Few people outside the medical world have heard of Acute
Respiratory Distress Syndrome, even though it kills more
Americans than breast cancer and often leaves survivors
in various stages of disability. Some Penn-related physicians
and researchers are working hard to blunt its impact.
BY SAMUEL HUGHES
By the time Kris Powelson arrived at HUP’s medical intensive-care unit, he was teetering on the thin edge of life.
A week before, that statement would have seemed preposterous. Just 33 years old and in seemingly robust health, he had—shortly after having his wisdom teeth removed, of all things—found himself wheezing and out of breath. He felt pretty sick, but even when his urine started turning brown, his oral surgeon said it was nothing to worry about—just a normal reaction to the Naproxen he had been taking for pain.
When Powelson’s take-charge girlfriend, Shelley Najjar, told a CVS pharmacist about that last symptom, his response was: Get him an emergency appointment with his primary doctor at once. She did. There they did a quick pulse-oximeter test. Powelson’s blood-oxygen level was barely 60 percent. (Normal is 95 to 100 percent.) His doctor sent him by ambulance to the nearby Pottstown Memorial Medical Center.
After a chest X-ray, the ER staff put Powelson on a BiPAP mask, which blows oxygen into the face with gale-wind force. He was admitted to the ICU. That night he was sedated into a coma and hooked up to a mechanical ventilator, with a breathing tube down his throat. The ICU physician pulled Najjar aside and showed her an updated X-ray: One lung was only 20 percent clear. The other was completely white, filled with fluid. They weren’t sure why. The next day a physician specializing in infectious diseases told her that a urine test indicated Legionnaire’s disease, a dangerous but treatable infectious disease that causes high fever and pneumonia. (Powelson probably contracted it because he had been on an immune-suppressant drug for ankylosing spondylitis, a connective-tissue disorder.) But they still didn’t know why his lungs were in such horrific shape. Najjar knew that he needed to be transferred immediately, to a place where they could deal with a condition whose outlook, she had just been told, “was not favorable at all.”
And so that night, in an induced coma, he was Medevaced to HUP, where he was admitted to the medical ICU. The resident on duty, Joanna Hart (now a pulmonary and critical-care fellow) comforted Najjar by telling her that her boyfriend was “in the best possible place.” But Hart could not promise a favorable outcome. She had never seen a patient that sick survive.
Powelson’s condition had morphed into something much more deadly: Acute Respiratory Distress Syndrome (ARDS), which kills more than one-third of the 150,000-plus Americans who come down with it each year, and leaves many more in various stages of disability.
The next 16 days were a wild ride through the underworld for the unconscious Powelson, whose lungs were drowning in fluid—barely functioning, even with a ventilator pumping in the maximum amount of oxygen. (In a healthy person, the P/F ratio—the amount of oxygen in the arterial blood divided by a fraction of the oxygen being given to the patient—is between 500 and 600. Below 300 is considered an acute lung injury, or ALI. Below 200 is full-blown ARDS. Powelson’s P/F ratio was less than 60.) He also had severe sepsis, which is characterized by an infection plus multiple-organ dysfunction. Given the dangerously low oxygen level, Hart notes, there was a very real possibility of brain damage.
It was an even wilder ride for the heroic Najjar, who would spend the next 86 nights sleeping in hospital recliners, including 16 while Powelson was unconscious.
“It was just relentless,” she says. “For many days they said it was minute-to-minute. Basically, all of his vital organs failed. He wasn’t even making his own urine anymore, so they took the catheter out because they didn’t even need one. They put him on the CRT machine, a 24-hour dialysis to clean his blood out. Then that machine would get clots in it, and that alarm would go off, and they’d have to get a new one to come in.”
At one point his fever spiked to 106.3 degrees, and at four o’clock one morning he started bleeding internally.
“All of a sudden he just started dropping off,” says Najjar. “It was like out of a movie, except in the movies they always throw the family member out and shut the curtains. I was jammed up against the wall, and I couldn’t even tell you how many doctors and nurses flew in there. They rolled the crash cart in, and right when they were getting ready to paddle [defibrillate] him, they’re like, ‘Wait! Wait! He’s OK!’ His heart bounced back.”
Somehow, from that point of no return, Powelson’s body began the long climb back. The ICU team slowly cut back his meds. And finally, after nearly 400 hours in a coma, the ventilator was removed. Eventually, he opened his eyes.
“Wow,” he said weakly.
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Photography by Candace diCarlo