COAL TOWNSHIP - Marcos "Mikey" Velazquez remembers suffering excruciating pain he describes as an explosion inside his head.

He remembers vomiting repeatedly, rushing with family to the hospital, being loaded onto a Life Flight helicopter and the whirring sound of its rotor.

He was in and out after that, and then he was unconscious for days.

When he regained his senses inside the Pediatric Intensive Care Unit at Geisinger Medical Center, Danville, he knew next to nothing about what, exactly, had caused his pain. He was also unaware he had undergone three consecutive brain surgeries.

The emergency surgeries saved his life. So, too, did the quick actions by his family to take him to Geisinger-Shamokin Area Community Hospital (G-SACH) and by hospital staff, who arranged for his transfer to Geisinger's main facility.

Had they waited it out, had anything delayed his transport, he likely would have died within hours.

"He came so close to the brink of death," said Dr. Tarun Bhalla, the neurosurgeon who performed Mikey's surgeries. "The pressure on the brain would have built up and he likely would have died."

AVM

Mikey was suffering from a stroke caused by a ruptured cerebral arteriovenous malformation, referred to as AVM - an abnormal vascular structure consisting of enlarged and tangled vessels, according to a study of the condition by Geisinger experts found online.

A condition people are usually born with and most likely found in children, it causes bleeding of the brain and intense pressure on the skull.

"It felt like there were drills on either side of my head," Mikey said. "At first, I thought it was just a headache or pain that would go away."

The condition is so rare it affects less than 1/2 of 1 percent of the population, Bhalla said, estimating he sees up to a dozen such cases annually.

It's often discovered in patients who have a CT scan for another condition or, as in Mikey's case, when a stroke or some other symptom occurs.

Life or death

On Nov. 10, Mikey had finished watching a movie with his mother and he went to his bedroom. One hour later, the pain had arrived. It was unbearable, he said.

Initially, Jessica thought it was a migraine, like Mikey had first assumed. She got some Tylenol and a drink and came back to see her son slumped in a kitchen chair, sweat soaking through his clothes. He had hardly enough energy to lift the drinking glass. She called her sister to pick them up.

"We had to go. Right away we had to go because that's not just a regular headache," she said.

A CT scan at G-SACH confirmed the hemorrhaging and arrangements were made to fly Mikey to Danville, where he was stabilized. Surgery was scheduled to begin the next morning.

"'Is he really telling us our son is bleeding from the brain?' I couldn't really comprehend what the doctor was telling me, because I didn't want to. 'Is my son going to live?'" Mike recalls asking.

3 surgeries

Bhalla compared the pressure Mikey was enduring to an overpacked suitcase. "You can only fit so many things inside it," he said.

The first surgery was to drain spinal fluid from the brain. A hole was drilled into his skull and a catheter snaked from the brain's surface to its center to access the fluid-filled spaces.

After more detailed images were taken of Mikey's blood vessels, the medical team began a second surgery to snake another catheter, this one from his groin all the way to his brain, gluing off the vessels at the AVM.

The third surgery was to open his skull and remove the AVM and a blood clot.

A fourth procedure later that evening confirmed the surgeries were successful.

The surgeries lasted about 12 hours, and through it all, Mikey's parents sat in a hospital waiting room fretting over their only child.

Feeling fine

Jessica Lopez and Marcos "Mike" Velazquez, his parents, feared the worst. But Mikey pulled through, and quickly, too. He was discharged 10 days later, successfully completed physical and speech therapy, and in February returned to Shamokin Area Middle-High School to resume his freshman year.

On Wednesday, one day after Mikey celebrated his 15th birthday, the Coal Township teenager walked briskly into the main lobby at G-SACH. There was nothing unusual about his gait; his speech was clear and his mannerisms confident. He has to stoop low, use his fingers to hold back the hair just above the nape of his neck to show off a small scar where an incision was made.

Bhalla called Mikey's recovery "remarkable." The boy's father, Mike, said it's nothing short of a miracle.

"It was all tears that day. It was nuts," Mike said. "My son could have died on the operating table. When they said that, we couldn't hear anything else. My wife and I cried and hugged each other.

"This kid was on his death bed," he continued before remarking on Mikey's restored health. "God is good. I don't care if people say He doesn't exist. I don't know what to tell them."

Since the AVM was located in Mikey's cerebellum, his coordination and balance were thrown off. His speech was slurred. Mikey's spotty recollection of the ordeal can be attributed more to trauma, anesthesia and medication, and not to his brain's malfunction.

After leaving Geisinger, he spent another three days at the Penn State Hershey Rehabilitation Hospital, Hummelstown.

"They asked me what my goal was, and I said to get home as soon as possible. In reality, my real goal was to get home before Thanksgiving. I got home before Thanksgiving, and on Thanksgiving Day, I felt pretty good," Mikey said.

Happy birthday

Mikey had just one outpatient rehab session and was given some suggested rehab to do on his own. After being homebound for three months, Mikey returned to school. He's cleared to do what most all other kids his age does, gym class, too. He'll have to take a pass on weightlifting and contact sports, though, for the time being.

Bhalla said there's about a 5 percent chance of an AVM recurrence. Mikey said headaches have returned now and then, something doctors prepared him for. They're nowhere near as painful as what he experienced Nov. 10.

His parents had a small birthday party for him last week. Mikey got his favorite breakfast: banana pancakes. Jessica had a cake waiting for him when he got home, and they all went out for dinner that night.

He got another birthday gift, too, this one from the Make-A-Wish Foundation - an electronics shopping spree, a good gift for a confessed video game addict.

While Mikey, Jessica and Mike wrapped up their story inside the lobby at G-SACH, his mother prompted her son.

"The struggle is what?" Jessica asked.

"The struggle," Mikey says, "is real."