Dr. Joshua Tepper said he received the call at 4 p.m. Dec. 3, 2021, with the message: “Can you help? I’ve attempted to clip the ulcer in her esophagus and it’s still bleeding.”
“That’s all the information I received at the time,” Tepper, an interventional radiologist at AMITA Health Saint Joseph Medical Center in Joliet, said. “Except that she was really sick.”
The patient was Linda Bland, 69, of Wilmington. Because Bland is receiving cancer treatments, she tends to attribute new symptoms such as vomiting to either the cancer or the treatment. But she knew throwing up blood wasn’t good.
The first time it happened, Bland went to the hospital, received two pints of blood and stayed a week. Twelve hours after she came home, she had an appointment with her oncologist.
“My husband had gone downstairs to get coffee,” Bland said. “When he got back up, he found me on the floor again, throwing up blood, quite a bit. So the ambulance took me to the hospital. And that’s the last thing I know.”
Tepper said a gastroenterologist diagnosed the ulcer in the esophagus. When the gastroenterologist couldn’t stop the bleeding, he called Tepper. Tepper asked for a CT scan, but the nurses told him Bland was too unstable.
So Tepper brought in a anesthesia team into the interventional suite with him in case Bland needed resuscitation. He performed an angiogram and put a coil into Bland’s left gastric artery to stop the bleeding, which took 10 to 15 minutes, he said.
After giving everyone a round of high fives, Tepper noticed Bland was still bleeding. It turned out Bland had an extremely rare, aortoesophageal fistula. Basically, a hole was allowing Bland’s arterial blood to escape from the aorta into the esophagus.
“I had never seen that before,” Tepper said. “Not only that, the amount of blood going through the hole was very concerning.”
Tepper said he placed a balloon into the aorta across from the “massive hole” to buy him some time to think. What Bland needed was a stent graft, Tepper said. Although Tepper has experience placing stent grafts, he was worried.
“You have to keep in mind, I have never placed stent grafts in this location before,” Tepper said.
So Tepper called a vascular surgeon, but the surgeon was more than an hour away from St. Joe’s. That was too far, in Tepper’s estimation.
“I didn’t think the patient had an hour to live,” Tepper said.
So Tepper said he asked the surgeon what supplies he needed. Tepper said the surgeon told him that Tepper must speak to the medical device representative – Kurt Kalchbrenner with WL Gore & Associates. Tepper asked the surgeon for Kalchbrenner’s number.
Kalchbrenner answered the phone. He was at a funeral but promised “to be right over,” Tepper said.
Then Kalchbrenner defined what “right over” meant.
“I was roughly about 45 minutes away,” Kalchbrenner said,.
Kalchbrenner said aortic stent grafts come in various sizes and lengths, to suit a patient’s individual anatomy. So very few hospitals, especially at the community level, keep these products on their shelves because of the high overhead of stocking them.
For that reason, Kalchbrenner and field reps like him are on call 24/7, he said. In fact, because of his distance from St. Joe’s, Kalchbrenner even called another rep, only to learn that rep also was addressing an emergency.
“You do everything in your power to get there in an adequate amount of time,” Kalchbrenner said. “It doesn’t always work out that way, though.”
At this point, Tepper went to speak to Bland’s family to let them know the situation, so they could “hold her hand while she dies.”
“And then I found out she had metastatic ovarian cancer,” Tepper said.
Tepper told the family there was a small chance he could place the stent graft to help stop Bland’s bleeding. Tepper said he also told them that the procedure carried a high risk of paralysis because of Bland’s low blood volume and the way the particular artery “fed into the spinal column.”
“Even if she survives, she has a risk of never walking again,” Tepper said. “And [Bland’s] husband and daughters were very distraught and they asked me to do whatever I needed to do. So I told them I had to wait for the appropriate equipment to arrive. And lo and behold, the rep came, brought me the device, and I was able to put it in and close the hole.”
That made Kalchbrenner happy, too.
“To be honest, I’m just happy she was able to spend another Christmas with her family,” Kalchbrenner said. “They were more than appreciative. That was something we do not always see on our end all the time – how grateful the family actually is.”
Tepper said it was a nice team effort among all the staff that came out to help. But Bland wasn’t out of the medical woods.
“Later that night, she coded and needed CPR,” Tepper said. “And that’s not a good situation. Surviving CPR is a feat in itself. She needed over 30 units of blood. The next morning, her pupils were unresponsive. The priest was called and last rites were given. But the family would not remove any care.”
The family was in church Sunday morning when they received word that Bland’s eyes were open, that she was extubated, and that she was doing well.
“She was not in organ failure, her memory was fine and she was not paralyzed. She was as sharp as a tack,” Tepper said. “It was unbelievable. I had never seen anything like this before.”
Especially in a patient who is receiving chemotherapy, he said.
Bland said she is receiving physical therapy for her right leg. During the ordeal, Bland had no blood flowing to it for 45 minutes, she said. And she marvels at her story when she hears it.
“I didn’t know I had that much of a drive, you know?” Bland said.
Bland said her primary care doctor has since told her, “Do you know you’ve just gone through something nobody has ever lived through before?”
And Bland, at 105 pounds, in pain and struggling to find an appetite, has often pondered those words.
“I just wonder what God had planned for me,” Bland said. “Why go through all this? I don’t know. It’s a miracle. I know it’s a miracle. But what does He have planned for me?”
Tepper is still in awe and said he often thinks about the quote from French practitioner René Leriche. “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray – a place of bitterness and regret, where he must look for an explanation for his failures.”
“Linda helped me find an exit from that cemetery,” Tepper said.