When a stroke interrupts a road trip, Connecticut family finds home away from home at Christiana Hospital
George and Gertrude Dingwell of Harwinton, Conn., have been making road trips with motorhomes since 1977. This March, they snuck away to Florida in their Winnebago.
But passing through Delaware on their way home, Gertrude had a stroke. The couple ended up having an unplanned, monthlong stay at Christiana Hospital.
From the time of Gertrude’s arrival until her discharge May 24, Christiana Care provided electricity and water for the RV, which served as home for George and their poodle Tobias as Gertrude recovered. This year, Mother’s Day fell on Gertrude’s birthday, and four generations of their family gathered in her hospital room, bringing a banner and cards.
George is effusive about the respect and compassion the staff has shown, embodiments of The Christiana Care Way. A nurse, for example, took time to explain to him why they were going to give his wife a certain medication and how it might affect her. The same was true of every procedure the staff undertook.
One afternoon, Rick Gerard, a security constable, knocked on the door of the RV and asked George if he’d like to join him and his family for a home-cooked meal. George was happy to oblige. They spent four hours sharing good food and conversation.
“It just made an adverse situation of my wife’s health into a pleasant situation for me,” George said.
Diane C. Bohner, M.D., FACP, medical director of Patient and Family Centered Care and Resource Management at Christiana Care, called the staff’s flurry of assistance “extraordinary.”
"And," she added, "it is exactly what you would want to have done if it was your family member. The Christiana Care Way is not only taking care of the patient, but also taking care of the patient’s family. And they treated him, even though he was from Connecticut, as if he was one of their neighbors. They figured a creative way to assist him while he and his wife were going through this particular traumatic period of their life. They did what they thought they needed to do for him without having a second thought about it.”
Teresa Celano, assistant to Christiana Care’s chief operating officer Gary Ferguson, got involved when two members of the X-ray staff asked for the administration’s help. Celano provided meal vouchers and ensured the public safety and maintenance departments were aware of the RV so they could share their water supply.
“When something like this happens,” Celano said, “it is difficult enough, but when you are hundreds of miles from home with no family support, it can be overwhelming.”
On Gertrude’s birthday, Chanel Etty, the charge nurse, ordered a birthday cake. Gertrude wasn’t able to eat cake – she had been without solid food for 24 days – but Etty gave her icing “so she could have a little taste of sweetness.”
During Gertrude’s fourth week of recovery, she began eating soft foods. Soon thereafter, doctors removed her tracheostomy tube. Five weeks after the Dingwells made their unscheduled stop, Gertrude no longer needed a feeding tube.
Meanwhile, she reached milestones essential to returning to her usual way of life, such as walking up and down stairs.
Jill D. Aaron, a radiologic technologist, said that even on days when Gertrude’s condition was touch-and-go, her husband would be walking the hallways, smiling, asking staffers how they were doing.
Though the Dingwells aren’t sure when they’ll embark on their next road trip, they intend to stop at Christiana Care when they pass through Delaware.
“I came into town a stranger, passing through,” he said. “I have met so many people here, that when I leave, I feel like I’m going to leave a lot of friends behind.”
Deborah Ligor woke up in the middle of the night in June 2011, vomiting and suffering from the worst headache of her life.
Initially, her doctor thought she had a virus. But when she didn’t get better, it was clear the 50-year-old banker had a much more serious problem, most likely a ruptured aneurysm in her brain.
The expert care and advanced technology required to save her life were not available at the community hospital near her home in Ocean Pines, Md.
“So my husband asked the doctor where he would send his own mother,” Ligor recalls. “Forty-five minutes later, I was on a helicopter to Christiana Care.”
Doctors there quickly confirmed that she was, indeed, suffering from a ruptured aneurysm, essentially a bulging blood vessel that was leaking. The situation was especially perilous because Ligor’s aneurysm was located deep within her brain, a position not accessible through open surgery.
“If you drew a line between your two eyes, it would be dead set in the middle of your head,” says Sudhakar Satti, M.D., the neuro-interventional surgeon on the case.
In such dire circumstances, half of patients die, Dr. Satti notes, and about 70 percent of those who survive have some sort of permanent neurological disability.
“Christiana Care is the only place in Delaware that is equipped to handle these cases,” he says.
With a state-of-the-art interventional neuroangiography surgical suite, Christiana Care Neuro-Interventional Surgery provides minimally invasive services and treatments 24 hours a day, seven days a week, for a variety of conditions, including strokes and vascular and brain malformations.
Because the aneurysm was inaccessible from Ligor’s skull, Dr. Satti used endovascular techniques to reach the site in her brain, guiding a catheter through an incision in her groin, no larger than the tip of a No. 2 pencil. Through the catheter, Dr. Satti packed the aneurysm with soft metal coils, stopping the bleeding.
In addition to providing quick, effective treatment, the technique also results in less pain and a faster recovery. Two weeks after her surgery, Ligor was home with her husband and two children. Several weeks after that, she returned to her job at a bank in Millsboro.
“She has made a complete recovery,” Dr. Satti says. “These kinds of happy outcomes are the reasons doctors go to work every day.”
Ligor says her healthy, productive life is a direct result of the expert and compassionate treatment she received at Christiana Care.
“I am glad for the techonology they have but it goes far beyond that,” she says. “Every person I encountered at Christiana Care was friendly and kind — and the nurses were wonderful. They really want to help you.”
She now returns to Christiana Care for regular checkups with Dr. Satti.
“I would never go anywhere else,” she says.
The devastating impact of Dinesh Nayak’s fall down his basement stairs in February 2010 was immediately obvious in the pain he felt radiating up from his left ankle. But today, he says his choice to seek help at Christiana Care was an “outstanding” decision.
Dr. Paul Kupcha, an ankle specialist at Christiana Care Health System, became his health care partner during the 11-month journey to recovery.
The effect of landing on his left foot resulted in a pilon fracture, a diagnosis Kupcha confirmed with a CT scan shortly after the injury. A pilon fracture refers to a high-impact injury where the tibia (the larger bone in the lower half the leg) shatters at the point where it hits the bones in the ankle.
Many people who suffer a pilon fracture never walk without crutches or a limp again. But two years after that fall down the basement stairs, Nayak has returned to everything he loves doing.
“It’s really a testament to the doctor that I’m able to walk,” Nayak said. “The fact that I can walk without even a cane is truly remarkable.” Nayak’s only lasting reminders are occasional pain and stiffness, and mild range-of-motion limitations in his ankle.
Kupcha performed surgery at Christiana Care’s Wilmington Hospital after the original injury to repair the damage.
Over the next five months Nayak used an external fixator — an external device of pins and rods — that is coupled with internal plates to stabilize the bone. They helped Nayak’s tibia knit back together. During weekly visits to Kupcha’s office, adjustments were made to keep the healing on track.
When the external fixator was removed – a few months early because Nayak was tired of keeping the weight off his foot — the healing process was well under way. Follow-up included various casts, splints and braces that allowed Nayak to gradually bear weight on his foot. When those were removed, Nayak began two months of physical therapy to build strength and learn to walk again.
At that point, a celebration was in order. Nayak decided on a trip to Antarctica. Since then, he’s traveled to destinations all over the world.
Nayak thanks Kupcha for helping him achieve that return to activity.
“I chose the emergency room at Christiana Care; I chose Dr. Kupcha; I made those choices,” Nayak said. “…My experience at Christiana Care was outstandingly good.”
Elizabeth Van Leeuwen was enjoying dinner and a lively chat with her 29-year-old grandson — and suddenly couldn’t speak.
At the time, the 86-year-old great-grandmother from Hockessin, Del., was staying in a rehabilitative center, where she was recovering from a fall.
This latest challenge was an ischemic stroke, sometimes called a brain attack, that occurs when an artery to the brain is blocked.
“When I lost my speech, my grandson immediately knew something was wrong — and he got help right away,” she recalls.
Van Leeuwen was rushed to Christiana Hospital, where a stroke team was poised to evaluate her.
“That saying ‘time is brain’ is true,” says Mary Ciechanowski, MSN, RN, ACNS-BC, CCRN, stroke advanced practice nurse. “We work in conjunction with the Emergency Department to quickly identify stroke patients so we can determine the appropriate intervention.”
Because Van Leeuwen arrived at the ED soon after her stroke, she could be treated with tissue plasminogen activator, known as tPA, a protein that is highly effective in breaking down blood clots. Ideally, tPA should be administered no later than 4.5 hours after the onset of stroke symptoms.
Gregg Zoarski, M.D., a neurointerventional surgeon, used a Solitaire, a new tool in the arsenal of stroke-fighting devices, to remove the clot. The device was approved by the Food and Drug Administration in March 2012, less than five months before Van Leeuwen’s stroke on July 29.
“Basically, it’s a stent on a stick,” he says. “After it’s inserted into a blocked artery with a catheter, it compresses the clot and traps it. Then the clot and the stent are removed.”
In all, the surgery took 44 minutes. Van Leeuwen was headed for recovery less than four hours after she suffered her stroke.
“We are making tremendous advances in stroke treatment and positive cases like Mrs. Van Leeuwen’s are becoming more common,” Dr. Zoarski says.
The Christiana Care Center for Heart & Vascular Health provides round-the-clock minimally invasive services and treatments in a state-of-the-art neurointerventional surgery suite. The health system has one of the highest volumes of stroke patients in the region, providing treatment for more than 1,200 patients a year.
“Everything we do here is 24/7, including surgery, labs, imaging and technicians,” Ciechanowski says.
Dr. Zoarski says Van Leeuwven’s experience illustrates the importance of seeking help immediately if someone shows signs of a stroke. In addition to difficulty speaking, symptoms include confusion, sudden and severe headache, problems with balance or walking, and numbness or weakness in the face, arm or leg, especially on one side of the body.
Today, she is healthy and happy and living at home. She has recovered her speech and is walking with a cane as she builds strength and balance.
“At Christiana Care, I got highly skilled doctors and the latest and greatest in technology,” she says. “After my surgery, I got wonderful care from the nurses. Everyone I encountered was very professional — and extremely nice.”
Justin Plank had imagined what the first moments of fatherhood might be like. His wife Brenda would give birth, their newborn son would wail upon gulping his first breath of air, and Justin would cut the umbilical cord, as if to celebrate the grand opening of a new life.
But when Waylon Plank was born Sept. 29 at a Delaware hospital, his father heard no crying. His newborn son looked purple. The doctor immediately knew something was wrong.
A yellow button was pressed, and within 60 seconds a group of nurses was in the room, providing Waylon with oxygen, and letting the new parents kiss their ailing son as they rushed him to the neonatal intensive care unit.
Baby Waylon was suffering hypoxic ischemic encephalopathy (HIE), which means his brain was not receiving enough oxygen. Five minutes of such deprivation can begin killing brain cells. The long-term effects can include intellectual disability, seizures, delayed development and cerebral palsy.
Reducing the brain and body’s temperatures can slow damage. Though it may seem counter-intuitive to those accustomed to seeing newborns placed in incubators beneath warm lamps, the doctors and nurses tending to Waylon in his earliest moments told the Planks their son was a candidate for a cooling technology that could be applied even as they transported him by ambulance to Christiana Hospital, where the most qualified personnel and equipment would give him a fighting chance.
Justin and Brenda agreed. Waylon was wrapped in a CritiCool blanket, which circulates cold water regulated by a microprocessor that responds to the baby’s temperature.
The cooling process must occur within the child’s first six hours of life, says Michael Antunes, M.D., medical director of Christiana Care’s neonatal hypothermia program.
“Those inflammatory cascades that can be initiated need to be stopped early-on,” Dr. Antunes said. The temperature reduction must be sustained for 72 hours. The choice to do so resides with the parents, but it is the job of doctors such as Antunes – he didn’t work directly with the Planks – to explain the harrowing scenario and the most hopeful medical response, all while cautioning that for at least the next few years, the parents monitor their child closely for signs of lasting damage.
At about 24 inches tall with a footprint of about 15-by-15 inches and weighing 30 pounds, the CritiCool is a mobile version of larger, stationary devices that serve the same purpose. Christiana Care has two CritiCool units and is the only delivery hospital in Delaware that has the equipment.
“Internationally,” Dr. Antunes says, “this has become the standard of care.”
Justin Plank, whose family lives in Greenwood, spent that first night of his son’s life at his wife’s side at the hospital where he was born. The next morning, while his wife continued to recover, Justin went to Christiana Hospital to see Waylon, who would remain hospitalized there for nearly two weeks. (Upon his body’s return to its normal temperature, Waylon’s blood sugar would have to stabilize.)
“One of the hardest things was to see him lying there, cold,” Justin said. “You know it had to be hurting, even though they had him on morphine to reduce the pain of the cooling process.
“You expect your baby to cry and to be overwhelmed with joy when they’re born, and we didn’t get that. When I got up there, he was on the cooling pad, and when he heard me talk, he opened his eyes. The nurse said that was the first time he had opened his eyes. I’m sure he heard lots of other people’s voices, but to me, it seemed he recognized my voice.”
That night, Justin again stayed with Brenda at the hospital where their baby was delivered. The next evening they stayed at the Christiana Hospital NICU.
Every morning, as doctors checked in on the Planks’ child, Justin would ask questions about the process. It eased his concerns to know that he or his wife could call the staff at any time, day or night, for updates on their son’s progress.
“That was really helpful,” he says. “It gives you peace of mind.”
Waylon has met his milestones in the time since his stay at Christiana Hospital. His parents say the respect and care they felt from the Christiana Care staff went beyond access to information.
“I think that we got the best care that we could’ve gotten,” Justin says.
Each day on Pat Miccio’s calendar lists a number, with a running total for the month on the top of the page – usually somewhere in the hundreds. It’s Miccio’s way of marking how many recyclables she has picked up on the daily walks she takes around her Pennsville, N.J., neighborhood, all carefully tabulated on the wall calendar.
In more than four years, Miccio has collected 18,000 recyclable items others dropped on the ground – soda cans, beer bottles, milk jugs, sports drink containers. But for nearly a year, from December 2010 until September 2011, those days on Miccio’s calendar were empty of anything except doctor’s appointments as she battled breast cancer with the help of the staff at Christiana Care’s Helen F. Graham Cancer Center.
Miccio’s odyssey from environmental steward to cancer patient to cancer survivor began with her daily walks more than 10 years ago. While she initially walked for the exercise benefits, Miccio quickly discovered another reason to get out of the house every day.
“I just needed to get out, and then it got to the point where I was walking and I’d see all this mess on the ground,” Miccio said. “It starts getting to you.”
Miccio saw an Oprah Winfrey special about the environment, and it inspired her to start carrying a plastic bag with her to collect some of the mess she would see.
“It started out, I brought one bag with me … and then after a couple of weeks, it would be two bags. Then, another couple of weeks, especially after Septemberfest, it jumped up to four bags,” she said. “It’s amazing what you find. It adds up.”
But the collecting was put on hold after Miccio went to her doctor for a routine mammogram in 2010. Miccio was diagnosed with stage 1 cancer in her left breast. She was sent to the Helen F. Graham Cancer Center to begin a treatment regimen. In October 2010, Miccio underwent a lumpectomy. Chemotherapy and radiation followed, lasting for nine months.
For a year, the fight against breast cancer took precedence over the mission to clean up the environment. Even after the treatment ended, she found that she didn’t have the energy to walk every day – because of the lingering effects of her cancer treatments and an ongoing battle with chronic obstructive pulmonary disease, or COPD.
“I’m realizing what a friend of mine had told me: It takes a while to get back into the full swing of life again,” Miccio said.
As the counts on Miccio’s calendar show, she is getting back. By the end of April, she had collected just 270 pieces for the year.
“I’m usually well over a thousand by that point,” she said.
By the end of August, Miccio’s count had climbed to 1,685 for the year.
“Maybe, by the end of the year, I might break 3,000 pieces,” Miccio said. That number would also put her running total at more than 20,000 recyclable items picked up.
Miccio found another cause to help her get back into the swing of life. She has donated the cans painstakingly collected, sorted, washed and crushed after her daily walk to a friend with a relative on dialysis. The money raised from the recycling effort helps to pay for the machine.
While she never expected to become so well acquainted with the Helen F. Graham Cancer Center and its services, Miccio is grateful that they were able to get her back to her daily walking and her ongoing fight against the mess others leave behind.
“It was one of those wonderful experiences I hope I never have to do again,” Miccio said.