet young drug addicted prostitutes that I killed back in my past were pretty much dead to the world long before I killed them. They were nothing more than walking Zombies looking for a few moments of pleasure from their sick, twisted daily lives of shame. I feel I have done those poor souls a favor. If I feel anything for them, I feel only some jealousy. For their pains are over. But, mine will continue on as I sit behind these bars till the day that I die.
Al said, “He signed it like he always does, Tony. It says, ‘You take care, be safe out there, my best friend.’”
“Is his thumbprint there?” Tony asked.
“Yes,” Al replied.
Metheny always marked his letters with a thumbprint pressed into his own blood.
“He’s enclosed something in the envelope,” Al added. Turning the envelope upside down, he gently shook it and a hard object hit the glass tabletop and bounced to a stop.
Tony snatched it. “It’s a tooth! Roots and everything. A molar.”
“Jesus!” Joey said softly, leaning forward to look at the object that his brother was holding. “Do you think he pulled it out himself?”
“Don’t touch the blood,” said Crystal.
Al read the final lines that Metheny had written along the margin of the letter.
I have enclosed my tooth for you. We never met but now you will always have a part of me with you. Ha! Ha!
“He sent me his own tooth,” Tony said.
That Girl Has Parents Somewhere
Al reminded everyone of the murdered woman. If Metheny had killed her as he had written, Tony would need to contact the police.
But Metheny might be lying, too — getting his kicks by exaggerating his murder count.
After several minutes, they’d formulated a plan. Metheny had not told them enough for Tony to substantiate the story, so notifying the police would be premature. Instead, Tony would try to flush more details from Metheny in future letters. He’d also try to verify the few clues that Metheny had given him.
Was there a 76 Truck Stop within a twenty-five-mile radius of Sparks? Was there a warehouse that handled semitrailer truckloads of salad dressing?
It wasn’t much, but it was a puzzle worth pursuing. He wasn’t about to dismiss the dead woman as Metheny had, simply as some “stinking ass.” Metheny not only had murdered her, but had stripped away her humanity. If Tony could help locate her body, then he could return some of her worth, her dignity. She’d be someone again.
“That girl has parents somewhere,” said Chris, who had returned to the room and heard enough to catch the drift of their conversation. “What he did to her — is unforgivable.”
“He’s bragged about others,” Tony said. “I need to find more about them. He’ll tell me, I know it. It will just take time.”
For a moment, no one spoke, and then Tony said: “Dad, read the next one.”
part one – the accident
On the occasion of every accident that befalls you, remember to turn to yourself and inquire what power you have for turning it to use.
—Epictetus, a Greek philosopher
july 23, 1992
A half-dozen boys running barefoot down an embankment into a cove at Possum Kingdom Lake. It was shortly after four o’clock. The afternoon temperature had just peaked at 93.9 degrees. Unlike most man-made reservoirs in Texas, which were muddy, the water in this twenty-thousand-acre playground was clear blue. It was home to Camp Grady Spruce, a popular YMCA getaway about a hundred miles west of Dallas.
Tony Ciaglia, Andy Page, and Grant Cooper were among the first to reach the Yamaha WaveRunner jet-ski there. The boys had met three years ago when they were assigned to bunks in the same tent. They had been inseparable ever since. Best buds forever.
This was the first summer the camp had owned WaveRunners, and anything fast and exciting was a welcome respite at the conservative religious outpost, which traced its roots to 1992. Only in the last nine years had girls been permitted to attend the camp’s two-week sessions.
The boys formed a line behind the WaveRunner and with a twist of the throttle, the WaveRunner’s powerful 650-cc engine roared to life. The first rider burst from the cove, sending a rooster spray rocketing from the tail of the red and white machine.
“Tony’s counselor had the day off,” Chris would later recall, “but it was hot and the boys wanted to take a WaveRunner out onto the lake, so they asked another counselor. He gave them the key and then disappeared, leaving them unsupervised.”
WaveRunners were supposed to be ridden only as far as a red buoy bobbing about two hundred yards offshore. After reaching the buoy, the rider returned to shore to let someone else take a turn. Andy was next in line with Tony and Grant behind him. But as the WaveRunner was returning to the cove, Andy yelled to a younger camper named David standing on the dock close to them. He was waiting to go waterskiing. Andy asked David if he wanted to switch places.
David did. He jumped into the lake and got to the head of the line at about the same time as the returning WaveRunner. He climbed aboard the WaveRunner and took off.
As the others waited in the waist-deep water for their turn, Grant splashed Tony and asked, “Have you asked her yet?”
“When we get done here,” Tony replied, smiling.
“You’d better hurry up.”
a cute blond from dallas
Tony had a crush on Kelly Christiansen, a fellow fifteen-year-old from Dallas. Blond. Cute. He wanted to take her to the Friday night dance, the last social event before camp ended. Unfortunately, so did Andy. They’d been competing for her affections while Grant played the neutral friend, watching amused from the sidelines.
Tony had first noticed Kelly last summer, but she’d not shown any interest in him or any other boys. Tony had promised himself that this summer would be different. He’d searched for her as soon as his family pulled into the Southern Methodist University parking lot twelve days earlier. It was where campers boarded commercial buses hired to transport kids in Dallas to the camp. Seats in the buses were assigned alphabetically.
Because “Ciaglia” followed “Christiansen,” Tony had known Kelly would be sitting near him. He’d get an uninterrupted, two-hour head start over Andy.
Tony had been so eager to talk to Kelly that he’d scooped up his gear from the back of the family’s Plymouth minivan and started running across the SMU parking lot without saying goodbye to his parents or Joey, his kid brother, three years younger. Joey also was going to camp — but at a different site.
Once inside the bus, Tony slipped into his assigned seat and immediately leaned forward to speak to Kelly. That’s when he heard someone rapping on the bus window. Everyone did. It was Al, signaling Tony to come outside.
Tony trudged down the aisle, and when he got outside, his parents — both Al and Chris — hugged and kissed him. Tony was totally humiliated. He could feel all of the kids inside the bus watching him. He wanted to yell, “My dad’s Italian, okay? That’s what Italian families do! They kiss and hug whenever they say hello or goodbye.” Just like in The Godfather.
He’d returned to his seat red-faced, without saying a word.
blood in the water
Despite that rocky start, this summer had been Tony’s best. He, Andy, and Grant were CITs, counselors in training. The younger kids looked up to them. It was their year to be the cool, older kids who taught the newbies the camp’s traditions.
Waiting for his turn on the WaveRunner, Tony appeared to be a teenager who had, as Texans liked to put it, “life by the horns.” He’d won more gold medals that week than anyone else in a camp Olympics. Even better, he’d sat next to Kelly several nights during dinner.
Molly Ray, another camper swimming in the lake, noticed Tony and Grant waiting in line for the WaveRunner to return. She thought it was odd because campers were supposed to sign their names on a clipboard the night before if they wanted to ride a WaveRunner. She began swimming toward the boys to claim a turn.
Because Tony was facing Grant in the water, he had his back to the lake and didn’t see the WaveRunner as it rounded the red buoy and began racing back toward the cove. But other kids did.
The WaveRunner’s young driver was not slowing down.
David apparently planned to make a sharp turn at the last possible second and splash the older boys with the wake. But the young driver had overestimated his skills. He couldn’t accomplish the maneuver as planned.
“The next thing I noticed was bright red in the water and, I thought, ‘Oh my God! That’s blood. That’s blood in the water.”
Grant Cooper looked up from the water just as the WaveRunner smacked into the back of Tony’s skull.
“It whacked him hard,” Cooper said later. “He took the brunt of it. I tried to duck and turn, but it hit me on the side of my head and I went under.”
Molly Ray would still remember the scene years later. “I saw this flash — this huge thing — suddenly shoot by me as I was swimming. The next thing I noticed was bright red in the water and, I thought, ‘Oh my God! That’s blood. That’s blood in the water. Oh my God! That’s from the WaveRunner and it almost hit me.’”
Grazed on the side of his head, Grant Cooper next remembered waking up on the shore. “I don’t remember getting out of the water or how I got to the shoreline, but when I came to, I was walking around in circles and people were yelling at me because my head was bleeding. I had a gash on the side of my head and a concussion.”
Grant looked for Tony.
“He was floating facedown in the water where we’d been standing. People were rushing to drag him out. I remember thinking, ‘Oh shit! Tony’s not moving. I think he’s dead!’”
clinically dead, three times
By the time the tiger-striped CareFlight rescue helicopter landed at Possum Kingdom Lake, Tony had been dragged unconscious onto the shore and was surrounded by campers.
“The golden light in this kid’s eyes is going out!” a park ranger yelled as two paramedics from the twin-engine chopper darted through the throng.
During the twenty-minute flight to Fort Worth, Tony’s heart stopped beating three times.
Three times, he was clinically dead. Each time, the CareFlight personnel brought him back to life. Fort Worth trauma nurse Bonnie Sweitzer was waiting when the helicopter touched down at Harris Methodist Hospital, the closest trauma unit to the YMCA camp. She grimaced when she saw it was a teenage boy, still wearing his swimsuit. She hated it whenever a young person was flown to the trauma unit. At least with someone older, she could tell herself the victim had already enjoyed a bit of life.
Trained as a nurse-anesthesiologist, Sweitzer first had to decide if the trauma victim needed to be intubated or whether he could breathe on his own. The boy’s eyes were not responding. He needed oxygen, and fast. Although he had only a small wound on the back of his head, he clearly had suffered a massive head injury. Seitzer had spent twenty years triaging patients. She took one look at Tony and gave him only a slim chance — a very slim chance — of surviving the next twelve hours.
Back at the YMCA camp, an official telephoned Al Ciaglia at his office inside a Pizzeria Uno restaurant, one of two eateries that Ciaglia owned in downtown Dallas.
“There’s been an accident involving your son,” the caller said.
“Which son?” Al asked, since Joey was at the YMCA’s younger kids’ camp across the lake from his brother.
“All I can tell you is there was an accident in the water at the Frontier Camp and your son is being CareFlighted to Harris Methodist Hospital in Fort Worth.”
Al knew it was Tony. Frontier Camp was for older kids.
The caller refused to say anything else about the accident even when Al got angry. There was no mention of the WaveRunner or the head injury. There was no indication that Tony was unconscious and in serious condition.
Chris was standing a few feet from Al listening to bits and pieces. By the time he put down the receiver, she was panicked. They had been planning on going to dinner with friends, which is why she was in his office. She worked for a medical company that hospitals paid to run their emergency rooms and as soon as she’d heard Al saying “CareFlight,” she knew it was serious. The emergency helicopter responded only in critical cases.
a race against time
Al checked his watch. It was a few minutes after five o’clock. Interstate 30, the main thoroughfare linking Dallas to Fort Worth, would be congested with Thursday evening rush hour traffic. The drive normally took about forty minutes, but it was going to take them longer.
Al used his car phone to call Harris Methodist Hospital’s emergency room as he swerved in and out of traffic, passing some cars on the highway shoulder. Neither of them had heard of the hospital.
“Your son is here,” a receptionist confirmed.
“Is he alive?”
“I can’t tell you anything more over the phone.”
“Please,” Al pleaded. “Can’t you at least tell me if he’s alive?”
“All I can say is you need to get here as soon as you can.”
Al and Chris left their car parked outside the emergency room entrance. They didn’t care if it got ticketed or was towed. As soon as a nurse heard their name, they were taken into a private waiting room.
“Would you like a chaplain?” a woman asked.
Al exploded: “I want to see our son! Now! I don’t want a chaplain. I want someone to tell me what the hell is going on!”
Trauma nurse Sweitzer was paged and told that the Ciaglias were in the hospital. She went to brief them.
“Your son has suffered a traumatic brain injury,” she explained. “The skull is hard. It protects the brain, which is sort of like Jell-O. When your son got hit in the back of the head, his brain got knocked into the front interior of his skull and he suffered what we call the starburst effect.”
“The what?” Chris asked.
“Starburst effect. Have you ever seen a baseball hit a windshield? There’s the point of impact but then there are thousands of little cracks that spread out from that entry point like a starburst. We know there was a lot of damage at the impact point in the front lobe but we have no idea where those other cracks have gone inside your son’s brain.”
“Is he going to die?” Al asked.
“That’s something you need to ask the doctor,” she replied.
“Can we see him?”
“Of course,” she said.
the starburst effect
Tony was lying on a bed. He was unconscious, still dressed in his bathing suit. For Chris, the entire scene was surreal. A ventilator was attached to her son’s face and the Darth Vader sound of air being sucked in and out of his body echoed inside the room. IV tubes were stuck into his tiny body, but she didn’t see any broken bones; there were no bandages, no bloodstains, no black-and-blue bruises.
In fact, Tony looked physically fit — and freshly tanned. He could have been taking a nap. The only mark that Al and Chris could see was a three-inch gash on the back of his skull.
“Will he wake up?” Al asked. He couldn’t get over how normal Tony looked.
“You have to understand,” Sweitzer said, “your son is in a coma. He’s in critical condition.”
Moments later, Sweitzer introduced them to Dr. George F. Cravens, the neurosurgeon on call that afternoon. He was one of Sweitzer’s favorites. If she had a child who needed brain surgery, he’s the surgeon she would have called.
But Chris wasn’t so sure. She sneaked out of the room and telephoned her boss at the medical company to ask what he knew about Cravens. “He’s one of the best in Texas,” her boss assured her. “Don’t move Tony to another hospital.”
Cravens was professionally polite and concise.
Not only had Tony’s brain been knocked forward into the hard interior of the skull, but the brain had then jerked backward after impact with the WaveRunner, causing further rupturing in the back of brain.
Tony had at least eight hematomas, blood leaking from vessel tears in his brain that was now pooling inside his skull. The largest pools were in the lower right and left frontal lobes, according to CT scans. Ideally, these pools of blood would be reabsorbed in the brain over time. If not, the blood would have to be drained and major tears in the blood vessels would need to be repaired — if they could be — during surgery.
Cravens explained that the large hematomas that were showing up on the CT scans were only the most obvious ruptures. Not only had Tony’s brain been knocked forward into the hard interior of the skull, but the brain had then jerked backward after impact with the WaveRunner, causing further rupturing in the back of brain.
“The tissues in the brain have different densities,” Cravens explained, not certain how much either Al or Chris could comprehend at a time like this. Still, he was obligated to explain. “What that means is that these different densities move at different rates of speed — it’s just the physics of these things — so it’s impossible for us to know how many shears and tears have happened inside your son’s brain between the front and back portions due to this jarring. We just don’t know where tiny shears have happened or how these shears are going to impact his brain.”
It was a starburst effect, he said, exactly what Sweitzer had mentioned earlier.
the mounting pressure
Bleeding wasn’t the only problem. There was a more immediate threat. Because his brain had been shaken so violently, it was swelling. The pressure was building inside his skull and there was no place for his brain to expand.
In a healthy adult, the pressure in the brain was anywhere from 0 to 10 mmHg (units of pressure). Any pressure greater than 20 mmHg was abnormal. If the pressure went past 40 mmHg, there was a high risk of permanent brain damage. Cravens told them he was going to perform surgery to insert an inner cranial brain pressure monitor in Tony’s skull.
“We have to do everything we can to control that pressure,” Cravens said. “We can’t let it get too high.”
“How high is too high?” Al asked. Cravens replied: “Anything above sixty mmHG will be fatal.”
There were several ways to ease the pressure building inside Tony’s brain. The first was with medication. The next was inserting a shunt or valve that would allow fluids to escape from the brain, easing the pressure. In the most extreme cases, a portion of the skull would be removed so that the brain could have room to expand.
“You might have to remove part of his skull?” Chris asked in disbelief.
“Let’s get the monitor in first and see where we are here,” Cravens said. “We’re already giving him medication. What happens next will depend on the pressure readings.”
Tony’s blood pressure also posed a threat. Normally, the heart pumps blood at a rate of 120/80. Tony’s was raging at 225/125, which put him at risk for a stroke, heart attack, or kidney failure.
As soon as Cravens left them alone, Al and Chris both began crying. How was this happening?
“He looks so great. Why can’t he just wake up?” Al stammered.
Al telephoned his older sister, Carol Bulthuis, who lived an hour away, and told her about the accident. She began calling relatives and friends. Within a few hours, more than thirty family members and friends were huddled in the ICU waiting room.
Back at the YMCA camp, Joey Ciaglia was becoming suspicious. He’d seen his older brother earlier that morning when Tony and other CITs had visited the younger boys’ camp. Tony had left for the opposite side of the lake at lunchtime.
Joey was suspicious because a counselor interrupted him while he was taking a shower just before dinner and asked him for his father’s telephone number at the Pizzeria Uno. No one in the camp’s main office could find an emergency contact number. When Joey asked why the camp needed to call his father, the counselor stalled and then offered a flimsy excuse.
Although Joey was only thirteen, he marched into the director’s office and demanded to know what was happening. Within the hour, he was being driven to Fort Worth by a counselor to meet his parents at the hospital.
By 11 p.m., Cravens had inserted the pressure monitor through a hole that he’d drilled into Tony’s skull. The ICU trauma team also began taking CT scans of Tony’s brain several times an hour to track the pools of blood. Those scans showed the pools were getting larger.
“These next forty-eight to seventy-two hours are critical,” Cravens told Al and Chris. “If he can get through them, there’s a good chance he’s going to survive. It will all depend on us getting the pressure in his skull and his blood pressure under control.”
Chris held Tony’s hand and began whispering to him. Immediately, the numbers on the monitors spiked — so dramatically that two ICU nurses rushed into the room.
As soon as Tony was brought from the operating room to the ICU unit, Al, Chris, and Joey circled his bed. Chris counted eight tubes now connected to her son. Nurse Sweitzer showed them how to read the monitors tracking Tony’s vital signs and measuring the pressure. Even though massive doses of drugs were being pumped into him, his heart continued to race. The only reason why Tony was still alive at this point was that he was young and healthy.
Chris held Tony’s hand and began whispering to him. Immediately, the numbers on the monitors spiked — so dramatically that two ICU nurses rushed into the room. Even though Tony was unconscious, he was reacting to his mother’s voice. The nurses told Chris that she needed to avoid talking to her son and not touch him; otherwise he might go into cardiac arrest and die.
Al, Chris, and Joey stood silently next to Tony’s bedside, watching the green flashing lights on the pressure monitor, listening to the ventilator breathing in and out for Tony, and hearing the rapid beeping of a machine tracking his heart rate.
It was the worst experience in any of their lives.
“is he going to die?”
A different neurosurgeon reported to duty later that night. After reading Tony’s medical charts, he asked the Ciaglias to step into the ICU hallway so they could talk.
“I don’t like to get people’s hopes up,” he declared. “If it doesn’t look good, I’m the guy in the hospital who tells you the truth. I’m going to be truthful with you right now.”
The doctor paused and then said, “I don’t think your son is going to survive. His arteries are not going to be able to hold up. His blood pressure is too high and his brain swelling is incredible. Picture yourself on a bobsled at the Olympics, okay? You’re going down a sheet of ice at a hundred and ten miles per hour and if you veer off an inch to the right or an inch to the left, then imagine what will happen. That’s where your son is right now. He is on that speeding sheet of ice and what’s probably going to happen is that his arteries are going to blow out and he is going to have a stroke and die.”
Joey was furious. He wanted to punch the doctor. Al and Chris felt their knees were going to buckle. Both began to pray. They were desperate.
When they returned to Tony’s ICU room, they stared at the monitor that was tracking the pressure inside his skull. The green numbers refreshed themselves every few seconds and they had gradually been moving upward. They were now in the mid-forties. Tony’s heart rate also had increased. It was as if they were watching Tony inching closer and closer to death.
And there was absolutely nothing they could do to prevent it.
“I don’t think your son is going to survive. His arteries are not going to be able to hold up. His blood pressure is too high and his brain swelling is incredible.”
Chris felt as if the air in the room were being sucked out. She began having trouble breathing. Al kept shaking his head in disbelief. How could this be happening? Joey wanted the doctors to do something, anything. This was his older brother. Why weren’t they saving him?
When the pressure monitor reached 42 mmHg, Al whispered to Chris, “What did Dr. Cravens say the maximum was?”
“Permanent brain damage over forty.” “Do they need to open his skull?” Al asked impatiently. Chris didn’t know. “They’re monitoring him, right? I mean, they know the pressure is going up. They’re giving him more meds. Do you think he needs more? Should we ask them?”
Chris didn’t know.
“What kind of permanent brain damage?” Al asked.
Chris didn’t know.
As they watched, the pressure went up to 43 and then 44.
“Oh my God,” Al said. “The drugs aren’t working. They’ve got to do something.” The monitor beeped and showed the pressure was now 46. Al and Chris were so frightened neither could speak. A few moments later, the numbers 47 and 48 appeared.
“Is he going to die?” Joey asked.
The next reading stayed at 48 mmHG. And the next, and next, and next. All of the subsequent readings were 48 mmHG. The pressure had peaked and moments later, for the first time, the tiny numbers on the screen gradually began to decrease. The machine tracking his racing blood pressure also showed that it was now in fact slowing.
The next morning, Cravens told them Tony had survived the most critical stage.
“He’s not going to die?” Al asked. He wanted to hear Cravens repeat it aloud.
“He’s stabilizing,” Cravens replied. “That’s a good sign. He’s going to survive.”
Al, Chris, and Joey felt a sudden sense of joy. But their relief was short-lived.
Al kept visualizing a windshield that had been struck by a hardball. Where had those cracks gone inside his son’s brain? What damage had they done?