Vol 104: Slow Motion, part 2
There are 20 main arteries intricately distributed throughout the human body. Together, with veins, they converge to form a branched labyrinth of blood vessels which function to transport blood and nutrients to and away from the heart. To a discerning eye, these blood vessels closely resemble the tortuous pathway adopted by the roots of trees. And like such roots, optimal functioning of this complex, awe-inspiring transhipment highway is necessary for life to be sustained.
The abdominal aorta, for example, runs from the diaphragm to immediately above the pelvis at which point it branches into five more arteries. These arteries then go on to supply oxygenated blood and nutrients to the lower spinal cord, legs and various organs in the abdomen and pelvis. When too much pressure builds up within the arteries, the weakened portion of the arterial wall begins to bulge creating an aneurysm which, in the event of rupture, can be fatal.
All that information is not merely meant to be academic. It is the basis for understanding the story of a mother who rose to the highest levels of success in hospital administration in the U.S. and the helplessness and pain she felt as she faced her own daughter’s health crisis.
Last week, I shared some of Cookie’s incredible life story. Living in New York during the 1940’s she faced the kind of discrimination which would never be tolerated in today’s world, stricken from university admittance despite excellent grades until she submitted an application without her photo. As an adult, the discrimination became more glaring, but driven by the work ethic and success of her mother and aunt, Cookie powered through. She became a nurse and eventually an esteemed hospital administrator. But, in the process, she almost lost custody of her daughter, Destiny, whom she loves dearly.
Even with the dissolution of her marriage after 12 years, Cookie fought hard to retain custody of Destiny, balancing life as her own career continued to flourish. But on May 12, 2022, Cookie (now retired and caring for her 99-year-old mother) faced her greatest trial. Destiny woke up with constipation and abdominal cramps so severe she couldn’t go to work and by that evening her life hung in the balance. She was rushed into surgery and Cookie arriving at the hospital to be with her daughter is where we resume their story.
Cookie’s head was spinning. Every one around her was moving quickly but she couldn’t seem to catch up. Her body and brain were in slow motion as she tried to process how her daughter was healthy yesterday but fighting for her life today. Speaking with Destiny’s surgeon, she was able to discern that when Destiny arrived at the hospital, she collapsed. They saw her clutching her stomach and quickly scanned her abdominal area which revealed an abdominal aortic pseudoaneurysm (pseudo meaning the artery had been previously injured, possibly from a childhood injury or during a hysterectomy or lap band procedure performed several years prior).
A catheter was quickly inserted into the pseudoaneurysm intraoperatively. In standard fashion, the catheter was packed with coils to promote blood clotting and prevent it from rupturing. Destiny, already intubated using a nasogastric (NG) tube, was placed in the surgical intensive care unit (SICU).
After two days she was transported to interventional radiology for medical imaging so surgeons could better visualize her repair but while there, she coded. One of the five arteries that branches off the abdominal aorta had ruptured. The coiling procedure didn’t work and she had severe internal bleeding so a grafting procedure was performed. This type of rupture is extremely rare and is associated with very high mortality rates. Had she not been in the radiology operating room already, she would not have survived.
Unconscious, Destiny went into acute respiratory failure. She was placed on a ventilator to help her breathe. Her liver began to fail because blood clots from mesenteric, splenic and portal vein thrombosis were clogging her liver and it was failing rapidly. At that point, the hospital was no longer capable of helping her. She had to be transferred to another hospital for a liver transplant. The clock was ticking, every minute counted.
Within hours, Mount Sinai Hospital in New York, where I completed my surgical residency, accepted her case and she was air-ambulanced, arriving the next morning. The transfer typically takes weeks but her surgeon phoned his colleague at Mount Sinai and expedited the process. Cookie acknowledges that throughout this ordeal, angels helped them through every step and crisis.
Doctors at Mount Sinai suspected that Destiny would not survive a liver transplant so on May 20, eight days after the ordeal started, presenting as intense abdominal pain, Destiny underwent a Transjugular Intrahepatic Portosystemic Shunt (TIPS) to create new connections between blood vessels in her liver. Three days later, she began to respond to external stimuli and eventually regained consciousness. By the 25th the ventilator was removed and she was placed on oxygen via a nasal canula. CT scans revealed that she was still bleeding internally, blood clots kept clogging her shunt and she developed small bowel ischemia. The following day she underwent a revisional TIPS procedure.
Four days later, Destiny’s oxygen levels had improved to a point where the nasal tube could be removed. On May 30th she was transported from the SICU down to a specialized unit. It was a cautiously happy day for Cookie and one she prayed desperately for but the ordeal was far from over. The reduced blood flow to her kidneys caused renal insufficiency and blood was being expelled in her urine in such large quantities that she required multiple blood transfusions. She also developed excess fluid in her lungs that had to be drained at bedside via an intra-pleural procedure and the use of a chest tube that was removed after one week.
Cookie recalls the deep fear and emptiness she felt when she looked at her daughter and her entire body was so swollen that she was almost unrecognizable. The massive amount of edema caused Destiny’s face, stomach and extremities to double in size. Doctors treated her swelling with high-doses of diuretics which eventually helped to the point that she was able to start ambulating with assistance. Her significant muscle loss left her weak and emaciated which was to be addressed with prolonged physical and occupational therapy.
Destiny was discharged to a short-term rehab facility on July 11th after having spent almost two months in hospital. She only spent two weeks in rehab, however, because her insurance company refused to pay for the six weeks that her surgeons recommended.
Today, Destiny is able to walk with the use of a walker. Prior to her health issues, she worked in retail but she now works full time at a doctor’s office where she is surrounded by doctors and nurses, a relief to Cookie who always worries about the daughter she fought so hard to keep. The ordeal has taken a tremendous toll on Destiny’s mental health but through it all, she is grateful to be alive.
Cookie and Destiny’s take-home message to readers is that you cannot take life for granted because it can change drastically at any given moment. Destiny had high blood pressure and she regrets not being more vigilant about keeping it under control. They both feel that the only way they got through this ordeal was through a community of prayer from friends and family. They are incredibly grateful and feel that access to the right medical care is essential during a health crisis.
Time is rather peculiar. There are days when hours feel like seconds and others where it feels as if time has been suspended. The feeling of being in slow motion while the world around you moves in hyper-speed is the epitome of feeling helpless. But feeling helpless is counter-intuitive for a mother, especially one like Cookie who teaches us all to never give up having spent her entire life as a trail-blazer forging her own path and lighting one for the future generations of young women of color who now succeed her.
This is The KDK Report.
