Scott DeBoer, MD, PHD
Medstar Franklin Square Medical Center
Department of Neurology, Georgetown School of Medicine
Cari Tobin, PA-C
Medstar Franklin Square Medical Center
Lauren Koffman DO, MS
In 1989 when Benjamin Peace was 29 years old, he had a dental infection that spread to two of his heart valves, known as endocarditis. Unfortunately, the infection in his heart caused a stroke and left him unable to use the left side of his body. He was told he had a 50/50 chance of being able to walk again. Treatment of the infection required surgery for two new heart valves, and he has been on a blood thinning medication ever since.
Mr. Peace is a hard-working optimist and was walking independently in six months. Later that year, he met Anne, whom he later married. Due to ongoing weakness, he could not return to his work in construction, so he returned to school and obtained a degree in Electrical Engineering Technology and has been fixing things ever since.
The Peaces have four grown children and seven grandchildren who call him Pop- Pop. One of their daughters is a Nurse Manager at a Stroke Unit in Connecticut, thus perfectly positioned to later serve a vital support role during Mr. Peace’s recent critical illness.
On March 15, 2021, now 51 years old, he awoke with fatigue and body aches but went still went into work. His wife was alarmed to see him when he returned home looking ill and took him to a clinic, worried that he had COVID-19. The clinic noted a fever of 104F and his heart rate was elevated. He was sent to the ED where he spent the night, but was sent home the following day after observation. Within hours of arriving home, Mr. Peace received a call that his blood cultures were growing a type of bacteria called a “Staph” infection. He returned to the hospital and was admitted for treatment of the infection.
When he spoke on the phone with his wife around 8pm that night, he sounded tired but was lucid. Anne was next awakened by a midnight phone call from doctor to get permission for emergency surgery.
Mr. Peace had become unresponsive and one of his pupils was large not responding to light. He was immediately treated with medications for brain swelling. Brain imaging showed a large collection of blood over the brain, known as a subdural hematoma, which had caused life threatening pressure in the brain. The bleeding came from two aneurysms, one in the left middle cerebral artery and the other in the left middle meningeal artery. A life-saving surgery removed the hematoma, and the next day the two aneurysms were treated. Two days later he improved and no longer needed the ventilator.
During this time his worried family had many questions. “Was the hospital doing everything possible? Is Mr. Peace in good hands? How can they understand what is happening when COVID-19 restrictions prevent them from visiting? How do they advocate for him?” Mrs. Peace anxiously awaited the daily phone update from medical staff. Their daughter with nursing experience provided crucial support; able to reassure them about the care he was receiving, translate medical jargon into terms they could understand and help Mrs. Peace know what questions to ask.
Even though Mr. Peace was the one hospitalized, he was worried about his oxygen dependent wife, aware of the pressure he knew she was feeling. He recalls, “It wasn’t until I had been in the hospital for over 3 weeks that my wife was finally allowed to visit. I was extremely happy to see her. Being able to physically touch each other after all that time meant so much to both of us.” He fought to “maintain a positive attitude.” Knowing that he could not control the outcome helped him to relax into his difficult reality. Though an optimist by nature, he is also realistic and had frank discussions with his wife pertaining to his wishes, he did “not want to live as an invalid.” As the days wore on, the Peace family was anxious to get to the ‘next step.’
The next step was an unfortunate turn for the worse on April 9. Mr. Peace became altered, and a CT showed that the fluid collection outside the brain had enlarged, again putting large amounts of pressure onto his brain. Another series of emergency surgeries were required. This time the decision was made to remove a portion of his skull in order to create space for his brain swelling. Things were stable for the next few weeks, but on April 27 he became altered again. He had developed a complication known as sunken skin flap. With a portion of his skull missing, his brain was now subject to atmospheric pressure which can create problems with the flow of cerebrospinal fluid and with the intracranial pressure.
Despite all the treatments Mr. Peace did not start to recover. His case was a complicated one and the neurosurgery team consulted with experts around the country. What was the path of wisdom? Is it best to manage the sinking skin flap syndrome by replacing the skull flap which had already been replaced and removed again due to herniation? After all, he still had significant brain swelling. The tough decision was made to commit to medical management, and eventually he started to improve.
His wife later celebrated her birthday at his bedside. She recalls that, “when I walked into his room and saw the balloons and gifts that some of the nurses pulled together so that Ben was able to give me something, I was so happy I wanted to cry. Knowing how much they cared about my husband and what they would do for him was amazing. Shortly later at least a dozen hospital staff walked in with a cupcake singing happy birthday. At that point, I did cry.” Staff members signed his helmet, and he was discharged home after 63 days in the hospital, able to walk with minimal assistance.
The Peaces are braced for hurdles ahead: a cranioplasty is scheduled for July 14, and then there is the possibility of needing new heart valves. Next weekend, his daughter will be visiting from Connecticut with her husband and two children. Due to COVID-19, this will be their first time being together since Thanksgiving 2019.