Treatment Saves Nurse's Life From H1N1 Flu

It started with a simple cough.

She dismissed it as just another seasonal cold on Thursday, Jan. 2.

But on Saturday she had a 104-degree temperature prompting her to go to the Allegheny General Hospital emergency room, where she was diagnosed with pneumonia, prescribed antibiotics and sent home.

What happened next represents the medical travail of Terri Thieret, 48, an AGH nurse of 25 years who forgot to get a flu shot due to the rat race of daily life, only to have that oversight result in a life-and-death emergency. When deteriorating health forced her back to the hospital the following Monday, she was placed in the intensive care unit.

And there she would remain for the next three months.

As it turns out, the West Deer resident developed pneumonia from an H1N1 influenza infection that packed her inflamed lungs so densely with fluid that her lung X-rays, usually mostly black, appeared as white. Each breath was a struggle.

"I felt like I was suffocating," Thieret said. "I couldn't have a conversation. All of my efforts went into breathing.

"I never before felt that poorly and knew something was very wrong," she said. In the hospital, she kept texting the doctors, with whom she works, that she was petrified. "Something was wrong. They texted back that they would come up. I don't remember anything after that."

That's because, while she was briefly on a ventilator, doctors quickly equipped her with extracorporeal membrane oxygenation, an artificial-lung system known as ECMO, that draws blood from veins near the heart, filters out the carbon dioxide and replenishes the blood with oxygen, before returning it at body temperature back to the heart. Her lungs were no longer working sufficiently.

Now heavily sedated, as ECMO requires, she would remain in a medically induced coma for what turned out to be 54 days, all due to her immune system's overtly aggressive reaction to H1N1.

"She wouldn't have survived another day or two without ECMO," said Stephen Bailey, AGH director of cardiac surgery, who served as her doctor. "She was undergoing respiratory collapse."

A very small minority of patients experience a toxic respiratory response from the flu, he said, noting that last year most H1N1 pneumonia cases requiring ECMO involved middle-aged women in their 40s and 50s. "I believe we had 11 patients last year on ECMO, and 10 survived for discharge," he said. One person died. That rate of ECMO cases "was a higher rate than typical," he said.

H1N1 has been in the annual seasonal flu vaccine since 2010, following the 2009 H1N1 global pandemic and continuing concern it creates, especially should it mutate and become even more deadly and more easily transmitted person to person. It caused 17,000 deaths worldwide in 2009 alone, the World Health Organization states.

With Thieret unconscious for nearly two months, with little signs of progress week after week, the challenges mounted for her husband, Joe, 47, and their two daughters, Madison, 17, and Ashton, 13. But Mr. Thieret also said they received help from his wife's colleagues at AGH, their church, their friends and their daughters' friends.

A week after Ms. Thieret was stricken, her daughter Ashton was taken to the hospital with a concussion she received while playing soccer. The family car broke down. A pipe burst in the garage due to the arctic temperatures. Then the furnace malfunctioned.

"I stood there at times and looked at what's going on in life and how life just goes on," Mr. Thieret said. "I'm standing there in the midst of a storm and had weird feelings. For months our lives are put on hold but the world keeps churning.

"I'm looking forward to next year."

Through late January and throughout February, Ms. Thieret showed little improvement, but the good news was that her condition was not declining. Mr. Thieret decided against allowing his daughters to visit their mother while she was unconscious.

But in late February, doctors started to wean her off ECMO and the sedation, as her X-rays began showing marked improvement, and she finally was removed from ECMO.

"I can't tell the exact moment I was awake, but it was early March before I was aware of my surroundings," Ms. Thieret said. "Someone asked about my children, and I told them that one daughter is 13 and the other is 16 and is going to be 17 in two weeks."

That's when Mr. Thieret interrupted: "Hon, it's March and her birthday was in January," actually Jan. 22.

The news that she missed her daughter's birthday made her cry.

"It's the first time I was aware of how long I'd been there — that I lost all that time. What had happened to me? I was very sick and hadn't seen them or had any recollections. There are some things I still don't remember. It's fuzzy. I saw cats running around from hallucinations. As a nurse, I knew they weren't there, but I saw cats and mice. I have two Siamese cats, and they were there, too."

Two months without any bodily movement left her feeling paralyzed. She was unable to lift her hand or raise her legs. She couldn't hold a pen or a phone. The months in bed also left her with a pressure ulcer on her back 5 inches in diameter and 3 inches deep into the muscle. Early in April, she was transferred to the West Penn Acute Rehab Unit and was released at the end of April, finally returning home to continue physical and occupational rehabilitation there.

Throughout the ordeal, she lost 50 pounds. She is still using supplemental oxygen as needed. She continues going through rehab and now says she's about 80 percent normal, with hopes of getting her doctor's permission to return to work with the colleagues and at the hospital where her life was saved.

Dr. Bailey said he can't stress enough "how phenomenal the nursing care in the ICU was while she was on ECMO for those many weeks. Many health complications can occur while a person is on ECMO, especially for those with heart or kidney disease," and especially considering how long Ms. Thieret was hooked up.

"Hers was an exceptionally long time on ECMO — 54 days — which is testament to the phenomenal nursing care she received that didn't result in any permanent complications," he said. The length of time on ECMO "is almost a record here and probably a record for someone with as good an outcome as she had. She may be coming back to work in a week." She's clear to return to work Monday.

The hardest thing for him, he said, is that "Terri is a colleague, a friend and we're close to the family. The hardest part is to try being objective and positive with the family but you know how serious it is. It made it challenging."

Of course, the big public message here is the importance of flu vaccines. She and her husband, a drugstore manager, say they are newly committed to getting immunized to help prevent the ordeal they just experienced.

Soon to return to work, Ms. Thieret said it likely will take a year for her to regain full health.

"I can tell you, it has definitely changed me as a person," she said. "It will make me a better nurse. I always had sympathy for patients, but now I have empathy as well when you go through an experience like this. It's amazing how your life changes in very little time, and we really need to educate people to get flu vaccines and take good care of themselves."

Because she underwent transfusions during the time on ECMO, due to the bleeding resulting from thinned blood, she also is planning to hold an Oct. 24 blood drive at the hospital.

"I owe my whole life to Dr. Bailey and Dr. (Robert J.) Moraca for their care and giving me my life back," she said. "How do you repay them for that? I'll be forever indebted to them. They see it as doing their job, but they were more than that to me. I got my family back.

"I don't want to get all mushy, but when you are close to dying, you evaluate things differently than you once did. It's difficult to explain, but I'm just a different person."

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Information from: Pittsburgh Post-Gazette, http://www.post-gazette.com