Le Barron interrupts. “She’s just passed out again.” “Ohhh,” the operator says, his voice dropping. He sounds tense as he reassures Le Barron that an ambulance is coming. The timing of the collapse, though traumatic for the staff, was incredibly fortunate for Kelly. If it had happened at many other times — driving in the car with a child, asleep, in the room of a patient who was barely conscious — Kelly might not have received help so fast. Her outcome, in that case, almost certainly would have been worse. How much worse is anyone’s guess. After the paramedics arrived and stabilized Kelly, Mike arrived at Hospice House, having been called by one of the nurses. He and Dr. Lisa Lewis, the medical director at Hospice House, followed the ambulance the few short blocks to St. Charles Bend’s emergency room.
In the ER Nurses and doctors leapt to Kelly’s side as soon as she hit the emergency room. They knew right away it was serious. A team quickly began checking her vital signs, giving her medications to alleviate symptoms and inserting intravenous lines. Kelly was terrified. She was conscious and confused about what was going on, Lewis said, becoming teary at times. “All these people were yelling orders at her,” said Lewis. Kelly’s head throbbed. “I hurt so bad,” she repeated over and over again. “My head hurts so bad.” Dr. Brett Singer was the emergency room physician on call that morning. He took a quick medical history, noting that this was the first time in her life she’d had a seizure and had no family history of the problem. With that kind of abrupt onset, he said, “aneurysm is the first thing that comes to mind.” With her symptoms, he said, ordering a CT scan to look for bleeding in her brain would be routine, and he ordered one immediately. It showed a massive bleed. Singer immediately called the neurosurgeon on call, Dr. Brad Ward. He took one look at the scan and called another neurosurgeon, Dr. Ray Tien, who specializes in fixing aneurysms. An aneurysm is a bubble in an artery, the blood vessels that carry oxygenated blood from the heart to the rest of the body. Like a
HIGH DESERT PULSE • SUMMER / FALL 2010
might never see her again. Later, while Kelly was being treated, Mike went back home. “I looked it all up on the Internet,” he said. “That sucked.” He learned that very, very few people come through without side effects. While he was online, their oldest son, 17-year-old Derek, came into the room. “Mom’s going to be alright, isn’t she?” he asked Mike. “I don’t know, man,” Mike replied. “I don’t know.”
Surgery
FILE PHOTO
Dr. Ray Tien, neurosurgeon
The ruptured blood vessel was near the parts of her brain that control vision, smell, leg strength and hormones. In Kelly’s surgery, all those functions were at risk. balloon, when the artery bubbles out, it becomes thinner and weaker. An aneurysm in itself is not dangerous and rarely has any effect. A person can live with an aneurysm for decades without knowing it’s there. The danger is that, as the blood vessel balloons farther and gets thinner, it can pop. There are several risk factors for aneurysms. A family history, high blood pressure and smoking make an aneurysm more likely. Kelly had none of these. No one knows what caused her aneurysm to form or rupture. It could have been, said Tien, that she was just unlucky. Mike, in the hospital waiting room, was in shock. In just a few hours he had gone from drinking a leisurely morning coffee to answering questions and signing papers about Kelly’s power of attorney and the executor of her will. He called his two teenage his stepsons, and told them to leave school. He called Kelly’s parents and her brother. He feared they
It was early afternoon, about three hours since Kelly had collapsed, when Tien began to work on Kelly’s aneurysm. There are two ways to fix a ruptured aneurysm, one in which the skull is cut open and one in which it is not. Tien wanted to try the less invasive procedure first. Tien is the only neurosurgeon in Central Oregon trained in a procedure called endovascular embolization that was first used in the 1990s. A catheter is snaked from a blood vessel in the patient’s thigh through the body and up into the skull to fix the aneurysm from within the blood vessel. Cardiologists commonly use a similar procedure to fix blocked arteries in the heart. An X-ray scan, done shortly after Kelly’s initial CT scan, had shown Tien the location of the ruptured blood vessel in her head. Using the X-ray scan to determine his position, Tien threaded a catheter up into her brain. Once there, his goal was to fix the rupture by sliding small metal coils through the catheter and pushing them into the bubbled-out aneurysm. When it works, the coils bunch up, like a balled-up Slinky, filling the aneurysm and preventing blood from flowing into it. A blood clot forms that seals the aneurysm, preventing further damage. Once he got into the ruptured blood vessel, Tien realized this procedure would not work for Kelly. Her aneurysm was not typical. Most bubble out on one side of the blood vessel; Kelly’s bubbled out on both sides. Tien described it as dumbbell shaped. “There just really isn’t a safe way under these circumstances to fix this from within,” he said. By late afternoon, Tien was opening Kelly’s head. He cut her scalp across the front of her hairline, drilled through her skull just Continued on Page 44
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