January 29, 2020 // Perspective

Miracle in D.C.

Dr. David Kaminskas

The Catholic Doctor Is In

In August 2018 a beautiful young lady living in Washington, D.C., experienced a sudden and excruciating headache. Seconds later she fell unconscious to the floor.

Her dog, Lacey, sensed something was terribly wrong and began to lick her face. This temporarily revived her, and she was able to dial 911. The medics arrived promptly and she was taken to MedStar Washington Hospital Center, which was only a three-minute ride from her condo. Soon after arrival at the emergency room she lost consciousness again and stopped breathing. A prompt neurologic exam by the emergency room doctor revealed a fixed and dilated pupil as well as decorticate posturing. These neurologic signs are indicative of a catastrophic brain event.

This young lady is part of my extended family. Her name is Christina, but her family knows her as Christie. She is a very close friend of my fourth-born daughter, and they are also cousins. Our families vacation together and frequently break bread together. Her parents are both highly educated and work in the medical field. She has two brothers; one had served as an Army Ranger in Afghanistan and was working for a big tech firm out west at the time, while the other is a physician in residency at one of the most prestigious hospitals in the country. They all immediately headed to Washington, D.C., to be at her bedside.

Once she crashed in the emergency room, she only had minutes to live without heroic efforts. She was immediately intubated and placed on a ventilator. She then had a “stat” CT scan of the head, which documented a subarachnoid hemorrhage (brain bleed) and evidence of dangerously high intracranial pressures that would cause brain damage and possible death if not immediately relieved.

The neurosurgical team was “stat” paged, and within minutes they were able to place an external ventricular drain to help relieve the high intracerebral pressure. This entailed drilling a hole in her skull. This life-saving procedure cannot even be performed in many hospitals. She was already lucky that the medics had taken her to this particular hospital, and she was also very lucky she had a special dog.

Christie was admitted to the Neuro-ICU unit and the nurses immediately noticed she had low oxygen levels, despite being on 100% oxygen. This would be the first of several life-threatening complications that were being driven by the brain hemorrhage. She had developed Acute Respiratory Distress Syndrome, in which, basically, the blood vessels in the lungs leak fluid into the lung tissues.

Her brothers arrived before her parents, and they received the first reports as to how critically ill their sister was. When mom and dad arrived and their sons told them how sick Christie was, their mom collapsed into their arms, exclaiming “Why couldn’t this be me!” A selfless expression of love for her only daughter.

By now the word was out and a huge contingent of family members began to pray. Because her father and I are physicians, we have always had a special connection. I received frequent phone calls and texts from him and then relayed any new information to dozens of our family members and friends almost on a daily basis. My four daughters were all quite close to Christie and were in shock. It was just hard to believe that in just one moment a vivacious, highly intellectual young lady would be fighting for her life.

Her physician brother also sent out frequent detailed updates by email, and it is with the help of these saved emails that I am able to accurately recall and share this incredible story.

The next morning she went for a cerebral angiogram to find the cause of the brain hemorrhage. She had bled from two aneurysms found in the back of the brain. The interventional radiologist was greatly challenged, but eventually two stents and two coils were carefully deployed to help prevent further bleeding.

The ICU nurses kept constant vigil, watching for any changes in neurologic status. Critically high intracranial pressures continued and the neurologic team decided to induce hypothermia, which has been shown to help preserve brain tissue and reduce potential brain damage.

The next life-threatening complication that occurred less than 24 hours after presentation was shock (low blood pressure) requiring high doses of vasopressors, which are intravenous medications to raise the blood pressure. Echocardiography performed to assess the heart discovered that there was severe dysfunction of the left ventricle. It is also known as “broken heart syndrome” and can suddenly affect the heart during extremely stressful situations.

The hearts that were truly breaking were the hearts of her mom, dad, two brothers and sister-in-law, who were at constant vigil at her bedside.

Thankfully, during the next two weeks her heart fully recovered and her lungs showed significant improvement, although there continued to be concerning neurologic signs supporting spasm or possibly brain damage.

I recall a phone call from her father one day where he shared his worry about a new concerning neurologic finding. Christie had developed divergent eyes. This can best be described as one eye looking one way and the other looking the opposite way. His anguish over the phone was palpable.

As this father struggled to make sense of what had befallen his child, he soon received more bad news. His mother had suddenly died. For several days he pondered if he should attend her funeral or stay in D.C. His family encouraged him to fly to South Bend for the funeral, and the team of physicians assured him that his daughter would be waiting for him when he got back. He did indeed attend, and family and friends came from all over the Midwest to pray with him and show their love and support.

After the funeral Mass this broken-hearted man headed to his alma mater, the University of Notre Dame. There he would go to the famous Grotto of Our Lady of Lourdes on campus, get down on his knees, and ask Mother Mary for her intercession.

Meanwhile, her brothers and close friends knew that Christie’s favorite books were the Harry Potter series. They decided to take turns sitting at her bedside, reading one Harry Potter book after another. This was good therapy for them, and they could only hope that maybe, just maybe, Christie could hear them.

She remained in a deep coma for 16 days. The coma was in part medically induced by the hypothermia and sedatives she received. Finally the neurosurgical team believed it was time to warm her up, withdraw the sedatives and see if they had preserved brain function.

There was little encouragement the first few days, with no movement or signs of awareness by our sleeping princess. The daily worry and anguish her mother, father and brothers went through is something that is not easily imaginable.

Finally, there was purposeful movement of her arms and legs. Soon she was tracking the medical staff with her eyes as they moved around the room. What happened next will never be forgotten by the family who never left her bedside.

Her oldest brother, the tough Army Ranger, was holding her hand and looking at his sister when Christie suddenly opened her eyes. Their eyes met and she smiled around the endotracheal tube and mouthed the words “I love you.” It was such a moving moment that he sank to his knees and this usually stoic man broke down in tears. She was in there!

The next huge hurdle was weaning her from her ventilator, which she had been dependent on for about three weeks. She unfortunately failed weaning and had to stay hooked up to the ventilator. This led to a tracheostomy. At least the uncomfortable endotracheal tube could be removed from her mouth, and the tracheostomy would provide more safety as she was weaned off the ventilator. The negative was that with a tracheostomy and ventilator support she could not talk, so it was even more difficult to get a good assessment of her neurologic status.

Prior to this event she was able to speak four languages: English, Mandarin, Spanish and French. To be able to hear any words in any language from her would be cause for celebration.

She was receiving nutrition through a PEG tube, a tube that goes through the abdominal wall into the stomach. Physical therapists came to her bedside daily several times per day to passively move her arms and legs. Finally, after nearly six weeks, she no longer needed the ventilator and could breathe on her own. It looked like she was going to survive. Early in her hospitalization, it looked like the overwhelming odds were against it.

After she was medically stable, the next step was to be transferred to a rehab center. Her parents chose Shirley Ryan AbilityLab in Chicago for not only its cutting edge expertise but also to be close to home. She was flown there by Angel Flight Medical transport in case there was any instability.

My fourth-born daughter, who lived in Chicago, begged her employer to allow her to be off for several weeks so she could be at Christie’s bedside every day to provide a familiar face, love and help with the long rehabilitation process.

The big question remained. Would her brain recover?

On arrival to Shirley Ryan she was unable to stand, walk or talk. She had severe short-term memory loss. What transpired just hours before could not be remembered. Every day that my daughter arrived, she learned that Christie did not remember that she had been there the day before. My daughter would tell her multiple times per day, “You’re awesome and you still have a world to change.” Christie would then touch her nose and point to my daughter, who was sure this was her way of saying, “Yes.”

Progress continued as she began to stand with help and take a few steps with a walker. Daily improvement could be documented. She still had her tracheostomy in place and my daughter had not heard word one from her cousin to this point. One day she coughed violently and her tracheostomy tube came flying out on the floor. Thankfully this caused no respiratory distress and the nurses were able to soon place an occlusive bandage over the hole in her neck. This now meant that air could flow through her vocal cords and she might be able to begin talking.

Soon an occasional word came forth and there was great hope. My daughter recalls two occasions quite vividly. A nurse came in the room one morning and asked Christie what she wanted for breakfast, and in a serious tone Christie said, “Can I have a beer?” My daughter and the nurse both laughed with great happiness as Christie tried to figure out what was so funny. On another occasion a therapist walked in the room and Christie blurted out, “Do they have Mass here?” She received Communion on a regular basis during her stay.

For approximately six weeks, she continued eight-hour-a-day intensive rehab at Shirley Ryan. Many physical and mental hurdles were overcome, and finally she was able to be discharged to her parents’ house. She continued outpatient rehab for the next four months and then she insisted that she be allowed to return to D.C. Her parents were reluctant, but they knew that when Christie made up her mind, they had little chance of changing it. She returned to her condo in Washington, D.C., and it was not that many more weeks before she returned to her work at a prestigious think tank where the brightest of the bright collaborate.

This is a story about a young lady and a family who just would not give up. As I prayed daily along with many others for Christina, and she fought for survival, I can recall thinking to myself how Mother Mary must be pestering her Son with daily requests to intervene. For as it is written in Luke 11:5-11: “Jesus said to them: ‘If one of you knows someone who comes to him in the middle of the night and says to him, “Friend, lend me three loaves, for a friend of mine has come in for a journey and I have nothing to offer him”; and he from inside should reply, “Leave me alone. The door is shut now and my children and I are in bed. I cannot get up to look after your needs” — I tell you, even though he does not get up and take care of the man because of friendship, he will do so because of persistence, and give him as much as he needs. So I say to you, “ask and you shall receive; seek and you shall find; knock and it shall be opened to you.” ‘For whoever asks, receives; whoever seeks, finds; whoever knocks, is admitted.’

Christie, we love you!

Permission was, of course, given by Christie and her family to share their incredible saga.

Dr. David Kaminskas is a board-certified cardiologist and member of the Dr. Jerome Lejeune Catholic Medical Guild of Northeast Indiana, www.fortwaynecma.com.