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The patient’s right hand was pale. His wrist had no pulse. He did have a blood pressure. These were among the symptoms Lehigh Valley Hospital (LVH)–Hazleton clinicians considered as they worked toward a diagnosis. Although they’re accustomed to handling critical situations, this case was personal. The patient was Bill Bauer, the hospital’s chief financial officer.
They suspected Bauer’s condition was life-threatening. His survival would depend on quick, coordinated care from numerous specialists. Follow his steps to survival:
Morning of November 2, 2015
The hospital is abuzz. Leaders are planning to announce LVH–Hazleton’s new designation as a Level IV Trauma Center, identifying its ability to provide quality care quickly. It’s exactly what Bauer would need. “As I walked to my office, I felt pressure in my neck,” says Bauer, 53. “I never felt anything like it before.” Noticing Bauer leaning against a cubicle, his colleagues get a wheelchair and bring Bauer to the emergency room (ER).
In the ER
After reviewing Bauer’s EKG and chest X-ray, heart attack is ruled out. Then Bauer starts shaking his right hand and complains of pain in his left leg. Intensivist Anthony Valente, MD, a friend and colleague of Bauer’s came to the ER to check on him, suspect an aortic dissection, a life-threatening tear in the inner lining of the aorta, the main artery that carries blood through the body. A CT scan confirms it.
A phone call to LVH–Cedar Crest mobilizes a team of caregivers who prepare for Bauer’s arrival via MedEvac helicopter.
Arrival at LVH–Cedar Crest
More than 20 caregivers await Bauer's arrival. It’s determined that the tear started in the section of the aorta that ascends from the heart and continued along the length of the aorta, which bends like a candy cane and descends through the abdomen. Blood is flowing through the tear into the lining of the aorta – instead of through the blood vessel itself – preventing enough blood from reaching Bauer's organs and extremities.
Bauer had a very extreme case of aortic dissection known as malperfusion syndrome. For patients with this complication, very little blood is going to the vital organs. The survival rate is 15 percent. Bauer needs emergency surgery to restore blood flow.
In the OR
Cardiothoracic surgeon Vincent Lotano, MD, and the cardiothoracic team replaces the section of the aorta where the tear originated with a polyester tube that keeps blood flowing through the vessel. He also repairs the aortic valve, which was damaged by the tear. During surgery, Bauer’s body temperature is lowered to 15 degrees Celsius (59 degrees Fahrenheit) to protect his brain. After the seven-hour procedure, his body is gradually warmed.
Recovery and Rehab
The next day, Bauer can breathe without a ventilator. Slowly he begins to regain function in his arm and legs, and his cognitive functions are normal. Once well enough, he is transferred to LVH–Hazleton’s Gunderson Center for Inpatient Rehabilitation. There, he's encouraged by visits from co-workers and motivated by therapists. In three weeks, he can walk the length of the center’s hallway.
Another Step
On Dec. 16, Bauer returns home to find a metaphorical step in his recovery – the step from his garage to his kitchen. "It seemed higher," Bauer says, but as he regains strength, it’s not as daunting. Bauer suffered minimal nerve damage in his hand, but his legs are now strong enough to drive him between his Bloomsburg home and work.
'Why Me?'
Still unknown is why this happened to Bauer. Although people with high blood pressure or Marfan syndrome (a connective tissue disorder) are at greater risk for aortic dissection, Bauer has neither. Yet he does know you can receive excellent care close to home. "Most people don’t survive what happened to me, let alone have a good quality of life," he says. "Mine is getting close to being back to normal."