October 22, 2010

Wherever Vicki Hay went, Charlie went, too. To the grocery store, out with her husband, in her car.

Charlie was the name Hay's grandchildren assigned to the oxygen tank Hay had to take with her everywhere. They knew it well because “that big old gas tank,” as Hay called it, had been part of her life—more accurately, her existence—for three years.

Charlie was also the reason Hay could never watch her grandbabies on her own.

“I couldn't chase them down,” she said. “Couldn't get a breath.”

“Couldn't had become a familiar word in Hay's vernacular. Couldn't travel. Couldn't keep the horses she and her husband, Tom, had on their property north of Lyons because she couldn't take care of them. And the doctors said they just couldn't do anything more for her.

But her husband of more than 30 years couldn't accept that.

Last January, after Hay was again hospitalized for pneumonia, he insisted on getting a second opinion. That's when they came, for the first time, to Saint Luke's.

Bubbles on an inner tube

Keith Allen, M.D., a thoracic and cardiovascular surgeon, was startled to learn that his new patient was only 52. Hay looked much older. She was also about 25 pounds underweight and admitted that she didn't recognize herself in a mirror.

“Vicki was at death's door with emphysema,” said Dr. Allen. “The only thing that could help her was a pulmonary blebectomy.”

Hay's lungs had giant blebs on them. Air blisters capable of rupturing, blebs are like big bubbles on an inner tube. They would fill up Hay's air sacs and then compress her lungs, preventing her from getting air.

“The chest can only accommodate so much,” said Dr. Allen.

Surgery was the only recourse

When Dr. Allen explained the procedure to Hay, she was both scared and hopeful.

“I didn't want to waste anybody's time or my husband's hope,” said Hay. “But I could tell I was going downhill fast. I knew I had to go through with it.”

Dr. Allen had performed the surgery many times before. Even so, he knew it was not a common procedure and that complications often arise because patients are so sick going into the operation. Many hospitals don't want to perform the surgery for this reason.

Saint Luke's, however, has the infrastructure to support it, including a multidisciplinary critical-care team at the ready once the surgery concludes.

“When patients are as sick as Vicki was, it's important to monitor them minute by minute, hour by hour,” said Michelle Haines, M.D., Cardiovascular ICU intensivist. “We continually reassess the patient, and doing this takes a team to focus on all aspects of the patient's status.”

An anesthesiologist who completed a fellowship in critical care, Haines served as Hay's intensivist—her physician while in intensive care—on the critical-care team. Hay also had a respiratory therapist, nurse, pharmacist, nutritionist and physical therapist working with her.

When Dr. Allen performed the surgery last March, he had two “inner tubes” to decompress—both lungs. This added to the procedure's complexity.

“I went in through Vicki's breastbone, which made her recovery easier than if I had opened up both the left and right chest cavities,” he said.

Three weeks after the surgery, Hay went home. Charlie was still with her day and night—but only for a week. After that, she didn't need it; she was building up her lungs.

And she started building up her appetite again, too, now that her lung was no longer pressing on her diaphragm, constricting her breathing.

Goodbye, Charlie—hello, stretch

After a month, Hay no longer brought Charlie with her as a just-in-case in the car. Now she uses the oxygen tank only at night.

During the day, she's back to helping her husband in the construction company they own. She also does something that had been unthinkable during her Charlie days.

“I can stretch and get a really deep breath,” she said. “You can't imagine how good it feels to do that without coughing.”

Dr. Allen is delighted, though not completely surprised, with the results.

“Once you're able to remove the pressure on the lungs, the lungs can expand and function again,” he said. “Vicki was very sick when she came to see us. She's made remarkable strides.”

Hay got her breath back; her husband got his wife back. And Hay's grandchildren no longer have to contend with Charlie. Hay can now keep up with them.

“The surgery gave me my second chance,” she said. “Now I can chase life.”