Sierra Tobia: From Brain Injury Patient to Nurse

When Sierra Tobia takes care of her patients at TIRR Memorial Hermann, she does so with a unique perspective. She first came to TIRR Memorial Hermann as a patient in 2014, and, today as a nurse at TIRR Memorial Hermann, she has first-hand knowledge and understanding of her patients’ journeys.

In May 2014, 20-year-old Sierra took a road trip to her hometown of League City, Texas, from Texas A&M University in College Station, Texas, where she was a student. After a weekend of laughs, catching up with friends and memorable times, Sierra left to drive back to College Station.

As Sierra was driving, a bicyclist suddenly appeared in front of her car. To avoid hitting the bicyclist, she swerved her car into oncoming traffic, resulting in a head-on collision with another vehicle.

Following the collision, Sierra was transported via Memorial Hermann Life Flight® to Memorial Hermann-Texas Medical Center. In addition to being diagnosed with a traumatic brain injury (TBI), she underwent multiple open reduction and internal fixation (ORIF) surgeries, where surgeons placed a rod in her left femur and two plates and several screws in her right humerus. The accident also caused Sierra to develop acute compartment syndrome, a condition that restricts blood flow to injured areas. To relieve the resulting swelling and pressure on her right arm, she underwent a fasciotomy.

“When I first met Sierra following her collision, she had a broken right upper arm and a broken left thigh bone, as well as other injuries,” said Dr. Mark Prasarn, orthopedic trauma surgeon affiliated with Memorial Hermann-TMC. “We elected to fix both broken bones surgically to optimize her healing and allow early mobilization with both the injured leg and arm. By performing surgery on both extremities, she was able to use them immediately for weight bearing and movement with therapy, which allowed for earlier recovery and helps prevent complications of lying in bed for extended periods of time.”

Sierra was a patient at Memorial Hermann-TMC for 3 ½ weeks. Once she was medically stable, she was transferred to TIRR Memorial Hermann to begin inpatient rehabilitation.

Upon arrival at TIRR Memorial Hermann, Sierra describes her state of mobility and consciousness as “early toddlerhood stage.” During her inpatient time at TIRR Memorial Hermann, she received speech, occupational and physical therapies.

“When Sierra was admitted to TIRR Memorial Hermann, it was important for her to immediately begin her rehabilitation treatment so that she could start to regain strength and mobility as well as address the unique needs of the brain injuries she sustained in her collision,” said Dr. Sunil Kothari, assistant professor of Physical Medicine and Rehabilitation and advisor for TIRR Memorial Hermann’s Disorders of Consciousness program.

Although her memory of her time at TIRR Memorial Hermann is intermittent, Sierra does recall the personalized and individualized care she received. “As a former soccer player, my therapists used a soccer ball during exercises to help me regain leg strength,” she said.

Sierra believes the efforts to incorporate her interests and hobbies into treatment aided her motivation in the recovery process.

To progress through therapy, Sierra and her team set small tangible goals, such as counting how many feet she could walk. Other goals were being able to independently feed herself, dribble a soccer ball and preform the necessary functions of daily living on her own. Her biggest goal was to return to Texas A&M and complete her degree.

“When she arrived at TIRR Memorial Hermann, Sierra was very confused,” said Dr. Katherine O’Brien, primary clinical neuropsychologist for TIRR Memorial Hermann’s Disorders of Consciousness Program and program manager of the Brain Injury Program. “Sierra progressed fairly quickly. She would frequently tell me how ‘smart’ she used to be. I explained to her brain injuries don’t make someone less smart; they just make it harder to show it sometimes.”

After a month of inpatient rehabilitation, Sierra discharged from TIRR Memorial Hermann inpatient care. At that point, she was able to walk, talk in coherent sentences, independently perform most of her activities of daily living and safely feed herself meals.

In August 2014, Sierra reached her goal of returning to college. She earned a degree in biochemistry in December 2017 and then earned a nursing degree in May 2021 from Houston Baptist University. Today she is a bedside nurse for patients diagnosed with TBIs at TIRR Memorial Hermann. From being a patient to now being a nurse for TBI patients, Sierra has turned her successful recovery into inspiration for the patients under her care at TIRR Memorial Hermann.

“We work together frequently now,” says Dr. O’Brien. “I love hearing her opinions of patients and the behaviors she observes. She asks great clinical questions about brain injury. I also think she has a unique perspective she can share with patients and their families, having been in their shoes. Years of experience in brain injury and/or different educational degrees can never give you the ‘lived’ experience she has.”