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.
For four long years, Wayne Johnson suffered with severe back pain, the result of a badly deteriorated disc.
He gave up golf and scuba diving, activities he once enjoyed. He quit gardening. He avoided driving. And because he couldn’t exercise, he started putting on pounds.
“I needed painkillers just to get through the day,” recalls Johnson, 45, of Wilmington. “Even with my medication, I seldom slept for more than a few hours at a time at night.”
Spinal injections of cortisone helped for a while. But the pain always returned. Johnson leads a groundskeeping team at the University of Delaware and it was increasingly difficult for him to do his job.
In 2012, Johnson and his wife were expecting a baby and he wondered if his back problems would impact his ability to be an active dad.
“Would I be able to get down on the floor and wrestle with my son?” he asked. “Would I be able to give him a piggyback ride?”
His orthopedic surgeon, J. Rush Fisher, M.D., recommended a Total Disc Replacement or TDR, in which the damaged disc is removed and replaced with an artificial disc.
“It looks like two Oreo cookies stacked on top of one another,” Johnson says.
A newer treatment, TDR helps patients to regain their range of motion and get relief from pain.
“It is a good option for someone like me, who is in his 40s,” he says. “I feel very fortunate that Christiana Care offers this kind of advanced treatment.”
Within a day of surgery, Johnson was out of bed and taking his first steps on the road to recovery. Within two days, he was home and walking with a cane.
He was an active partner in his care, giving up smoking to help speed the healing process. He learned to rely on the muscles in his legs to lift objects to avoid another injury to his back. He started shedding the weight he had gained, going from 208 pounds to 180.
“I feel like I’m back in my 30s,” he says. “I’m in the gym four days a week, doing 225-pound squats.”
Johnson is on the job at UD, maintaining landscaping on campus. He also is enjoying family life with his wife and baby. The pain is completely gone.
“In the past six months, I have taken two Advil — and that was for a headache,” he says. “I used to live in constant pain — and now I am happier than I have ever been in my whole life.”
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.
Sally Cratty fights aging and the joint deterioration caused by osteoarthritis with all the tools medical technology has to offer. So when she had to make a choice about how to deal with the deteriorating condition of her right ankle, she didn’t take long to decide to add a total replacement to her collection of artificial joints that already included two hips and two knees.
“I am bound and determined to remain as mobile as I possibly can through my aging process,” Cratty said. “That’s very important to me. I realize that I’m in my 70s, but I don’t think that way. I want to live an active life.”
Thanks to the artificial ankle implanted by Dr. Paul Kupcha at Christiana Care Health System’s Wilmington Hospital, Cratty has once again defied the mobility limitations imposed on her by osteoarthritis.
Nearly a year after her ankle replacement, Cratty maintains her own household, cooks for herself and spends time out on the town with friends and family. Most days, she can do all of that without the use of a cane or walker.
“I do all of the things for myself that I’ve done all my life,” Cratty said.
Cratty first began to feel pain and notice swelling in her right ankle in early 2011. After seeing Dr. Kupcha for the first time in May 2011, she knew that having the total ankle replacement was one option to fix the problem and an ankle fusion was another.
“I came home, and I thought about it and I thought about it. It got worse. Physically, I was really limping. My back was hurting. Everything was happening because my posture was terrible,” Cratty said.
After more than a month of considering her options, while the pain in her ankle worsened and her gait deteriorated to the point that falls were a serious problem, Cratty decided on the total ankle replacement and underwent surgery July 14, 2011, at Wilmington Hospital.
The surgery and physical therapy went well. A subsequent stress fracture in her right foot required another surgery to stabilize the fractured bone. Cratty completed more physical therapy after that surgery.
“From the beginning, I had a special feeling with Dr. Kupcha,” Cratty said. “I felt very confident. His approach is just so comforting and extremely knowledgeable.”
Now, nearly a year after the ankle replacement surgery, Cratty is back at home and living her life the way she wants to live it.
“I’m very happy that I went through the process,” she said. “Dr. Kupcha did beautiful work. He got me up on this ankle. I’m walking. … The happiest day of my life was when I stood up on this foot. I was just so thrilled I could do it. I have no regrets. I made the right decision.”
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.