Tales From the E.R.

Home for the Holidays

Tiny Molly gets a second chance at life

For obstetrician/gynecologist Andrea Collerius and her patient, Jill Wipfield, there seemed nothing unusual about the pregnancy, Wipfield’s first.

Wipfield, 29, went into labor on Sunday, Dec. 19, and the next day, doctor and patient were at St. Joseph Medical Center, ready for the birth of a baby girl, following an epidural injection. She was to be named Molly.

“I came into the room and checked her and told her it was time to start pushing,” recalls Collerius, 43, a mother of two herself and in private practice for 12 years.

“When she started pushing, though, the baby’s heart rate went down,” says Collerius. “That can happen even from little things, like changing position. But no matter what I tried, it wouldn’t come back up.” And then Collerius couldn’t get a reading at all.

Suddenly, an emergency C-section was the only answer. As soon as Collerius wheeled Wipfield into the OR and opened the uterus, she saw the problem: An abruption of the placenta, meaning it had separated from the uterus, causing the mother to bleed heavily, denying Molly oxygen, and causing the baby to bleed through the umbilical cord.

“The baby wasn’t breathing, and it wasn’t moving,” says Collerius. “Typically, you warm a baby when it’s born, because it has just come out of the uterus.” In this case, though—with the help of St. Joseph’s pediatric and neo-natal intensive care (NICU) staff headed by NICU director Dr. Michael Langbaum—the baby was put through a hypothermia protocol, actually cooling her to prevent organs—at least for a short period—from metabolizing, in the hope they could get Molly breathing normally again with CPR, respirators, and transfusions.

When mother Jill awoke groggily from the anesthesia, she sensed right away something was wrong.

“She could see it in my eyes,” recalls Collerius.

Collerius and Langbaum knew that The Johns Hopkins Hospital was running trials on a new hypothermia protocol, so the decision was made to transport Molly downtown. “First and foremost, I wanted to see her before she left,” recalls Wipfield. In recovery from the C-section, her vision blurred by anesthesia and pain killers, Wipfield was nevertheless wheeled to the NICU so she could squeeze Molly’s hand to say goodbye.

“The first 72 hours were touch and go,” says Collerius. “You just have to hold your breath and see how things go.”

Molly was gradually warmed to normal body temperature and eventually could be taken off the breathing tube. “It wasn’t for another week that we knew she’d be okay.

“It’s hard to say when the abruption happened,” reflects Collerius. “But I’ve never seen an abruption that looked normal in all the tests. Molly is a miracle.”

“With all that was going on, I was on autopilot for a while,” says Wipfield, who soon followed Molly to Hopkins to be by her side. “It was much later that the gravity of what could have happened really hit me.”

And Molly today? She’s a happy, healthy, 10-month-old. She’s ahead on all her developmental milestones, teetering around rooms grasping onto furniture, forming her first words, putting dirty things in her mouth, and doing everything else babies are supposed to do.

“The only reminder for awhile was the funny haircut the doctors gave her in the NICU. It took four months to go away,” says Wipfield. “So we bought her a lot of hats.

“We were very, very lucky.”

Miracle In the Snow

Record blizzards can’t keep a good neurosurgeon down

The Baltimore-Washington Medical Center in Glen Burnie was running with a skeleton crew on the night of Feb. 10—high-level adminstrators were manning the front desk—as the region bowed under the weight of the record-breaking “Snowmageddon” storm of 2010, which was piling it on after another big blizzard had hit just three days before. As the fresh white stuff added two feet in some spots, things were pretty quiet at the hospital. That is, until the arrival of patient Justin Windsor.

The 20-year-old restaurant worker was suffering from a large blood clot on the brain, which, unless treated quickly by a skilled neurosurgeon, was going to win him a toe tag for President’s Day.

Problem was, helicopters that might have flown him to Shock Trauma were grounded by the storm, and the big guns of brain surgery weren’t there—they were snowed in.

Ten miles away, neurosurgeon Dr. Clifford Solomon, 50, the hospital’s director of neurosciences, was trying to make the best of the storm in the warmth of his Severna Park home when the call came. It was 7 p.m. The message: They needed him on the case, pronto.

Easier said than done: Snow drifts that were chest-high were blocking his driveway, an obstacle even his big GMC Yukon Denali couldn’t see past. But coming to the rescue were his neighbors, Bill Gassaway and Buzz Kalafos, who, unbeknownst to him, were busy digging him out just in case he got such a call. It took them two hours to clear a narrow path for the SUV, so Solomon’s four-wheel drive beast was able to crawl onto the street, its big headlights peering warily through the blinding snow and 40 mph winds. “I was slithering around, but, amazingly, I got to Ritchie Highway,” recalls Solomon. “There wasn’t a soul on the road.” Thirty minutes later, he was at the ER.

“Despite the short staff, we got things together and rushed the patient into the OR,” says Solomon. “I turned a large flap on his head, cut out a large piece of skull, took the clot out, and closed the covering. And then he woke up.”

Solomon had treated life-threatening clots many times.

Twenty-two years ago, he was working at The Johns Hopkins Hospital where a construction foreman was transported after falling eight stories off a scaffold—with no helmet. ER staff counted him as a goner, but Solomon decided to operate on a clot in his brain right on the gurney. He was saved, and, 10 years later, showed up unannounced in Solomon’s office.

“He told me he had grandkids now. He’d tracked me down after all those years just to say thanks.”

And the cause of Justin Windsor’s head trauma? Having a bouncer slam his head into the ground after he tried to extricate a friend from a scuffle in a bar.

“They showed me [a picture of] how big the clot was, and it was ridiculous,” recalls Windsor. “If it wasn’t for Dr. Solomon and his team, I don’t know what would have happened.”

A Laying On Of Hands

Higgins is his name, extremities are his game

As an electrician, Keith Brown put strenuous demands on his hands and wrists. And that eventually resulted in ligament tears and separation of the tiny carpal bones in his left wrist joint. Then, he suffered the same injury to his suddenly overtaxed right wrist.

Brown was staring disability in the face when he met with Dr. James Higgins, chief of Union Memorial Hospital’s Curtis National Hand Center.

The novel solution Higgins and his team came up with on the right wrist—a technique pioneered by Higgins in collaboration with colleagues in Austria—was to dissect a wafer-thin piece of cartilage-bearing bone from the patient’s own knee and shape it to fit exactly into the gap created in the wrist bones by the damaged ligaments. Higgins then transferred the bone with its own small blood vessels and its own cartilage into Brown’s joint to solidly fuse the unstable wrist segment.

“Transferring not only the bone, but the bone and cartilage on the same blood vessel, may be the most exciting new development in our field,” says Higgins, 42, a Homeland resident and father of two. “Keith is the first person in the U.S. to have this procedure.”

Now, however, Higgins has been recruited into a team of top specialists—from his Curtis National Hand Center, The Johns Hopkins Hospital, and the University of Pittsburgh Medical Center—for a much more ambitious mission: transplanting new arms onto a young soldier hit by a roadside bomb, a blast that resulted in amputations above the elbow on one arm, and below on the other. Led by Hopkins’s Dr. W.P. Andrew Lee, the group hopes to achieve the first such transplant in Maryland, but there are plenty more candidates waiting in the wings: The soldier is one of many who have lost multiple limbs, yet survived because their torsos were protected by body armor.

The team has conducted several rehearsals of the surgery on cadavers. Now, they plan to operate on the soldier as soon as a donor search is successful.

“The rehearsals are tailored to this one specific patient to make sure that when the day arrives, everything goes smoothly,” says Higgins, whose hand center has long been the training ground for U.S. Army hand surgeons.

But if you think matching a liver, heart, or kidney is tough, consider this: Matching a limb is not just about blood types, but about the race, body build, and sex of the donor.

“Lower-extremity prosthetics are pretty advanced now, but it’s the upper extremity solutions that we’re focused on,”says Higgins.

“For multiple-extremity amputees, this procedure offers a huge beacon of hope.”

A Shoulder To Cry On

Two docs solve a migraine mystery

The car accident 11 years ago didn’t seem a big deal at the time for young Cara Frye, who was fresh out of law school. She recalls that just before her car was rear-ended, she was reaching into the back seat to find her briefcase. “It was a tiny accident,” she recalls. And then it was forgotten.

Soon thereafter, though, as a freshly minted associate in a law practice, the migraines began. They started with an aura, then two hours of searing pain, and pills, of course, then a migraine hangover for two days. At first, it was once a month.

“I hadn’t had symptoms in law school,” says Frye, now 36 and living in Butchers Hill. “I figured maybe it was stress or the long hours as a first-year law associate.” Then the migraines increased to three a week.

Her search for relief included five neurologists, acupuncture, yoga, diet changes, biofeedback, and all sorts of drugs.

“The funny thing was that I sometimes had this pain in my shoulder in the morning when I woke up. And I soon became aware that if my shoulder hurt, I’d get a migraine. But when I mentioned that to doctors, they all said it was a coincidence.”

It was her internist, Dr. Francis Strain at Mercy Medical Center, who first guessed the cause. “I was in his office talking about the migraines and I said, ‘You know what, my shoulder is killing me.’ He closed the office door to reveal a chart of the body’s muscles. I pointed and said, ‘It’s that one, the blue one.'”

In June of last year, Strain referred her to Mercy orthopedist Dr. Joseph Ciotola, whose exam suggested a nerve impingement in the shoulder blade that was the apparent cause of the migraines. It very likely dated back to the car accident 11 years before and the petite lawyer’s reach into the back seat with her right arm at the moment of impact. Since then, the muscles in her shoulder had tried to compensate, tightening and forcing her shoulder forward. But Ciotola wanted a second opinion: And so off Frye went to Mercy’s Dr. David Maine, an interventional pain specialist. Maine, 35, injected the suspect nerve with a temporary painkiller, and presto: The pain went away.

Ciotola’s surgery to free the trapped nerve was three months later. “After the operation on my shoulder, there was immediate relief,” says Frye. “But I had so many muscular issues from holding my shoulder in the wrong position for so long that Dr. Ciotola referred me to a massage therapist, Salifou Ngouyamsa at Medi-Spa at Mercy.”

“I still have to remind my muscles every day where they should be,” says Frye. But before I went to Mercy, not a single person said it could be a structural issue. Why didn’t someone ask, ‘Does your neck hurt?’

“I love them both, Maine and Ciotola. It’s changed my life.”

The Eyes Have It

After 41 years, both Susan’s eyes can see again

Dateline: Inner-city Philadelphia, 1969. Nixon is president, Vietnam is going badly, racial tension is in the air, and a bunch of giggly white kids in a VW are headed home after seeing Midnight Cowboy. Among them is budding artist and college sophmore Susan Sigel (nee Shay), 19. They decide to take a shortcut through a rough part of town. “We’d just come back from Woodstock,” she recalls, “and I guess we thought everyone was full of peace and love.”

Not so much in West Philly. A passerby throws a glass bottle through the windows of the car, showering glass everywhere. Blood is pouring from Sigel’s right eye, its cornea lacerated by a shard.

Fast forward to 2010: It’s been a 41-year odyssey of pain, frustration, and false hope for Sigel. First, there was a cornea transplant. It didn’t work. Since then, there have been 13 unsuccessful surgeries. For years at a time, she gave up, waiting for technology to advance. But inspired by her brother, a successful lawyer, who, ironically, had lost an eye as a child, she, too, succeeded, as a monocular graphic artist.

But that was before she’d met GBMC ophthalmologist Dr. Sudeep Pramanik. Though trained in the U.S., he had studied difficult eye cases in India, where surgeries considered unusual here abound because of the huge population. And with the advance of stem-cell and transplant technology, those surgeries had become old hat for top eye surgeons at the two Indian hospitals where Pramanik teaches for a month each year. (“They save the most complicated cases for me,” he says with a laugh.)

Sigel, now married and living on the Eastern Shore, learned of Pramanik a year ago from a local ophthalmologist. Now 61, she hesitantly made an appointment with—yes—another eye doctor.

“I told him right away that I had lost all faith in eye doctors,” she recalls. But Pramanik, 36, eased her apprehensions. After an exam, he saw the original cornea transplant had been rejected, but that all the nerves were there for vision to be restored.

A combination of a partial cornea transplant (from a donor), stem cell therapy, and advanced contacts has given her back the nearly perfect vision that a beer bottle stole in West Philly 41 years ago.

The healing has been emotional, too, especially regarding her faith in medicine. “I believe anything Pramanik says is true,” says Sigel, almost surprising herself. “And he never patted himself on the back.

“I remember when his associate at GBMC, Dr. Brett Levinson, a lens specialist, made a final fitting for hybrid contacts for my new cornea, I wandered through the halls and into the glass lobby like I was watching a 3-D movie. I felt like I was in a fun house. There was an extra dimension to everything I hadn’t had since I was 19.”

And what’s she going to dress up as for Halloween? “I’m thinking of going as an eye chart,” she says with a laugh.