SWIFT-ACTING EXPERTISE SAVED THE LIFE OF BLOOD TRANSFUSION PATIENT ADAM MERRIAM
When Adam Merriam woke up at Baystate Noble Hospital, the first thing he saw was a dry erase board in his room with the current date. Three days had passed since his arrival to the Noble Emergency Department. But how could that be? He thought it was still Tuesday, the day that he'd arrived at the hospital.
A nurse removed his breathing tube, after which Adam was unable to talk for the first few hours. Instead, he used a notepad to communicate. When his wife, Erin, came in, his first question to her 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 but his life was saved by the swift-acting expertise and smooth coordination of the medical staff at Baystate Noble Hospital.
"If you feel something is not right, definitely go with your gut." – Adam Merriam
Adam knows what he's talking about, since it was his gut that could have ended his life. His wife, Erin, who also happens to be the director of Human Resources at Baystate Wing Hospital and Baystate Mary Lane Outpatient Center, could not agree more. She was the one who had to live through the bulk of the anxiety on her husband’s behalf.
Before the hospital visit, Adam suffered from a series of mysterious symptoms: fatigue, nausea, and stomach pains. He was also gaining weight, which prompted Erin to joke that he ought to cut down on his beer drinking. The two of them thought that he was tired from working 4 am shifts. But Adam’s discomfort continued for many months, until his wife pushed him to see his primary care doctor – a non Baystate Health internist. The doctor told him he was fine and that nothing was wrong with him.
Then one day in April 2014, Erin came home to find her husband sick in bed with no appetite. Their two dogs were lying over his body, as if shielding him from danger. Adam had left work early that day – a highly unusual move for him – because he believed he was coming down with the flu.
That evening, Adam’s sickness alarmed Erin when it escalated to severe nausea, vomiting, and diarrhea. Erin rushed to Adam’s side in the bathroom, where she found the sink and floor stained with black, tarry blood. Adam himself 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, suspected 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. Dr. Schmelkin explained that the presence of red blood indicates active bleeding and shows the severity of the emergency. To find out, the ER staff put a tube down to Adam’s stomach where they found a huge quantity of active blood – which confirmed that he was bleeding from his gastrointestinal tract.
THE SOURCE OF THE BLEEDING
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 flexible tube is passed through the patient’s esophagus, or “food pipe,” in order to visually examine the upper digestive system.
The endoscopy showed that Adam had a deep cut known as a Mallory Weiss Tear at the junction between his esophagus and stomach. 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 successfully 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 – drawn blood from his stomach into his lungs – causing respiratory failure. Blood in the lungs also put Adam at risk of developing aspiration pneumonitis, an intense inflammation of the lungs. To address this complication, pulmonologist Dr. Denzil Reid was called in to perform an emergency bronchoscopy, 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 a total of 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 procedure determines the patient’s blood type and screens for the presence of 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 conducted through the use of 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 conducted 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.
A WELL-COORDINATED MEDICAL TEAM SUPPORTED BY A LARGER SYSTEM
“We couldn’t have asked for anything more." – Erin Merriam
Dr. Ira Schmelkin, who is now 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. Were it not for the blood transfusions, too, Adam would not have survived.
“It really highlights the quality of care that someone could get at a small community hospital which oftentimes is not routine,” he says.
The smooth integration between different health practitioners at Baystate Noble that saved Adam Merriam’s life is paralleled by the entire Baystate Health system. Small hospitals like Baystate Noble benefit enormously from their membership in a larger health system.
“It’s critical,” says Dr. Schmelkin. “So that when we do have complex patients that are difficult to handle, you have seamless integration with the folks at the larger center. Being able to pick up the phone is just absolutely wonderful.”
As HR director for another community hospital and outpatient center in the Baystate Health system (Wing and Mary Lane), Erin agrees:
“The big message is that no matter where you go, you’re going to get the same level of care – and that was true, because we couldn’t have asked for anything more.”
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 their love and gratitude to their own dogs (one of which has since passed away) for helping them through Adam’s health crises 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.
Learn more about laboratory services and gastroenterology at Baystate Health.