Time seemed to slow as Marjan Ghassemi saw her 17-year-old son, Bobby, lying in a hospital bed after a car crash.
He had a thick band of gauze wrapped around his head and a tangle of tubes protruding from his body. A hole was cut into his windpipe, and the hollow-sounding hiss of machines helping him breathe filled the room.
At that point, there was no telling whether he would live or die, but Marjan was determined not to cry.
"From day one, when we got there, I didn't want him to know we were crying, that we were upset," she said. "I wanted all positive energy in the room.
"I went in his ear and said ... 'You fight your way and come back to us.' "
It was March 2010. Bobby Ghassemi had been driving fast along a winding road in Virginia when his car barreled off the road. By the time paramedics arrived, he was in a coma and barely alive.
"For all intents and purposes, he was dead on the scene," said Dr. Michael Lewis, a physician who later advised the family. "I'm looking at the reports, and they report a Glasgow Coma Score of 3. A brick or a piece of wood has a Glasgow Coma Score of 3. It's dead."
Ghassemi was airlifted to a hospital. For the first three days, it was touch and go.
Ghassemi's brain was so engorged, doctors needed to relieve the pressure by taking out a portion of his skull. He also had what is called diffuse axonal injury: bleeding that suffused nearly every part of his brain.
"His doctor said to me, 'Listen, he has survived. It is a miracle that he lived, that he made it,' " Marjan Ghassemi said. " 'If he comes out of the coma ... I don't know if he's going to be a vegetable for the rest of his life or whether he'll remember anybody.' "
Ten days later, as Bobby lay comatose but stable, his father, Peter Ghassemi, was sick of waiting and desperate for an intervention. After a series of phone calls to friends, he ended up speaking with Lewis, an Army colonel and doctor.
After some discussion, Lewis proposed something that Peter Ghassemi had never heard about for traumatic brain injuries: fish oil.
At that point, Peter Ghassemi was open to anything.
"Every minute passing was hurting my son ... because they weren't really doing anything to help him besides keeping him alive and stabilizing all of his vital signs," he said. "If there was a chance to improve, I wanted it to be done right then."
'He was really in dire straits'
Fish oil -- which is composed of omega-3 essential fatty acids, also found in the brain -- had been used only once before to treat a brain injury as devastating as Ghassemi's. That was in 2006, in the case of Randal McCloy, the sole survivor of a mine disaster in West Virginia.
McCloy, 26, was trapped in a mine for 41 hours while the air around him and 12 other miners filled with noxious methane and carbon monoxide. By the time he was pulled from underground, he had had a heart attack, was in liver and kidney failure and had a collapsed lung, according to his doctors.
His brain was also riddled with damage from the carbon monoxide and methane.
McCloy's prognosis was not very different from Ghassemi's. According to his neurosurgeon at the time, Dr. Julian Bailes, restoring McCloy's normal brain function was truly a long shot.
"Randy was really on death's doorstep," said Bailes, now co-director of NorthShore Neurological Institute in Evanston, Illinois. "He was really in dire straits."
Like with Ghassemi, once McCloy was stabilized, there was little doctors could do to stem the tide of inflammation and cell death occurring in his brain.
But Bailes and other doctors on McCloy's team resisted the "wait and see" course common in these types of cases and began an unorthodox treatment regimen, including hyperbaric oxygen treatments and high doses of fish oil.
"The concept was then trying to rebuild his brain with what it was made from when he was an embryo in his mother's womb," Bailes said.
The brick wall analogy
That's the theory behind using omega-3 fatty acids to heal brain injury. The human brain, which itself is a fatty mass, is about 30% composed of omega-3 fatty acids, according to Lewis.
In his words, high doses of omega-3 fatty acids, since they mirror what is already in the brain, could facilitate the brain's own natural healing process.
"It really gets down to what I would call my brick wall analogy," Lewis said. "If you have a brick wall and it gets damaged, wouldn't you want to use bricks to repair the wall? And omega-3 fatty acids are literally the bricks of the cell wall in the brain."
Most of the studies about omega-3 for traumatic brain injury are in animals, but they indicate potential for healing the human brain.
After a trauma, the brain tends to swell, and the
connections between some nerve cells can become damaged, while other cells simply die.
National Institutes of Health research suggests that omega-3 fatty acids may inhibit cell death and could be instrumental for reconnecting damaged neurons.
Another recent study revealed genes that are activated to contain massive damage -- especially inflammation -- when the brain is injured. What activates those genes: omega-3.
"We have strong data that suggest omega-3 will activate good proteins to cope with brain damage and turn off proteins that cause neuroinflammation," said Dr. Nicolas Bazan, director of the Neuroscience Center of Excellence at LSU Health in New Orleans and author of the study.
And besides that, according to Bailes and Lewis, fish oil may be the only solution for brain damage that continues after a traumatic brain injury patient has been stabilized.
"There is no known solution; there's no known drug; there's nothing that we have really to offer these sorts of patients," said Bailes, who along with Lewis received money from companies that make fish oil after their treatment of Ghassemi and McCloy.
The damage to McCloy's brain was profound, according to Bailes. Not only did it experience massive cell death, the protective sheath around McCloy's nerve cells had been stripped during the hours of exposure to toxic gases. That sheath, called myelin, allows brain cells to communicate with one another.
Bailes consulted with a fish oil expert and eventually decided that administering 20 grams a day of omega-3 fish oil through a feeding tube might repair the myelin sheath. (For comparison: A typical supplemental dose for someone with an uninjured brain is about 2 grams a day.)
"We decided to throw the kitchen sink at him," Bailes said. "If we were going to fail, we were going to fail with all guns blazing, so we gave him a very high, unprecedented dose to make sure we saturated and got high levels in the brain."
Less than three weeks after the mine disaster, McCloy was emerging from his coma. Three months after that, he was walking and speaking.
Citing McCloy's dramatic recovery, Lewis spoke with Peter Ghassemi about introducing omega-3 for his son. After that conversation, Peter Ghassemi was convinced and began to pressure his son's doctors.
"It was a fight," Peter Ghassemi said. "They didn't believe, and they said, 'Fine, the West Virginia miner was one case. Bring me 999 more cases, a thousand more cases ... before I can give it to your son.' "
But eventually they conceded, and Bobby Ghassemi was started on high-dose fish oil therapy, at a dosage that mirrored what Bailes had given to McCloy in 2006.
'The whole place was cheering for me'
Two weeks after beginning the regimen, Ghassemi was emerging from his coma.
"We saw hand movements on the left side," Peter Ghassemi said. "Around the fifth or sixth week, there was some movement, and then his hands started moving more, the leg was moving more."
Soon after that, Bobby began to show signs of recognizing his family and his dog and of discerning things like colors and numbers. Slowly, his brain was recovering, and his family ardently believes that the high-dose fish oil is the reason why.
"His brain was still recovering, but with (omega-3), it recovered much faster and in a shorter amount of time," Peter Ghassemi said. "His brain was damaged, and this was food for the brain."
Three months after his accident, Bobby Ghassemi was well enough to attend his high school graduation.
"The whole place was cheering for me, and they all stood up and were screaming and cheering my name," Ghassemi, now 20, recalls with a smile. "I took my graduation cap off and waved it around."
He still has significant left-side weakness and is relearning how to walk, but his progress has been tremendous, according to Lewis.
"In my opinion, and this is pure speculation, he never would have come out of a coma if it hadn't been for the use of omega-3s to allow that natural healing process to occur," said Lewis, founder of the Brain Health Education and Research Institute. "In the end, the brain has to heal itself. There are no magic cures for brain injury."
Large-scale study needed
But what do these two dramatic stories really say about omega-3 as a potential treatment for traumatic brain injury? For now, they are merely stories with omega-3 as a common denominator.
The remaining questions are as poignant as the stories themselves: Could youth have been a factor for Ghassemi and McCloy? What about other treatments given to McCloy, like hyperbaric oxygen? Could they have played a role?
Those and other questions could and should be answered, according to experts, with a large-scale clinical study.
"These two clinical cases where we have a wildly unexpected recovery, was it just luck that they woke up?" asked Dr. Joseph Hibbeln, an omega-3 expert and chief of the Section on Nutritional Neurosciences at the National Institutes of Alcohol
Abuse and Alcoholism. "Or is there some reasonable scientific explanation for it?
"Given that there aren't any other treatments, this is a good bet," Hibbeln said. "It's really only reasonable to go forward with doing the full press of careful intervention studies."
The implications of a successful study are huge: 1.7 million people suffer a traumatic brain injury each year in the United States.
And research into how omega-3 might function for stroke, Parkinson's disease and early Alzheimer's disease is ongoing.
"The message that I'm trying to get across is, there's more you can do," Lewis said. "If you add omega-3s, we can then begin to let the brain heal itself a little more efficiently."
"Up until the time the pharmaceutical industry gives us a drug that cures all brain injury, this is the best hope we have," Bailes said.