Sunday, September 7, 2014

A Subarachnoid Hemorrhage, the Day I Thought I lost My Wife

By Horatio Green

An Angiograph of a grape sized berry aneurysm in a cerebral artery.
 Credit: Lucien Monfils; Copyright:GNU Free Documentation License

On May 27, 2014, my wife Kathy woke up happy, singing and humming to herself, ready for the day. But, for the little girl I married fifty-one years ago, and me, it only took an instant for our lives to change; certainly Kathy’s more than mine.

On that day in May, our day started out as normal for a Tuesday morning. On Tuesdays and Thursdays, Kathy and I would pick up two of our grandsons and drive about 20 miles north on route 3 and onto the southeast expressway in order to take our oldest grandson to preschool.

On those days, we would leave our home at about 6:45 a.m. But on that Tuesday, just as we were about to leave, Kathy went into the bathroom. After a couple of minutes, I called her name and shouted, “We’re going to be late!” There wasn’t a response. I again called her name. When she didn’t respond, I unlocked the door. I found her unconscious, seated with her head back, and hardly breathing.

I immediately called 911. The Fire Department’s Emergency Medical Technicians (EMT) arrived about 5 minutes later. EMT attempts to arouse Kathy failed. On the stretcher, before being lifted up into the ambulance, it didn’t look like Kathy was breathing. They closed the ambulance’s doors. After about 15 minutes, which seemed like forever, they summoned a firefighter to drive the ambulance. With two EMTs in the back with Kathy, they drove off to Beth Israel Deaconess Hospital Plymouth.

When I arrived at the hospital, a nurse told me the E.R. physician needed to speak with me. I thought, at that moment, Kathy had died. The physician explained that my wife experienced bleeding in her brain. He said they had called for a helicopter to medflight her to Beth Israel Deaconess Hospital Boston (BIDH). He cautioned me not to have high expectations that she would survive.

After notifying our families, I drove to BIDH Boston. Those who could take the remainder of their workday off met me at the hospital. We were escorted into a conference room; we all knew this was an indication we were going to receive bad news.

Dr. Christopher Ogilvy, Director, Endovascular and Operative Neurovascular Surgery at BIDH, met with us.

Dr. Ogilvy explained that Kathy had suffered a subarachnoid hemorrhage (SAH) because of a ruptured aneurysm (a bulging spot on the wall of one of her brain arteries between the brain and the membrane covering had ruptured), and that she was in a medically induced coma.. He told us a Surgical Intensive Care Unit (SICU) physician had inserted a tracheostomy tube so that she could breathe, and he performed a ventriculostomy to insert a draining tube to relieve the buildup of cerebrospinal fluid in the space surrounding her brain. He said he would need to operate on her in order to surgically prevent any further bleeding; the surgery was successful. Kathy was put on life support and medications to control blood pressure and to reduce the risk of stroke and seizure.

Dr. Ogilvy explained that my wife’s prognosis for a full recovery was not good; her progress would have to be assessed on a day-by-day basis. He said we should expect days of hopefulness but also days of disappointment. He said that in about 4 out of 10 people a brain aneurysm that ruptures is fatal, and for those who survive, about two-thirds have some permanent disability. He said recovery could take six months to a year.

After about 12 days, Kathy awoke from her coma. On June 10, day 14 of her hospitalization in BIDH’s SICU, Kathy was transferred to the New England Sinai Hospital (NESH) Stoughton, a long-term acute care hospital.

Early on, NESH predictions for Kathy’s recovery were very uncertain. We were told her tracheostomy may be permanent, she may never be able to walk, may never regain her ability to speak, and may never fully recover her memory.

Over the next six weeks, Dr. Ogilvy’s prediction of days of hopefulness and days of disappointment became evident. Initially the days of disappointment were greater than days of hopefulness. But gradually that turned around, and days of hopefulness became more the norm.

There were some very hopeful signs. For instance, Kathy would recognize me but not smile, she would hold my hand, put her lips together for a kiss, kiss me, and hug me very tightly. Out of that grew many smiles and recognition for those visiting her. She began mouthing their names and attempted to mouth responses to their questions. She began to respond to questions and commands from her nurses and therapists.

Then all that hopefulness went downhill. Kathy began sleeping more than expected and was not alert or responding as she had been previously. As a result of those symptoms, on June 20, a lab test of her spinal fluid was taken, the test indicated she had acquired an infectious type of bacteria. The attending physician prescribed an antibiotic and put her on room precautions.

The attending physician prescribed arm restraints and hand restraint mittens to wear. This meant arms tethered to each side of the bed and large mittens to prevent her from pulling out her tracheostomy tube and other flex tubes that were inserted in order to deliver nutrition, medication, and for other purposes.

Previously, Kathy was receiving physical (PT) and occupational (OT) therapy inside and outside of her room three times a week, which was to increase to five days a week the stronger she got. Room precautions, however, hindered PT and OT because therapy was now confined to her room.

After four days on antibiotics, as if someone had turned on a light switch, the hopefulness returned.

From that point on, Kathy’s road to recovery made steady progress.

Over the next two weeks, smaller and smaller sized tracheostomy tubes were inserted. And on July 10, the tube was removed.

Kathy’s recovery now was in high gear.

Swallow test were performed to determine Kathy’s ability to safely swallow foods and liquids. When Kathy could safely eat and drink, progressively her diet went from puree/thickened foods once a day to three times a day, then advanced to mechanical soft food trays, and finally she was eating regular food trays.

Day by day, her ability to speak improved. I was told that she even called her friend to scheme their next Bingo trip to the Foxwoods Casino in Connecticut.

On July 20, room precautions were removed. PT and OT were now able to work with Kathy every day. Kathy increasingly gained her ability to walk and go up and down stairs. She was now able to use the bathroom without assistance, and took her first shower.

Then on Tuesday, July 29, we received the exciting news we all had been waiting for: on Thursday, July 31 at 11 A.M. Kathy would be coming home.

At home, healthcare services were arranged. A registered nurse visited once a week, and a physical therapist twice a week. On September 2, the registered nurse and physical therapist discharged Kathy.

At home, as in the hospital, some days were better than others. But, considering what Kathy experienced on Tuesday, May 27, the day I thought we lost her compared to what she is experiencing now, her recovery has been extraordinary. It has been and continues to be an extraordinary recovery, not only because of the EMT’s who first responded, BIDH’s SICU medical team and NESH’s medical team and physical therapist, but also because of the love and support from her family and friends. However, probably more importantly, it was because of Kathy’s attitude and determined spirit. “I want to do it by myself” is what Kathy will inevitably say whenever I think she needs help.

As of this writing, Kathy’s full recovery is foreseeable. Kathy and her friend went to their first Foxwoods Bingo game on Saturday, September 6. It was their first trip since a few days before Kathy’s SAH in May.

Copyright © 2014 Horatio Green