Authored by: Mary Beth Hanley, D.O. Kent Hospital – Warwick, Rhode Island
I cannot remember a time in my life when I was not interested in Medicine. As a young child I loved watching medical programs on TV, and pretending to cure my sick stuffed animal patients! These were still the days when girls were not encouraged to pursue careers in medicine. I decided to pursue a career in Nursing. My favorite high school teacher voiced his disappointment to me that I was not going to go to Medical school, but I had been accepted at a wonderful college with an excellent Nursing program and I was going to change the world.
I graduated Magna Cum Laude with a Bachelors degree in Nursing and a double minor in Biology and Spanish. I took my first job in an ICU step down unit and ultimately ended up in the Emergency Department. I became more and more frustrated with the limitations on my practice and skills and finally one of the Chief Surgical residents said to me, “When are you going to stop messing around and just go to Med School?” I took my admission tests, got accepted and 4 years later I was in innercity Baltimore doing my internship year. I did my Anesthesiology and Critical Care Medicine residency at the Johns Hopkins Hospital in Baltimore. I fell in love with Pediatric Anesthesia and with kids in general. I was Chief Resident my senior year, and joined the Faculty of the Johns Hopkins School of Medicine after completing my Residency.
In 2002, 2 weeks after the birth of my fourth child in 4 years, my husband and I moved our young family back to Connecticut to be closer to my Mother and family. I took a job at a small community hospital in the Northwest part of the state, and settled in to the role of part-time anesthesiologist, full-time Mom! Life was good.
In May of 2008, I was at work when I noticed my right hand was swollen, red, and becoming more and more painful. I showed it to a hand surgeon colleague who said, “you have a hand cellulitis, and you need IV antibiotics”. “O.K.”, I thought, I can finish my shift, have one of the nurses put in an IV and give me the medicine, and that will be it. Unfortunately, it was the beginning of a nightmarish 2 year journey that led to multiple surgeries, loss of the use of my dominant right hand, loss of my job and insurance benefits, the realization that many people who I thought were my friends were not, and near financial ruin for me and my family.
My cellulitis progressed to Necrotizing Fasciitis, a potentially deadly infection that almost cost me my arm. I was taken to the OR emergently on a Saturday so a hand surgeon could open up my hand and forearm and debride dying tissue and hopefully stop the spread of the infection. I was fortunate that this was done in a timely fashion, otherwise I probably would have lost my arm. It was Mother’s Day 2008 and I was in the hospital fighting for my life when I should have been enjoying brunch with my family. I was discharged home after 8 days in the hospital with a central IV catheter called a PICC line that snaked from my left upper arm to the right side of my heart. I gave myself IV antibiotics at home every 4 hours around the clock for 6 weeks. I began a program of intensive hand therapy and splinting that would go on for months. I learned how to dress myself and my children with one hand, how to feed, dress and groom myself with my non dominant hand and most importantly to write with my left hand. I could no longer use a keyboard with 2 hands, play my guitar, or paint and draw as I had enjoyed doing in the past. I battled non-healing wounds and ulcers on my wrist and forearm that stubbornly resisted healing and closure. I wore a Wound Vac, which is a large cumbersome device designed to close wounds, for weeks. I received a phone call from one of my former anesthesia colleagues in January 2009 telling me they did not want me back and that my medical benefits (which I carried for my family), would end February 1. I was profoundly depressed. I felt like my world, and everything I had worked so hard for was falling apart around me. The only thing that kept me going was my children. I was determined to get better to be the Mom that I was before all this; the Mom who taught them how to fish, and ski and play tennis, and played catch with them. I eventually taught myself to do all these things with my left hand, albeit not well.
Things sort of continued to drag on with one PICC line after another; one course of IV antibiotics after another; one surgery after another until March of 2009. I was re-infected and had several non healing wounds on my forearm. I had developed a deep ulcer on my wrist where a splint had dug in too deeply. There was black tissue and tendon visible from the surface. I was in agony. The surgeon tried unsuccessfully to debride the wound in the office which was incredibly painful. Everytime I moved my arm it throbbed. I was beside myself with pain. I was admitted on a Friday and started on around the clock IV narcotics which helped get the pain down to a manageable level. I was in a private isolation room which was a converted supply closet. It was too small for a comfortable chair for me to get up and sit in. My only trips out of bed were to walk 8 feet to the bathroom and back. On Sunday, March 21, I awoke around 7 AM and took my IV pump into the bathroom with me. As I washed my hands and looked at myself in the mirror, I thought I looked very pale. Then I began to feel short of breath. I just could not catch my breath. I made my way back to my bed and sat down in it. I thought “I’ll just sit here awhile and I’ll be fine.”
When the Nurse came in a few minutes later with my foodtray, I was unconscious, unresponsive and blue. I remember a very peaceful feeling came over me and I could see the Nurses and the resuscitative equipment and hear the STAT pages, but I did not care. It was like I was floating above everyone and I did not care in the least what was happening! Then I heard the sounds of my children’s voices all calling “Mommy” at different times. When I opened my eyes, they were pushing air into my lungs with a resuscitation bag. I looked at my hands and thought “ wow, I am really blue..this is not good”, with a clinical detachment only a doctor turned patient could have. Everyone kept telling me to take a deep breath so my oxygen level would go up, but try as I might, I still felt like I just could not catch my breath. I was being wheeled down to radiology as the Surgeon said , “I think you had a P.E, hang in there”. He looked scared.
The emergency CAT scan of my chest showed a “massive pulmonary embolism” . There was barely any room in my pulmonary artery for blood carrying oxygen to get through. My right heart was failing due to the increased force it encountered in what is normally a low pressure system. My next stop was the ICU where the Intensivist covering the unit said, “you had a massive P.E., you’ll be here for awhile”. I was started on injections of a low molecular weight heparin product to decrease my blood’s ability to clot. This does nothing to dissolve clot that has already been formed, it only prevents further clot propogation. I struggled to breathe for the next few days. My oxygen saturation would plummet to the low 80’s everytime I stood up and pivoted to use a bedside commode, (normal is 97-100%) . My feet and ankles swelled up due to the fact that my heart could not pump hard enough to keep everything moving forward. I developed enormous bruises all over my abdomen from where the heparin shots were given. The ulcer in my wrist continuously oozed as my blood became thinner and thinner. I was at grave risk of dying for the first 72 hours. My husband, a physician, came in with my Mother and children, ostensibly to say good-bye. I will never forget the stricken look on my 8 year old son’s face when he saw his Momma in the ICU struggling to breathe. He tried so hard to be brave. His teacher later told me he cried everyday in school and told her he was scared his Mom was going to die. That went on for months even after I came home from the hospital.
The ironic part of this horrible situation is that every first year medical student learns about something called “Virchow’s Triad”. The Triad consists of (1) injury to the inner lining of the veins (usually the leg veins), (2) stasis of blood flow in the veins (usually the legs) and (3) hypercoagulability of the blood. One or two of these symptoms puts a patient at an increased risk of a deep vein thrombosis or pulmonary embolism. In my case, I had all three, plus I was overweight, taking hormone replacement therapy, had diabetes and rheumatoid arthritis. I should have just had “HIGH RISK FOR DVT /PE” tattooed on my forehead! So how is it that not one doctor or nurse who saw me, or saw my chart ever thought to do anything to prevent this PREVENTABLE disaster? There was a form in every patient’s chart in my hospital where the attending physician or primary nurse was supposed to assess the patient’s risk for blood clot, and order appropriate interventions. Some of these interventions are as simple as wearing support stockings while hospitalized, or daily low dose injections of heparin while hospitalized. They are simple, relatively painless interventions, and yet in thousands of hospitals and for tens of thousands of patients these simple interventions are overlooked, often leading to catastrophic events. Nobody wrote any orders for DVT/PE prophylaxis in my chart, even though the hospital put the assessment and order sheet in every patients chart. I was an attending anesthesiologist at this hospital, my hospital, and because they did not follow their own protocol, I almost died. The Surgeon General in 2007 called DVT/PE one of the leading killers of hospitalized patients and urged all hospitals to aggressively initiate prophylactic treatment on any patient admitted to the hospital. If this can happen to me, a physician, I can only imagine the danger the lay public faces from this silent killer when hospitalized.
After spending 7 days in ICU I was finally discharged home on continuous oxygen therapy, and on lifelong blood thinner medication. I was able to go off the oxygen after about 8 weeks, but I still get short of breath easily. I take medication for my heart everyday as well. There has been some permanent damage to both my heart and lungs, as well as to my faith in my former hospital. I always try to find the best in a situation, and even though this was by far a physically and mentally devastating experience, I now believe that I survived so that I can teach the lay public to ask their physicians about this if you are ever admitted to a hospital, and also to enlighten my fellow medical professionals, hospital administrators and risk management personnel how easy this is to prevent, and how tragic it can be. I survived my PE against the odds; I hope to level the playing field by preaching prevention so no one has to try to beat the same odds that I did.