Together, Portsmouth and Frisbie hospitals save Kasey's life
“Take care of her.”
Those were the words of Nick Watson to physicians at Frisbie Memorial Hospital in Rochester, NH, when they escorted him out of his wife’s ICU room.
Nick had called 911 on a Thursday afternoon in late January, when his wife began having significant difficulty breathing -- her adult-onset asthma exacerbated by the flu. Her usual medications failing her, It wasn’t long before Kasey, 33, was admitted to Frisbie’s ICU.
Soon it was all hands on deck.
“When I came into work Friday morning, I heard our respiratory therapy manager, Meagan Laviolette, talking with our administrator on call about a patient in the ICU,” said Megan Gray, chief nursing officer at Frisbie. “It was clear from her tone that something serious was going on, so I joined the conversation. This patient, Kasey, was decompensating very quickly. Our team had been talking with Dr. Dawn Barclay on the ICU at Portsmouth (Regional Hospital), who had done virtual rounding on Kasey, and we knew we needed to get this patient on ECMO, and fast.”
ECMO stands for extracorporeal membrane oxygenation. It pumps blood from the body to a heart-lung machine that removes carbon dioxide from the blood, and sends oxygen-filled blood back into the body. This process bypasses the patient’s heart and lungs, allowing these organs to rest and heal. It is used in critical care situations, including for treatment of severely ill COVID-19 patients.
It was determined that without ECMO, Kasey likely had less than three hours until she’d be brain dead. As a small community hospital, Frisbie doesn’t have ECMO, so they had to make a decision: Do we get Kasey down to Portsmouth; or get Portsmouth to Kasey?
To make things more complicated, New Hampshire was in the middle of a snowstorm, so a med flight was out of the question as all med flights were grounded.
And to add emotional insult to injury, Kasey’s 31-year-old brother John had suffered a severe asthma attack one month earlier, and while he called 911, it was too late. He died at Portsmouth Regional Hospital after arrival. So the teams at Frisbie and Portsmouth knew that the family was dealing with the added fear of losing a second loved one in a matter of weeks.
Knowing that time was of the essence, the ECMO team piled into the PRH ambulance and a colleague’s car and made the 21-mile drive to Frisbie, in a snowstorm.
“It was like what you see in the movies,” Gray said. “I’ve seen a lot in my years a as a nurse, but nothing quite like this. Seven people from the Portsmouth ECMO team as well as others to support them came out of the elevator on the Frisbie ICU -- bags, backpacks, totes full of supplies, and faces full of focus and determination. They had one goal: To save Kasey. the doctors took her husband out of the room and explained what was going on, then we got to work. The room was quiet, but everyone knew their roles and worked together like a well-oiled machine, everyone was in sync.”
“As soon as she was placed on ECMO, her carbon dioxide levels started to turn around quickly, it was truly miraculous.,” said Laviolette, respiratory therapy manager at Frisbie Memorial Hospital. “And once she was stable enough to be transported, we left the room so that her husband could go in to give her a kiss goodbye, and she was taken to Portsmouth by ambulance.”
Kasey woke up a few days later at Portsmouth Regional Hospital. She was still on ECMO, and in the ICU room right next to the one where her brother had died a month earlier.
“ECMO is a very simple solution really, to a deadly medical issue,” said Christopher Lawson, MD, director of the cardiac catheterization lab at Portsmouth Regional Hospital. “In Kasey’s case, her body wasn’t releasing carbon dioxide, it was building up in her lungs and had nowhere to go. By putting her on ECMO, we were able to give her heart and lungs a break, and to regulate the oxygen in her blood. It didn’t take long at all for her to start looking and feeling better, a matter of days really.”
“In many ways this was a straightforward case,” said Dawn Barclay, MD, critical care medical director. “But it also was one of those situations in which we were all impacted. All of us on the ICU remembered her brother John – he had a similar incident due to asthma, but unfortunately, he didn’t survive. We couldn’t let these parents lose another child, or let Kasey’s six-year-old daughter, Maddison, lose her mom.”
Kasey was taken off ECMO after four days, and discharged just two days later.
“I believe the first words I said after being taken off ECMO were ‘where is Maddison,’” Kasey said. “I had no idea how long I had been in the hospital, how many days I had lost while in the ICU. All I cared about was seeing my family.”
It’s been a whirlwind. Kasey’s hospitalization came at a time when she, her husband and her young daughter were in the middle of packing their home for a move. It was the middle of winter. Plus the loss of her brother, with whom she was incredibly close. All of these things adding to an already stressful and terrifying situation.
Since her discharge, Kasey has come back to Portsmouth and Frisbie hospitals to visit with staff. On her last visit, cupcakes in hand, her daughter and husband joined her while nursing staff showed Maddison where they had hung the drawings she made to thank them for saving her mom.
ECMO isn’t typically used on asthma patients, so Kasey is a bit of an anomaly. But without this treatment – and without Portsmouth Regional Hospital’s cardiovascular team having the foresight to credential the ECMO team at Frisbie in case this need ever arose – this likely would have been a very different outcome.
“Kasey was very sick, without ECMO she wouldn’t be here today, she was just hours away from brain death, so there was no doubt in our minds what we had to do, and how quickly we had to do it,” said Dr. Lawson.
For Kasey and her family, it’s surreal, and they couldn’t be more grateful.
“I can’t thank the teams at Portsmouth and Frisbie enough for saving my life, they’ve become like family to us,” Kasey said, touching the necklace given to her by her mother, a necklace that holds her brother’s thumbprint. “When I woke up in the ICU and realized I was in the room right next to where my brother had been, I knew he was watching over me, and I knew I’d be ok.”