Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, March 6, 1990 TAG: 9003061699
SECTION: VIRGINIA PAGE: A6 EDITION: METRO
SOURCE: CHARLES HITE MEDICAL WRITER
DATELINE: LENGTH: Long
Donnis Patton is afraid Frantz will do just that. "She looks like she's going to die," says Patton, a doctor on the Medical Intensive Care Unit.
Patton has been called to evaluate Frantz, a 29-year-old who several hours earlier had given birth to her first child. Patton is not encouraged by what she sees.
Frantz is ashen and in pain. Just touching her abdomen makes her scream. Her temperature is 103 degrees. Her womb is bleeding profusely. Her blood pressure is dangerously low and her heart rate is 160. Her hematocrit - a test measuring the oxygen-carrying capacity of the blood - is 11, compared to a normal level of 37 or more. It's the lowest Patton has ever seen in a patient who wasn't dead.
Patton and the medical resident on the obstetrical unit believe Frantz has DIC, a blood-clotting disorder that can be caused by infection or a complicated pregnancy. Patton decides to get her to the intensive care unit as quickly as possible.
The trip - from the old hospital building to the new - is more than a quarter of a mile. The ride is a grueling one for Frantz, who screams each time her bed is jostled.
Once Frantz is at the MICU, Patton gets cultures to check for infection. She orders tests to check critical clotting factors. Frantz gets eight units of packed red cells, nine units of platelets, eight units of fresh frozen plasma and 12 units of factor VIII, a concentrate with an essential blood protein.
Frantz also gets two powerful antibiotics to treat any possible blood infections and intravenous solutions to replace the calcium, magnesium and potassium she has lost.
At one point she grabs Patton. "You have to help the pain," she says. Patton orders morphine.
In a few hours, Frantz' lab tests start improving. Her temperature drops. She is able to sleep.
The next day, Frantz is able to sit up and drink juice. She asks one of the nurses about getting her hair washed. She wants to see her baby girl.
\ `Highlight of our day'
The doctors and nurses do everything they can to see that she gets her request. New mothers and babies are rarities in the ICU. With Frantz out of danger and the prospect of a newborn coming for a visit, the ICU staff gets a lift.
"Now that's what an ICU should be all about. Patients like her," says Bill Lawing, the intern who's been treating Frantz.
"This is the highlight of our day. Can't you tell?" Dot Cage, an ICU nurse, tells Frantz when Sarah Katherine is wheeled into her room in a portable bassinet.
For Patton, who has just seen two patients in their 20s die from complications of leukemia, Frantz' recovery is a reminder that death can be defeated.
"The hardest thing for me is young people," she says. She had known both the leukemia patients when they were on another floor in the hospital. Watching them linger before dying was hard to do, she says. Frantz' quick turnaround gives her faith.
Frantz' father, a Boston pediatrician, knows his daughter is lucky to be alive. "I've seen people die from DIC," says Dr. Russell Irons, who came down for the birth of his granddaughter. "It was extremely good teamwork that saved her life."
Irons also recognizes his daughter's importance to the medical team. "It's always good to see something nice like this," he says. "I've been in medicine a lot of years. You can count on your fingers the number of patients you save that someone else couldn't."
Hopelessly ill patients are so common on the MICU that it's easy for the staff to get jaded, to wonder why they work so hard when a patient is going to die anyway, says Priscilla Merrill, the unit's head nurse. But now and then a patient comes along to remind them that sometimes it is possible to beat the odds.
"I've been doing this over 16 years," Merrill says. "When they tell you there is one chance in 100 that this person will live, there is always that one chance that keeps me honest."
Jimmy Ogles' spleen is chewing up blood platelets as fast as doctors try to replace them.
"He could bleed out any time," says Carolyn Wilson, a MICU resident who worries that Ogles' blood is too thin to clot. "There's nothing there."
Ogles, 24, has AIDS. He came to the emergency room the night before after bleeding from his gums for four days. He was given five units of platelets, then sent to the medical intensive care unit where Wilson gave him even more blood transfusions.
Lab tests show Ogles' platelet count is less than 10,000. A normal level is 150,000. Without enough platelets, his blood isn't able to clot.
On top of his clotting problem, Ogles is a hemophiliac and has a rare bacterial lung infection similar to tuberculosis. Ogles tested positive for the AIDS virus two years ago, but his wife says he has never told her he has the disease. She says he isn't willing to face it. Ogles says he has told his wife. He says she doesn't want to accept it. They have two sons, one 3 years old, the other 8 months.
Wilson and Russ Bailey, a MICU intern, feel they need to let Ogles' wife know that her husband may not make it out of the hospital.
They ask her to tell them about Ogles' hospitalization several months earlier in Richmond. Jeanette Ogles says she thought her husband had a bad flu. He had a high fever, vomiting, night sweats. She knew that Jimmy had been told he had the AIDS virus. "I didn't know if he was getting worse or what," she says.
Wilson says it sounds like the two-week hospitalization was linked to her husband's illness, that it probably signalled the start of a downhill course for his disease. "He does have AIDS," she tells Jeannette Ogles.
Tests show that Jimmy Ogles has an extremely low number of the type of white cells attacked by the AIDS virus, Wilson tells his wife.
\ `He could go quickly'
Jeannette Ogles says her husband doesn't seem to be taking the disease seriously. Sometimes he gets depressed and drinks heavily, she says.
"Right now the platelet problem and bleeding problem can't be reversed," Wilson says. "Even though he looks good now, he could die. He could go very quickly."
Wilson and Bailey tell Jeanette Ogles that the wouldn't recommend aggressive treatment: no breathing machines, no cardiopulmonary resuscitation. That's what her husband told doctors in the emergency room.
"I realize that," Jeanette Ogles says. "As much as I love him. . . . I just wish I could do something."
"We do too," Bailey says.
"We're helpless," Wilson says. "We can extend his life by some little bit of time but in the long run the situation is pretty grim."
For the next five days, doctors keep Ogles going by giving him five or six units of blood a day. They debate what else can be done. Treatment with prednisone, a steroid, is a possibility but that hasn't always worked with AIDS patients. A splenectomy - surgically removing the spleen - has been tried with a few AIDS patients and the results looked encouraging. But none of those patients had hemophilia. And the surgery in Ogles weakened state would be very risky.
\ `A matter of months'
"He could go on indefinitely like this," Wilson says during an informal consultation with an AIDS specialist.
"As long as you keep pumping the blood in," says the specialist, who's not too keen on the idea of surgery. "It's going to be a matter of months anyway."
Ogles says he's willing to try surgery. But after hearing about the risks, he becomes less enthusiastic. The doctors decide to try prednisone first before risking surgery.
By afternoon the next day, Ogles seems to have responded. His platelet count goes up. His appetite returns. He has more energy, says he feels better. He feels so good in fact, that he asks to sit up in a chair. He asks to watch television, so the nurses bring in a set that gets only one channel. (The ICU rooms were never outfitted with cable connections).
"I'm waiting for some soup right now," Ogles tells his wife when she comes for a visit. He is sitting in a chair, being careful not to tug too hard on a catheter in his thigh that is used to give him blood. He's dressed in tube socks with red, white and blue stripes and a white hospital gown speckled with blue dots. He asks her to bring his guitar on her next visit.
He is already reading a magazine she dropped off earlier: "Muscle Car Classics."
"I had a 1969 Olds Cutlass. Looked just like that," Ogles says, pointing to a picture in the magazine. "That car would move, I tell you."
When a nurse comes in to draw blood, Ogles offers to do his own stick. He says he learned how when he was in the Richmond hospital.
"Sometimes you think a patient will never make it out of here and he does," says Alice Hutchens, a nurse who helps care for Ogles. "It teaches you never to say never."
Ogles hasn't given up. He continues to improve. The next day, he walks around in his room a bit. He reads magazines watches the fuzzy television and occasionally picks up his guitar and does finger exercises (the nurses won't let him play it because it would disturb other patients).
On his 10th day in the MICU, Ogles is like a caged animal. He wants out. He talks about riding his motor scooter. He tells the doctors that he needs to be home with his wife and children. They've moved to a new apartment and it isn't in a safe part of town, he says.
Ogles isn't ready to go home, the doctors say. They need to watch him a few more days, give him blood if he needs it. So they make a deal. They will let him go to a bed on a regular floor - where he can watch cable television with multiple channels and a clear picture. They'll also let him go down to the gift shop for 10 minutes if he'll be careful not to pull out the catheter in his leg.
Four days later, Ogles is sitting up in bed, eating chips and guzzling apple-raspberry juice. He's dressed in jeans, white socks and a blue shirt. Jerry, his 8-month-old, is curled next to him, sleeping. Jeannette is in a nearby chair, waiting.
Ogles is getting his last two units of blood, a "tune-up" before he leaves the hospital. He's made arrangements to be seen regularly at the hospital's AIDS clinic. He can't wait to get home.
He wants to get a car and rebuild it from the frame up. Maybe he'll even have his own garage or shop in a couple of years, he says. Then he adds, "If I'm still around."
Memo: Life and Death in Intensive Care