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20170824  Adam  Erin Merriam 4488 1200x630

From Mystery to Emergency: Adam Merriam’s Story

What he thought was a flu was actually a health emergency that required many blood transfusions.

Category: Gastroenterology

When Adam Merriam woke up at Baystate Noble Hospital, the first thing he saw was a board in his room with the current date. Three days had passed since his arrival at the Noble Emergency Department. But how could that be? He thought it was still Tuesday, the day that he'd arrived at the hospital.

After a nurse removed his breathing tube, Adam couldn’t talk for a few hours. Instead, he used a notepad to communicate. His first question to his wife, Erin, was, "What happened?"

Adam soon learned the details of what he'd been through. He had suffered a gastrointestinal bleed and blood in his lungs. His life was saved by prompt care and coordination from the medical team at Baystate Noble Hospital.

MYSTERIOUS SYMPTOMS

Before his hospital stay, Adam had a variety of symptoms that were a mystery to him. He was tired and felt sick. He had stomach pains. He was also gaining weight. He and Erin thought that he was just rundown from working a 4 am shift. 

But Adam’s discomfort continued for months. His wife, Erin, who also happens to be the director of Human Resources at Baystate Wing Hospital and Baystate Mary Lane Outpatient Center, pushed him to see his primary care doctor. This doctor was an internist who is not part of Baystate Health. The doctor told him he was fine.

Looking back on this time, Adam says, "If you feel something is not right, definitely go with your gut."

One day, Erin came home to find her husband sick in bed with no appetite. Adam had left work early that day, which was pretty unusual for him. He thought he was coming down with the flu. Even their two dogs were quite worried. They hovered over him.

That evening, Adam’s sickness became much worse. He was experiencing nausea, vomiting, and diarrhea. Erin rushed to Adam’s side in the bathroom, where she saw the sink and floor stained with black, tarry blood. Adam had turned gray.

Erin drove Adam to the emergency room at Baystate Noble Hospital right away. He was so weak when he arrived that he was clinging to the walls for support.

A SEVERE EMERGENCY

At the emergency room, Dr. Ira Schmelkin, the gastroenterologist, thought that Adam was bleeding from the upper gastrointestinal tract (stomach and intestines), from an ulcer or lesion, because of the color and consistency of the blood. “When it’s black and tarry," he says, "it’s a lot of blood.”

The first order of business, then, was to determine whether Adam was losing fresh red blood in addition to old blood. To find out, the ER staff put a tube down to Adam’s stomach. They found a lot of blood. This confirmed that he was bleeding from his gastrointestinal tract.

DIAGNOSING THE PROBLEM

Because of Adam’s gastrointestinal bleed, Dr. Schmelkin performed an endoscopy. An endoscopy is a procedure in which a tiny camera attached to the end of a tube is passed through the patient’s esophagus, or “food pipe,” in order to view the upper digestive system.

The endoscopy showed that Adam had a deep cut known as a Mallory Weiss Tear where his esophagus and stomach meet. The cut was the major source of his gastrointestinal bleeding. What started out as an ulcer on a blood vessel had worsened in the course of Adam’s sickness, causing blood to collect in his stomach.

Dr. Schmelkin stopped the bleeding by putting a clip through the endoscope to staple the wound shut. However, anesthesiologist Dr. Abhiji Desai made an unwelcome discovery when inserting Adam’s breathing tube: there was blood in Adam’s lungs. Adam had aspirated, meaning he had taken blood from his stomach into his lungs. This had caused respiratory failure.

Blood in the lungs also put Adam at risk for aspiration pneumonitis, an intense inflammation of the lungs. To fix this complication, pulmonologist Dr. Denzil Reid was called in to perform an emergency bronchoscopy. This is a procedure in which a long, thin tube is inserted into the lungs to suck out the blood. Adam was then put on a ventilator and brought to the Intensive Care Unit (ICU). In order for him to rest comfortably with the breathing tube and recover from the procedure, he was sedated for a 24-hour period.

NEW BLOOD TESTING TECHNOLOGY

Because Adam lost so much blood, he received five blood transfusions. As with every blood transfusion patient, a “type and screen” was performed on Adam’s blood before the transfusion could take place. This test checks the patient’s blood type and screens for any antibodies from prior transfusions (to make sure that the transfusion can be done safely).

This process of matching a patient’s blood type is now done using Gel Technology, which uses much less blood from the patient than the standard test tube. James Lane (of Baystate Health’s Laboratory Services Department of Pathology), is the Lead Medical Lab Technologist in Transfusion Medicine at Baystate Medical Center. He did the training of staff at Baystate Noble Hospital in this new technology.

“Red blood cells are vital for a patient such as Adam with a gastrointestinal bleed, since they carry oxygen to all organs of the body in the form of hemoglobin,” he says.

Because of advances in transfusion medicine, red blood cells can be separated from plasma before the patient is given blood, dramatically improving the patient’s chances of survival. In most cases, it takes only 60 minutes to get the blood ready for a nurse to transport it to the patient from the blood bank.

COORDINATED CARE SUPPORTED BY A LARGER SYSTEM

Dr. Ira Schmelkin, the Chief of Gastroenterology for the entire Baystate Health system, remembers this case well. He recalls the coordinated care provided by the medical team—from gastroenterologist to anesthesiologist to pulmonologist—in addition to the phenomenal work of the nursing staff. The blood transfusions were another key factor.
“It really highlights the quality of care that someone can get at a small community,” he says.

The smooth integration between different health practitioners at Baystate Noble that saved Adam Merriam’s life is reflected in the entire Baystate Health system. Small hospitals like Baystate Noble benefit enormously from being part of a larger health system.

“This greater system is critical,” says Dr. Schmelkin. “When we have complex cases, it’s important to have seamless integration with the folks at the larger center.”

Erin agrees. As HR director for another community hospital and outpatient center in the Baystate Health system (Wing and Mary Lane), she says, “The big message is that no matter where you go within Baystate, you’re going to get the same level of care—and that was true, because we couldn’t have asked for anything more.&rdquo

A NEW LIFE

Since Adam’s recovery, Erin and Adam have slowed down quite a bit. They relax more and take the time to go on vacations. They have also reached the exciting decision to have children, something they were on the fence about before Adam’s illness. And gratitude to their dogs for helping them through Adam’s health problems led them to get more involved in animal rescue.

Erin is now a co-founder of a nonprofit in Westfield called Open Arms Rescue that specializes in providing funds for the emergency medical care of dogs. It was the memory of their dogs’ unconditional love for Adam on the night of his trip to Baystate Noble that inspired her to pursue this path.