Celeste's story: Driven by determination

Recovery fueled by grit and resolve

"I was driving home, and the next thing I know, I'm in the hospital," recalls Celeste Nasuti, the CFO of Summerwood, a Conshohocken-based company that operates more than 200 Taco Bell and KFC franchises across six states.

It was 5:30 p.m. on December 5, 2023. Celeste, then 71, was driving her regular route home from work with her dog Marci in the back seat when, according to the police report, she swerved to avoid something in the road. "That's an area where you could have had deer coming across the street," she says. "Anything's possible. It was night, it was dark."

Celeste was involved in a collision and suffered major head trauma. Firefighters arrived on the scene to assist the paramedics in extricating her from her car (they rescued Marci as well, who sustained no injuries), and Celeste was transported to Lankenau Medical Center. A CT scan revealed a subdural hematoma — bleeding around the brain that was causing dangerous pressure and swelling — and she was rushed into emergency surgery.

By the time Celeste's husband Jim arrived at the hospital, she was already in the OR. "They had already started working on me," she says. "They were trying to relieve the pressure on my brain at that point. I was heavily medicated. I never felt anything."

Three weeks post-surgery, Celeste was moved to a long-term acute-care facility to recover while her respiratory status improved; she still needed a ventilator to support her breathing.

"I don't remember a lot from that period," she says. "I was there over Christmas, and I was told stories about my husband and my sister visiting on Christmas Day, but I have no memories of that. I was lying there at times, thinking about things that had to be done at work. If people came by and I was awake, I knew who they were. When you're sedated, you don't necessarily remember everything, but I never felt that I had lost something with my brain."

After six weeks, she was weaned off the ventilator and her feeding tube was removed before she was admitted to Bryn Mawr Hospital in early February 2024 for a cranioplasty to reattach the bone flap to her head, which had been removed during her first surgery to accommodate the brain swelling. A couple of days later, on February 9, she was transferred to Bryn Mawr Rehab Hospital.

"We wanted to go to Bryn Mawr Rehab Hospita because it has an excellent reputation," Celeste says. "If you're going to go somewhere for something like this, that's the place to go."

Putting in the (hard) work

"When Celeste first arrived, her mobility skills were compromised and she still needed a considerable amount of assistance to do some of the things you and I might take for granted," says Mithra Maneyapanda, MD, medical director of the brain injury program at Bryn Mawr Rehab Hospital, who oversaw Celeste's recovery process.

"Her cognition was impaired as well. She was still having some difficulty with knowing the exact date, and she had a lot of challenges with attention and memory skills." As her language skills were also not entirely intact, Celeste had to point to letters or write on a whiteboard to communicate with her family and medical care team.

Celeste embarked on a month-long, intensive inpatient rehab program with grit and perseverance. Whether it was physical, occupational or speech therapy, she approached each challenge with focus and determination.

Celeste entered the facility at a "moderate assist" level: She needed 50 percent help for most daily living activities, including eating, dressing and bathing, and transfers, from the bed to the wheelchair to the walker. She was also struggling with some balance issues and weakness on her left side — her left arm, hand, and leg — due to her right-sided head injury. Celeste was eager to regain her independence and demonstrated a strong work ethic throughout her stay.

"Celeste was very motivated," says Casey Converse, Celeste's inpatient occupational therapy advanced clinician. "She liked us to time or score her tasks and return to them periodically so we could track her progress. She would be like, 'How did I do? I have to do it faster. You have to time it.' She liked to have the numbers for comparison.

"When you have patients who are high functioning in their regular life, they have higher expectations for themselves," adds Casey. "A normal score on a task is not indicative of their previous level of function. If you were a top 10 percentile person before, we need to keep working and we don't just stop because they reached the standard average metric."

Family filled her corner

Celeste's recovery was strengthened by her family's support, advocacy and commitment. Jim was a regular visitor, as was her younger sister, a retired anesthesiologist from California, who relocated back East the day after Celeste's accident to help manage her care. While Celeste was still at Lankenau, her sister was proactive in her recovery and doubled the therapy the staff provided, learning everything they were doing and repeating it on Celeste's off days or whenever she had some extra energy. Celeste's other regular visitors included her children and another sister, who lives in Maryland.

"Celeste had a ton of advocates in her corner," shares Dr. Maneyapanda. "Her sister, who is a doctor, was a strong force and a strong voice throughout the process. Even in the outpatient phase, she was still here overseeing Celeste's care and making sure she could advocate for her."

At Bryn Mawr Rehab Hospital, Celeste's sister had so much confidence in the team and their plan for Celeste's recovery that she finally felt she no longer needed to manage her day-to-day care. "I could tell that Celeste was in excellent hands," she shares. "I was incredibly impressed with the staff and program."

During her stay, Celeste participated in all of the offered therapies, including art, music and recreation. Her favorite activity was going to the greenhouse, where she worked on her balance by managing a watering can while using a walker and practiced fine motor skills by making floral arrangements.

"I liked going to the greenhouse, that was very nice," recalls Celeste, who refers to Bryn Mawr Rehab Hospital as "the luxury resort" of rehabs.

Back in the driver's seat

Once she was able to perform the basics of selfcare, Celeste transitioned to the rehab's outpatient program, where, over the course of three days a week for approximately six months, the focus turned toward relearning and mastering skills that would allow her to live more independently, including walking on her own, improving her balance, returning to work and getting back behind the wheel. Celeste demonstrated the same level of drive and determination that she had during her inpatient stay.

"We worked on many high-level, multistep tasks to support her executive functioning skills," says Jolynn Thomas, Celeste's outpatient speech language pathologist. "She was determined to return to her job and was willing to put in the work to take the 'baby steps' needed to get there. We worked on everyday tasks and those related to her expertise in finance/accounting, which required a high level of attention and problem-solving skills."

"From the day I met Celeste, I knew I admired her," adds Jacki Santillo, one of Celeste's outpatient occupational therapists. "Her motivation, drive and strength showed through even on that first day. She was the type of person who would receive a home exercise program and then ask for more. Her husband also was a big cheerleader for her, encouraging Celeste to perform a huge number of 'sit-to-stands' each day to whip her back into shape."

Celeste supplemented her outpatient therapies with twice-weekly personal training sessions, which she coordinated with her therapists at Bryn Mawr Rehab Hospital. "She wanted to get back to work as soon as possible," confirms Dr. Maneyapanda. "She especially wanted to get back to driving."

In preparation for her return to the road, Celeste completed Bryn Mawr Rehab Hospital's specialized driver's rehab clinic, which involves some pre-driving assessments, such as cognitive reaction times and anticipation of environmental hazards, and uses dual-control vehicles for taking patients on the road to safely test their driving capabilities. In November 2024, she passed her driver rehab evaluation and on-road testing.

"I went out with my husband a couple times to practice driving in a cemetery. It's a very good place to practice because the residents don't care," Celeste shares, demonstrating the wry sense of humor that several of her therapists commented on in their reports. "Once I could drive the 10 minutes from my house to the office, I was back at work full time."

Thanks to the excellent care she received at Bryn Mawr Rehab Hospital, Celeste was able to achieve all of her goals.

"The crew at Bryn Mawr is amazing. I wanted to be able to get out of there walking on my own without any assistance. I wanted to drive a car and be able to go back to work. I just wanted to live my life the way I had before," explains Celeste.

Less than a year after that fateful December evening, Celeste was able to resume what she refers to as her "normal life." One of her doctors highlighted how remarkably well she has recovered compared to others with similar injuries.

"I didn't want this injury to define my life," she says. "It happened, yes, but it's not who I am."

Next steps

Learn more about rehabilitation care at Main Line Health

Learn more about outpatient rehabilitative therapy

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