Torn From Caring Magazine, Fall 2007 The CMH Emergency Department and Heart Team respond to a torn aorta and a 90% mortality rate. More than two months after the fateful mid-August Sunday, Christine Grandpre still tears up at the memory. She knows how close she came to losing her 44-year-old husband, Christopher. And Christopher knows that without a speedy, accurate and difficult diagnosis of an aortic dissection – a tear in the inner layers of the aorta, the same medical emergency actor John Ritter died from – in the ED, followed by a six-hour operation by cardiovascular surgeon Dr. Lamar Bushnell and Community Memorial Hospital’s expert “Heart Team,” his wife would today be a widow raising their two young daughters by herself. “I thought I wasn’t going to make it. The odds were not with me,” says Christopher, who grew up in Westlake and has lived in Oxnard for the past eight years. “I’m not overly religious, but thank God for CMH and its outstanding doctors.” Dr. Alex Kowblansky, CMH’s Emergency Department Medical Director, was the first physician to see Christopher when he came through the ED doors. Though the life threatening dissection usually happens quite suddenly – in Christopher’s case – he had experienced symptoms for days which may have been due to very high blood pressure – a common finding in patients suffering aortic dissection. “With the extent of his dissection the mortality rate is probably close to 90 percent,” Dr. Kowblansky estimates. “Off and on that month I had been tired, but didn’t think anything of it,” Christopher recalls. “The day before I was supposed to go surfing, but I didn’t because I had no energy, which is unusual for me.” Also unusual was the day he had at work on Friday. A land surveyor, Christopher found himself struggling to concentrate. “I was straining to do math. Easy things for me were suddenly giving me a hard time,” he shares. Sunday morning, despite still feeling lethargic, Christopher was on his hands and knees cleaning the hardwood floors for his wife when he felt a shooting pain in his neck. “It was intense,” he says. “My shoulders also hurt and I had some tightness in my chest.” Pausing to gather his emotions even in the retelling, he adds: “Thank God I wasn’t in the water surfing.” Christopher sat on the couch to rest, thinking the pain would pass. Christine, who had been upstairs with the couples two young daughters – Chase, 4, and Chelsea, 2 – thought differently. Because St. John’s Regional Medical Center was closed for fumigation for a mold problem, she drove Christopher to Community Memorial Hospital. “On the way to the ED the pain got worse,” Christopher says, including down in his right leg. “My wife was already scared, but I scared her even more when I said, ‘You need to hurry and start running red lights.’” “It was not the typical profile of a serious heart problem,” Dr. Kowblansky remembers. “He’s a very buff, fit guy in his early 40s with no risk factors.” An IV quickly brought Christopher’s plummeting blood pressure back up. His EKG was normal as was a chest X-ray. However, the pulse in his right leg was weak. “That raised a red flag,” Dr. Kowblansky explains. “Now it sounds like possible aortic dissection.” The gold standard for diagnosing aortic dissection – to confirm there is a tear in the aorta, and not a heart attack – has historically been an angiogram of the aorta but the diagnosis can now often be made much more rapidly with a CT Scan with contrast (dye). One problem: Christopher’s blood work came back and indicated his kidney function was not normal, and the contrast can pose a slight risk of renal failure. After discussing the situation with Christopher and Christine, it was decided to have the “study of choice” with CMH’s state-of-the-art CT Scan. It was a wise choice. “It showed a massive dissection,” Dr. Kowblansky notes. Christopher’s six siblings quickly arrived; his parents rushed up from San Diego; and more than a dozen friends from work also showed up to lend support in the waiting room. Meanwhile, a call had already been made to Dr. Bushnell who rushed from the OR to the ED. “Alex’s diagnosis was right-on,” says Dr. Bushnell. “This was a surgical emergency.” As Dr. Bushnell explained to Christopher, without surgical repair of the torn aortic wall the mortality rate is twenty-five percent in the first 24 hours. Fifty percent die in the first week. “Most people panic in such a situation but he was incredibly calm,” Dr. Bushnell remembers. “He was like, ‘Let’s do it. Let’s go.’” “It was an easy decision for me,” Christopher says. There is nothing easy about the open-heart operation that includes cooling the patient to 18 degrees centigrade and turning off the heart-lung machine during the actual repair of the aortic arch. A quick-setting, high-tech bio-glue made of protein is used to put the split layers of the vessel together. Next, thin sterile sheets of Teflon felt are sewn on the inside and outside to reinforce the aorta. Oftentimes the heart valve needs to be replaced, but Dr. Bushnell was able to save Christopher’s. Christopher doesn’t remember waking up later that evening or being visited by Christine the following day. However, Dr. Kowblansky remembers seeing Christine that next morning. And also this: “I remember the last thing I said to Christopher as he rolled out to go to surgery. I shook his hand and said, ‘I’ll see you tomorrow in the ICU.’” Monday morning, on his way to hopefully keeping his word, Dr. Kowblansky saw Christine in the hallway. “How did he do?” the anxious ED doctor asked. Christine was speechless. “She just gave me the biggest bear hug in the world,” Dr. Kowblansky continues. “I got teary eyed.” He pauses, thinks about the “extremely nice young man” facing the long odds, and adds: “It was a good save. I still get teary eyed thinking about it. A lot of things we do in the ED is small stuff really. Then something like this comes along. It reminds you what emergency medicine is all about. This is what we do. We’re trained for this – to make the right call and see that definitive care is received.” Mission accomplished. Christopher left Community Memorial Hospital after 10 days; within weeks was walking 30 minutes at a time; and only nine weeks later was given the medical clearance to go surfing. “To be able to tell him he can paddle out again is a wonderful feeling,” says Dr. Bushnell, an avid surfer himself. However, even better was when Dr. Bushnell told Christopher he could once again lift his young daughters high overhead, something they enjoyed and missed. “For more than two months I couldn’t pick them up on my shoulders,” Christopher shares, noting that his daughters call the 12-inch scar on his sternum “Daddy’s boo-boo.” “When Dr. Bushnell gave me the OK, I lifted Chase up, and she was so excited and happy. She said, ‘You can lift me again, Daddy!’ That was wonderful.” Daddy knows the story almost didn’t have a happy ending. “At one point a priest was brought in,” Christopher shares. “Like I said, I’m not overly religious, but I am so thankful. When I was in the ED, I honestly didn’t think I was going to make it. But I did because I had absolutely great docs. Thanks to them and the outstanding nurses and everyone else, I get a second chance with my girls.” Comments are closed.
