Monday, June 27, 2011

Friday the 13th

May 13, 2011 started out like most of my Fridays, with a 5 am jaunt to the YMCA for masters swim class. As I was nearing the end of my workout, the day quickly took an unexpected turn as the receptionist ran into the pool area.

“The hospital needs you to call immediately,” she said. I was instantly in the locker room, digging through my giant bag for my phone. I wasn’t on call, so for the nurses to track me down at the gym, something seriously bad had to be occurring. I assumed that one of my partners must need help with a hemorrhage or some other emergency. Never in my wildest dreams did I expect to get the news I received.

“JB just suffered a cardiac arrest. She was transferred to the ICU. We are not sure if she is going to make it...” My partner’s voice was shaking on the other end of the line.

At this point, I just went numb and everything began to happen in slow motion. This could NOT be happening. JB was my friend. I had delivered her baby just a few days before. She was most likely going to die. I had failed her. She was my patient, my responsibility. I had obviously missed something.

The four mile drive to the hospital seemed to take two hours. My mind raced through all the possibilities: stroke, seizure, heart attack, pulmonary embolus. None of the options were acceptable. I tried to think of what I might have missed. I analyzed every detail of our last conversation. She had called me from home the night before with symtoms of a headache and high blood pressure. I had told her to go to the ER. Being the clever nurse practioner that she was, she tried to talk me out of it, but I had insisted. Later my partner had admitted her, in order to watch her overnight. I had delivered her third baby 10 days earlier, boy number three for her. At the end of her pregnancy she had developed preeclampsia, a fairly common complication that usually resolves with delivery. I kept thinking of what I could have done differently, but as I went back through the case in my head, everything seemed to have been done appropriately.

This can’t be happening. I’ve never lost a mom. Healthy 35 year old women’s hearts don’t just stop. My prayers were brief and desperate. Lord, let her live.

With my hair still wet from the pool and my eyes still puffy from my swim goggles and crying, I arrived in the ICU a few minutes later. She was stable, but still in a coma. I began to have hope that she might make it, but could dare to hope that she would really be OK, to not have a brain injury?

I reviewed the history with my partner and the other physicians. Her husband had stayed with her in the hospital overnight, and heard her gasp and stop breathing. He quickly called for a nurse. She found no pulse. A code was called. After 12 minutes of resuscitation the team brought her back. She was essentially dead for 12 minutes. All the while her husband stood by, holding their newborn son.

I tried desperately to focus on the medical facts and numbers, while pushing the emotions to the side. This became impossible as I walked into her room. My beautiful, intelligent friend lay intubated in the ICU. Her normally tan skin was grey and dusky. Her blonde hair disheveled, while tubes and monitors encapsulated her small frame. The girl who never stopped moving or talking now lay before me unresponsive, with restraints on her hands.

When I saw her husband’s swollen, tear stained face; mt own tears once again began to roll. We hugged.

“Doc, Is she going to be OK?” He asked fearfully.

“Yes, I hope so.” I said, more as a statement of faith, than medical fact.

The morning was a blur of activity. A stream of specialists were consulted to help us search for a cause. More tests were ordered, but no answers were found. We ruled out some dreaded possibilities: brain hemorrhage, heart attack and tumor. I tried to remember if I've ever had a patient fully recover from a cardiac arrest. The only patients who had coded in my care were elderly. The ones who made it, had severe brain damage. The thought of her surviving but in a severely disabled state was almost as frightening as the thought of her funeral.

As all the tests began to come back negative, I began to let go of the guilt over what had happened. None of the things I knew to check for had occurred, so maybe it wasn’t my fault after all. Still the questions lingered.
Being a typical Friday, my office schedule was fully booked. All patients who could be were rescheduled. The rest I saw in short bursts, as I ran back and forth between the office and the ICU. In the office, I attempted to feign interest in the mundane yeast infections and round ligament pain. I tried my best not to be distracted, but it was nearly impossible.

As the morning stretched forward, we got our first bit of amazing news: the neurologist finished the EEG and it showed normal brain activity. He was hopeful for a full recovery. When I told the good news to our office staff they literally cheered. I assumed the recovery would be long and painful, but there was hope.

The afternoon led to even more good news as her oxygen requirements began to decrease. Yes, she was still on a breathing machine, but needing less and less help to breathe. She was beginning to wake up and fight the restraints. The specialist in charge of ICU decided to keep her sedated and let her heal, and then take her off the breathing machine in the morning.

I left that evening guardedly hopeful, praying for a full miracle.

When I finally made it home, I embraced my husband and kids like I hadn’t seen them for weeks. My heart was so thankful. Never would I take my life or family for granted. The usual dinner routine seemed surreal. Then as I was finishing my hamburger helper, my cell phone rang.

“Call from JB,” it said on the display.

My hand was shaking as I picked it up and hit the accept button.

“Hey it’s JB Husband, just letting you know that they took the tube out and she’s awake… and talking!”

“I’ll be right there.”

Within minutes, I was walking back on to the unit. The neurologist had warned us that she would have short term memory loss, likely for a week or two. He felt that she would most likely not remember the cardiac arrest. Still, I wasn’t sure what to expect.

As I walked into her room, she was sitting up in bed, looking absolutely fine.

“Hey, what are you doing here?” JB asked.

“How are you?” I said.

“A little sore…. Why are you crying?” JB responded.

“I was worried I would never hear your voice again.” I replied. Weeping. Again. For what felt like the millionth time, during this roller coaster of a day.

“Really? I don’t understand, I just had a c-section?” JB replied

The room, which now included several members of her family, laughed with relief. She remembered nothing that had occurred since she had her son 10 days before. She just woke up, assuming she was waking up from her c-section.

During the first few days, talking with her was akin to having a conversation with your elderly aunt who is suffering from dementia. It was definitely ‘her’ in there. All distant memories were intact, but during a conversation she would begin to repeat herself every few minutes. This also created the challenge of having to tell her, over and over, what had happened. Each time she would react emotionally as she ‘heard’ the dramatic news for the first time. After about 4 days her memory began to improve and she could remember things that had occurred the day before. Currently, she reports occasional forgetfulness, but has had a full recovery. She required no rehab and has had only minimal discomfort.

With all tests essentially coming back normal, the heart specialist determined that she had an underlying arrthymia. This abnormal heart rhythm was then exacerbated by the stress of preeclampsia on her body, causing her heart to go into cardiac arrest. This extremely rare event just happened to occur at the right time and the right place. He felt she could be at risk for cardiac arrest in the future, so a permanent device was implanted in her heart before she left the hospital. The device will automatically shock her heart back into a normal rhythm should she ever go into arrest in the future.

Since that day, I have thought many times of the ‘what ifs.’ What if she hadn’t called me? What if I hadn’t sent her to the hospital? What if her husband hadn’t stayed with her? What if the code team hadn't responded so quickly? If any one of these elements had not occurred, she would not be with us today. I am so thankful for the prayer chains that were activated, the attentive nursing staff and the many specialists who were involved in her care. I am most thankful to God for allowing her to have a second chance on life.

-The previous story is true and told with the patient's permission. It is cross posted at The Pregnancy Companion

13 comments:

  1. So glad this had a happy ending.

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  2. There was an article in NEJM a few years back about cardiac arrest outcomes and where you had your cardiac arrest. The ICU's the best place.

    Your post also reminded me that one of the amazing things about the brain -- especially younger brains -- is how plastic they are.

    Your friend is really lucky to have you.

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  3. Took my breath away,
    All on one post the reason I question my career choice and the reason I wouldn't do anything else.
    Thank you.

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  4. She was actually on a regular postpartum floor, when the arrest occurred. I Her last BP before the arrest was normal, and she was getting vitals q 2 hours.

    Again, why I'm thankful that her husband was in the room.

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  5. Well in any case, better in the hospital than at home.

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  6. your posts are always so exciting and so touching all at once. loved it. and I also love the refreshing humility you have, and how you give thanks to God for the outcome. very beautiful.

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  7. Even as a fellow ob/gyn, your post had me in tears reminding me again of the fragility of life and how quickly things can go bad in our profession. Can't believe you have never had a mom die either. God bless JB!

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  8. Thank God your friend is okay. Sometimes I think some people are meant to survive, in spite of the odds. Take care.

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  9. What an amazing story. I do not imagine things will be the same for you for a while. Did this just happen this May? Incredible. I am thinking about how difficult this must have been. We are trained to deal with terrible situations with impartial strength. To watch (and feel) the tragedy unfold must have been agonizing. What a relief that she woke up! This reminds me that even the darkest days are often part of God's plan, yet it often seems a mystery during the struggle.

    Rh+ so great to hear you are a Master's Swimmer! Fantastic. I love to swim too..... I like to say that I am in training for the "Senior Olympics"!

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  10. Wow, what a powerful story. So glad it ended well!

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  11. Kellie (general surgeon)June 28, 2011 at 5:04 PM

    So glad that your friend, patient and colleague was ok. Things aligned just right for her to be a survivor. This is the swiss cheese theory happening in a good way.

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  12. Your post had me in tears. 6 months ago I was on the code team responding to cardiac arrest in a women who just 30 minutes post-partum. I coded her for 2 hours hoping that we would keep that pulse but she never regained cardiac activity. Its the only time I've had to code someone who has just delivered a child and I hope to never do it again. Your friend is a miracle and I am so happy that she is recovering.

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  13. Just catching up after a week off. Fantastic post. Gave me goose bumps. Thanks for sharing.

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