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Story of Hope: Yuridia

By Currents Editor posted 09-13-2022 20:16

  
Written by: Camilo Andres Diaz Cruz, MD
Division of Neurosciences Critical Care, Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

Written by: Tachira Tavarez, MD, MS
Neurocritical Care Faculty
Division of Neurosciences Critical Care, Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
Section Editor
Lauren Koffman, DO, MS
Assistant Professor of Neurology, Lewis Katz School of Medicine, Temple University
Philadelphia, PA

A Trip Gone Wrong

On October 27th, 2021, Yuridia had planned on running errands, nothing out of the ordinary. She was a very active woman; she worked a full-time job as a cleaner, cooked meals, cleaned the house, and looked after her three young children until her husband arrived home from his construction job. On that day, she remembers walking out of her house and heading towards her car, but she doesn’t remember much after that.

Yuridia was found down on the street next to a car by a family friend who called 911. Over the past year she had been having some episodes of passing out, known as syncope, due to her blood pressure being low. Because she was unconscious paramedics inserted a breathing tube and placed her on a ventilator so that she could be airlifted to the Johns Hopkins Hospital. At the time she was only 35 years old…and was also 31 weeks pregnant. A CT scan of her head showed a large blood clot called a subdural hematoma compressing the left side of her brain, along with bruising in another area and a large skull fracture that extended into the base of her skull. The most concerning finding on the CT was “midline shift,” referring to the pressure the blood clot was placing on healthy brain tissue, which posed an impending threat of further brain injury.

Soon after the CT scan, her left pupil became fixed and dilated, an ominous sign indicating pressure within the brain was increasing at an alarming rate. She was immediately treated with hypertonic solutions, which can temporarily decrease the swelling and excess pressure in her brain. However, the next step would be brain surgery, in which the neurosurgeons would remove the clot and alleviate the increased pressure damaging healthy brain tissue. While the medical team was preparing her to go to the operating room, her COVID swab results came back positive. At that moment, this result was interpreted as an asymptomatic infection because there was no evidence of lung damage. The most meaningful consequence of this finding would be that her family and future baby would not be able to visit. Members of the ICU team recall seeing Yuridia’s husband sitting outside the glass door quietly looking in nearly every day.

During the operation, the neurosurgeons noted the swelling of her brain was so severe that they decided to also remove a portion of her skull to allow her brain to swell outward. This procedure, known as a hemicraniectomy, is performed as a life-saving measure to relieve the pressure in the brain. Additionally, the surgeons placed a sensor in her brain that would allow monitoring of the

intracranial pressure while she was in the neurocritical care unit (NCCU).

Given Yuridia’s prior history of premature labor and her recent trauma during pregnancy, the obstetrics team was called early on in her hospital stay. They placed a fetal monitor on her and visited the unit daily. Working together, the anesthesia, obstetrics, and neurocritical care teams came up with a plan if she were to go into labor. They discussed in detail important physiologic parameters to consider given Yuridia’s brain injury, such as maintaining a certain blood pressure to ensure adequate cerebral perfusion.

The Bumpy Road to Recovery

During her 29-day admission in the NCCU, Yuridia fought multiple complications in addition to her severe brain injury. While in the intensive care unit she was treated for a ventilator-associated pneumonia, a urinary tract infection, and Clostridium difficile colitis. Despite all the hurdles she had to overcome while in the hospital, Yuridia doesn’t recall much of the experience. She says, “At one point, I think I was having a dream. I’m not sure if this was a dream or a memory. I was volunteering for a study at the hospital, and there were people in scrubs, wearing masks, drawing my blood.”

Despite all these challenges, her brain functions began to recover bit by bit every day. She was slowly becoming much more awake and interactive. The values registered by the intracranial pressure monitor eventually normalized, allowing it to be safely removed. While she was showing signs of improvement from the brain injury, she was still too weak to breathe on her own and required a tracheostomy.

The team continued to monitor Yuridia’s pregnancy throughout her acute illness and recovery process. Alarm bells were raised at 33 weeks gestation, in late November, when the fetal monitor showed multiple concerning episodes of low fetal heart rate. The obstetrics team had continued following along since Yuridia’s admission, and this change necessitated urgent action. Soon after, Yuridia underwent a C-section and delivered a baby boy whom she named Angel. Due to his premature delivery, Alexander Angel had to be immediately transferred to the neonatal intensive care unit for specialized care.

Despite being apart from each other during this critical period, Yuridia and her Angel continued to get healthier and stronger. Due to her severe traumatic brain injury, Yuridia was not able to recover her ability to swallow initially and she needed to have a feeding tube placed. On the twenty-ninth day of her hospitalization, she was transferred from the NCCU to the neurosurgery ward where she continued her recovery. A lactation specialist was required to help with breast pumping due to Yuridia’s limited hand mobility. While on the neurosurgery floor, she faced additional complications such as endometritis (an infection of the inner lining of the womb) and blood clots in the veins of her arms. Yuridia recalls days where she began to feel hopeless, afraid she wouldn’t recover, which prompted her nurses to print photos of her baby and place them on the wall of her room. Yuridia says these photos “helped me stay motivated. I would look up at those pictures and tell myself that I have to keep going for him.” Once baby Angel was stable, he was finally able to visit his mother on the evening of December 3rd. Yuridia remembers crying as she saw him through the door of her room. She remained in isolation due to her positive COVID test, and baby Angel wasn’t allowed in the room. This was a very painful experience for her, but she also found motivation to continue persevering.

After she had been in the hospital for ten weeks, a team of neurosurgeons and plastic surgeons performed a cranioplasty. This procedure closed the hole in her skull that had been opened that first day of her admission, a surgery that had ultimately proved lifesaving. She remembers feeling embarrassed from having her head shaved for the procedures, as she had always had her hair at least shoulder length in the past. She says, “I remember seeing a nurse wearing a cool scrub cap and telling her that I wished I had one to cover my hair.” The nurses didn’t need to be told twice—they brought her multiple caps to choose from later that week.

Out of the Hospital at Last

Yuridia was discharged to a rehabilitation facility after spending a total of eleven weeks in the hospital.

By then, her recovery process had hastened to the point that she could breathe independently and swallow again. The tracheostomy and feeding tubes were removed, bringing her one big step closer to her normal life. She was now walking and talking again.

She eventually was able to return home in February 2022. After seeing her newborn out of the Neonatal Intensive Care Unit, and holding him for the first time, she said, “I was overwhelmed with emotion. I had been wanting to hold my baby.” Her other children were still at school, but when they arrived, they ran to her to give her a big hug. She remembers all of them crying, happy to finally be together.

Yuridia is now a full-time, stay-at-home mom. She and her family are too nervous for her to drive, but she does miss driving to work, going shopping, and visiting her friends. During the day she takes care of the baby while the older children are at school. She can walk around the house, and only uses her cane for long walks outside. She still has some weakness in her fingers, but only in her non-dominant hand. She can still cook meals, clean the house, bathe her baby, and prepare his bottles (although she is unable to breastfeed because of the medications she is on). Along the way, her family has been incredibly supportive, and her husband and eldest son help her with chores and with the baby.

She says, “I am very thankful to have survived. I always keep hospital staff, the nurses, and all the doctors in my heart. I know that their job is very difficult and I am thankful for what they have done for me and my family.” She has a different perspective on life now and wants to learn new things. She plans on taking French lessons with her children because she has always wanted to learn a new language. She hopes to be able to drive again someday so that she can work again.

Baby Angel and Dr. Tachira Tavarez.


#StoriesofHope

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