Virginia's story

Subdural hematoma

Virginia remembers little from 2017, but there is little that her husband, Glenn, will ever forget.

The drama began slowly enough. Virginia, who goes by Jenny, began having balance problems, memory slips, and periods of confusion. Glenn thought she might be getting Alzheimer's. Jenny thought she was just getting old. "It took me a long time to get to the point where I was at death's door," she says. "We both knew there was something not right with me, but we never thought to ask a doctor about it."

The morning of Halloween, Glenn came home after working the third shift and found Jenny sound asleep and sprawled out, half in bed, half out. Because she had fallen many times, Glenn wasn't overly worried. He lifted her back into bed, then lay down for a short nap.

Later, when Glenn tried to wake her, Jenny was still unresponsive.

"My first thought was that maybe she took extra medicine and was having a hard time waking up," Glenn recalls. "I poured a little water on her and she sputtered and still didn't wake up. I got scared and called the doctor, who said to call 911."

Emergency responders assessed the situation as dire and transported Jenny "with lights and sirens" to the closest hospital, Mercy Anderson. There, the fast-acting emergency department diagnosed a life-threatening subdural hematoma, a large collection of blood between the tissues that surround the brain.

Most subdural hematomas are caused by a head injury (a fall or accident) that tears blood vessels near the surface of the brain. In Jenny's case, the hematoma likely was caused by mild repetitive falls, which eventually led to the formation of a large, acute blood clot.

A helicopter air-lifted Jenny to The Jewish Hospital – Mercy Health, a tertiary neurosurgical care center, where she was assessed by Zachary Tempel, MD, a neurosurgeon with Mayfield Brain & Spine, and Andrea Stoll, NP, who heads the hospital's nurse practitioner team.

Skilled tertiary care at The Jewish Hospital-Mercy Health

"When it comes to neurosurgical emergencies, when every second counts, this is as dramatic as it gets," Dr. Tempel says. "When Virginia landed at Jewish Hospital, she was in extremis, demonstrating signs of imminent brain death. Many thought it was too late and questioned whether we should even take her to surgery. Andrea Stoll and I disagreed."

They whisked Jenny into the operating room, where Dr. Tempel performed a hemicraniectomy. He removed a large portion of one side of Jenny's skull, relieving pressure and giving her brain room to swell.

She was still in surgery when Glenn arrived at the hospital. "I wasn't going to eat anything, but the staff brought me a plate of food," Glenn says. "They were really good to me. After she was out of surgery, Dr. Tempel came out to talk to me. He was not very optimistic. He explained that this was a life-saving procedure, but he didn't know where it could go from here. It was a 48- to 72-hour wait-and-see period to see whether she came out of it."

"Or died," Jenny adds.

The 72-hour window came and went, and a day of reckoning approached. Would Jenny, still unresponsive, be placed on long-term life support, with breathing and feeding tubes? Or would she be allowed to drift away peacefully?

"I was always very firm about heroic measures," Jenny says. "I always said, 'Promise me, Glenn, no feeding tubes. And no burying my body. Just ship me off to the medical school."

"This was the second hardest time for me," Glenn says. "They wanted me to make a decision about a trach tube. I knew she didn't want that, but nothing had been written down. I thought I was going to lose her anyway. I got on Facebook and told everybody, 'We need a miracle because she's not healing fast enough."

Unexpected glimmers of hope

The next day, a Monday, the medical team huddled, as usual, in Jenny's room in the intensive care unit. They discussed breathing and feeding tubes and long-term care. They discussed palliative care, and what that would entail. At that very moment, however, Jenny's status appeared to be changing. Earlier that morning she had opened her eyes. She had moved her head "yes" and "no" to questions. She had moved her limbs. She had slammed down her fist, surprising her nurse.

As Glenn sat and worried about what to do, Jenny continued to emerge. "It was all of a sudden like the Christmas tree lights coming on," Glenn says. "She started showing that she was alive in there after all, and she hadn't shown that up to that point. That basically changed my mind. It was not worth giving up yet. Throughout the whole day she improved. So much happened on that Monday."

The pulmonologist, Erich Walder, MD, returned and helped Glenn with his decision. "He explained that a trache tube isn't a permanent solution; it's a temporary solution to get her where she can breathe on her own again."

Jenny spent several weeks at the Daniel Drake Center for Post-Acute Care and then many more weeks at a nursing home. During that period, she says, "My life began again."

Virginia and her husband, Glenn

In December, Jenny returned to Jewish Hospital so that Dr. Tempel could replace the portion of skull that had been removed. Her brain, once terribly swollen, had by now settled into its normal contour. The day was momentous for Jenny, and for everyone involved with her care.

"In Neurosurgery, the stakes are substantial," Dr. Tempel says. "The highs can be really high, and the lows can be really low. Saving a life will always remain a special feeling for those who are fortunate enough to have experienced it.  When she returned to the hospital to have her bone flap replaced, I took a video of her smiling and thanking all of the people at Jewish who gave her a shot.  A lot of happy tears were shed in the ICU and in the operating room that day. It catches me every time I think about it."

An anniversary trip to Disneyworld

Today, Jenny is once again herself. She uses a walker, and she won't take a shower unless Glenn is nearby. But she can type again, and Glenn declares her "every bit as good as she was before." Their 10th wedding anniversary is approaching, and they will celebrate with a trip to Disneyworld.

To others who face a neurological emergency, Jenny has a message, which she places in the context of one of her favorite television shows, the long-running "Dr. Who."

"When one actor is getting ready to change into another one, to keep the series going, he says, 'Where there's life, there's hope,'" Jenny says. "I feel the same way. As long as they were seeing a little bit of life sparkling around, it didn't seem like anyone was going to give up and go home. Especially a husband who was told 'no heroic measures' by his wife. I would say to other people, hold on to the last possible moment that you can, because miracles do happen. And ours happened through Dr. Tempel and the staff at Jewish Hospital.

"I did a lot of rehabilitation there, too," Jenny adds, a bit of spunk showing through. "They really push you, so if you are up there, you are going to get well."

~ Cindy Starr

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