Beating the Odds: With the Expertise of Temple Medicine – and a Dose of Luck

Lisa McCown, 43, a waitress at the Golden Dawn diner in Burlington, N.J., liked going to casinos on her day off. Her mother once won $40,000 on a penny slot. This family knows a lot about long odds.

Back in April, Lisa got the flu. After a few days, she couldn’t breathe and told her daughter to call an ambulance. At a local hospital, doctors intubated her, induced a coma, and helicoptered her to Temple University Hospital.

Most people with flu get well in a few days. But in rare cases, like Lisa’s, the immune system inflicts far more damage than the initial flu virus. Her lungs became swollen and inflamed. This condition, Acute Respiratory Distress Syndrome, is often fatal.

Lisa landed in TUH’s 28-bed respiratory intensive care unit, where she was sedated into a coma and given drugs to paralyze her. Any movement consumed the little oxygen in her blood, depriving the brain. Doctors adjusted her ventilator constantly and with extreme care.

“Imagine the inside of her lungs as fragile as wet tissue paper,” said Erin R. Narewski, DO, a pulmonary and critical care doctor at TUH and Assistant Professor of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University.

Lisa was strapped into a RotoProne bed, spending most of her time on her stomach, allowing the back of the lungs slightly more room to expand. Doctors also tried ECMO, extracorporeal membrane oxygenation. A tube as thick as her thumb was inserted into Lisa’s groin and carried blood to the machine at her bedside. ECMO exchanged carbon dioxide with oxygen and returned the blood through Lisa’s neck into a vein above her heart. “You can imagine how easy it would be for blood to clot, or for infection to come in, or for one of these cannulas to tear the heart or a vessel,” Dr. Narewski said.

After five days, Lisa developed high fever from infection and ECMO was stopped. Her children, siblings, and mother sat in vigil at her bedside. Lisa’s youngest child, Frankie, 15, held her hand and wept.

After about six weeks, doctors worried that the likelihood of survival was slim, and if Lisa did survive, the chance that she’d ever get off a ventilator, out of bed, or be herself again was slimmer still. “Whenever there’s a patient who is so ill, and has gone so far beyond the point where we can easily imagine a recovery, we get really worried,” Dr. Narewski said. “Is this person going to make it? Am I coming here to help someone and instead causing suffering? No doctor wants that for a patient.”

Doctors thought it was time for Lisa’s family to at least consider stopping all aggressive treatments, letting her die peacefully. It might be enormously painful for a family to hear the truth, especially the family of a 43-year-old woman with teenage children, but Dr. Narewski felt it was important. “If we are not communicating in a respectful, open, honest, and evidence-based way with families about what’s going on,” Dr. Narewski said, “we are doing a grand disservice. If we don’t give them a choice, then they can’t make one.”

Staff from the ICU and Palliative Care team met with Lisa’s siblings, children, and mother on May 23, giving them the option of withdrawing care and telling them the risks of continuing to fight. Lisa’s family decided to wait a bit longer.

On June 17, one of Lisa’s lungs collapsed and her care team inserted a tube into her chest to re-inflate it. On June 18, her other lung collapsed. “We agonized for her, and for her family,” Dr. Narewski recalled. “We were worried both that the family had made the right decision and that we weren’t going to be able to keep her alive, or that the family had made a decision just to prolong her suffering. We were terrified of both.” On June 22, doctors put Lisa back on ECMO a second time, which is almost unprecedented.

But on July 2, 77 days after Lisa’s arrival, her lungs began to improve. A week later, she was awake, and spoke. “Against all odds, she survived,” said Yaniv Dotan, MD, an ICU fellow who cared for her. “I guess her biology was stronger than the inflammation, so she healed herself— with our help, of course.”

“Eventually, she stopped having complications,” added Dr. Narewski. “Her pneumonias were treated. The ongoing cycle of inflammation after inflammation resolved, to the point she was able to breathe on her own. But that was just luck. And it was the barest margin of luck.”

The family has its own theory. Lisa’s older sister Stephanie has a grandson—Lisa’s great-nephew— named Jayden, age 9. He started collecting ladybugs and rescued his first in a swimming pool just before Lisa improved. “Ladybugs are lucky and I think that made her health better,” Jayden said.

Slowly, Lisa began to recover during several weeks of physical therapy. Doctors explained to her that a seasonal flu shot likely would have prevented her from getting so sick. Lisa promised them she’d get one every year from now on.

Lisa’s last afternoon at TUH, August 25, was a parade of goodbyes. “Take care,” said Dr. Dotan. “You’ve been amazing.” Lisa started crying. “I don’t want to leave,” she said. “But I have to. My friends are here.” Lisa gave flowers to Debra Gillman, a nurse practitioner. “I’ll be passing by your room and I’ll be missing you,” Gillman said. “But that’s a good missing.”

Dr. Narewski kneeled down, took Lisa’s hand. “I cared for you for a couple weeks in the ICU when you were at your very, very sickest,” the doctor said. “I know you pretty well, but not the real you.’’

“You’ve got a wonderful family,” the doctor continued. “They never gave up on you. Not once. Even when we talked with them about our concerns that you may not make it, they said you keep the full press going.”

“Would you sign my book?” Lisa asked.

“I’d love to sign your book.” Dr. Narewski wrote: “We are so proud of your resilience and tenacity. You inspire us all. And help us remember why we fight so hard for every patient.”

The transport team had arrived. Lisa was off to a rehabilitation hospital in New Jersey. As EMTs wheeled the gurney down the hall, Lisa faced backward, toward her family and nurses. Tears rolled down her cheeks. 

She blew them all a kiss. Then disappeared around the corner.