Sudden Bedtime Aneurysm Turns MD Couple Into Doctor

Dr Taylor Delgado: It was Saturday night, and we had just gone to bed. Suddenly, Ali sat up, and screamed, "My head!" She then became nonresponsive and had a seizure. I was in disbelief, but I also knew exactly what was happening. I called 911: "My wife is having a head bleed. I need an ambulance." It was a bad connection, and they could barely understand me.

As I tried to carry Ali downstairs, she vomited. She still had rubber bands in her mouth from the jaw fracture that was a result of her accident just a month ago. I knew she needed an airway.

I grabbed a tracheostomy tube, but the opening over her trachea put in for the accident had since closed. I tried to push the tube through her neck, but it hurt her; her eyes opened.

I thought to myself: Maybe she doesn't need it. This can wait until she gets to the hospital. I can't do this to her. But she vomited again, and I knew what I had to do.

We were at the top of our stairs. I didn't have a blade or any other equipment, just the tracheostomy tube with the dilator. I pushed hard, and she started fighting me. I had to hold her hands away with one arm. The tube popped in and she stared back at me in pain and fear.

I finally got her downstairs and called medical control at University Hospital of Cincinnati. I was able to speak with one of the attendings: "Ali's aneurysm ruptured, and she just had a seizure. She has a GCS of 11 or 12. I replaced her tracheostomy tube. We'll be there shortly."

When I heard sirens come down our street, I carried Ali outside, but the sirens were from a firetruck. They likely assumed someone had fallen and had a head laceration. It was beyond deflating. I yelled incredulously: "We need an ambulance here now !"

When the ambulance finally arrived, they tried to tell me that I could not ride with them. Or if I did, I would have to sit up front. After arguing back and forth for a few seconds, I finally demanded: "This is medical control. This is MD-88, and this is my patient. I'm sitting in back with you. She needs four Zofran and two midazolam IV now."

One Month Earlier…

Dr Taylor Delgado (left) and Dr Alison Delgado with their son.

Dr Alison Delgado: Taylor and I were both 4 months into our second year of residency, and we had been married for 5 months. I was a pediatric resident at Cincinnati Children's Hospital. She was an emergency medicine resident at the University Hospital. I was having my first day off in a couple weeks, and she was working a shift in the emergency department. She was also a part of the flight crew that day. Second-year residents would go out to the scenes of accidents or to other hospitals to transport the patient back to their Level I trauma center via helicopter. The resident was the physician and considered the leader on these flights.

That afternoon, I went for a bicycle ride. About three quarters of the way through my ride, I was struck by a car.

The EMS crew got to me fairly quickly. They intubated me at the scene and got to me to the closest hospital. Immediately, the hospital realized my case was outside the scope of their care. They contacted University Hospital requesting that their flight crew come to transport me.

Taylor Delgado: At around 5:30 PM the day of my shift, the tones went out on the radio: "AirCare 1 and Pod Doc, you are requested for inter-hospital transfer, 27-year-old Jane Doe, GCS 5." That was the only information given.

When we landed at the hospital, I walked in with my nurse. I was listening to the doctor's report and doing my once over. The patient was a little bit bradycardic, heart rate in the 40s or 50s. Blood pressure was normal if not a little bit elevated. There was obvious facial trauma. The endotracheal tube in place.

She was covered with a blanket, but some of her clothing was visible. Suddenly, I recognized it. It was our cycling team's kit. I thought, please don't let it be Ali. I looked at her face and realized that this was Alison.

I said, "That's my wife." Everyone stopped and looked at me. The room went silent.

My flight nurse went out and called back to dispatch. "This is my doc's wife. Dispatch the second helicopter!" She had to repeat herself a few times before they understood what was happening.

As Ali's spouse, I couldn't be the flight doctor. I didn't care. I called medical control myself and told them: "This is Ali. We have to fly her. She has a head injury." They said, "You can't fly her." I said, "We can't delay her care. I have to fly her." They said, "No, you can't fly her." I broke down. Devastated.

I went back into the room and looked at Ali. Her heart rate was dropping. My flight nurse was in the trauma bay with the emergency physician. We realized definitive care was being delayed because of my presence, which was an awful feeling to have. I think at that point we realized, you do nothing, or you act. So, we acted.

I told my flight nurse, "Let's give her atropine to increase her heart rate." I asked about sedation, and she hadn't had anything. I spurted off some doses: "a hundred of fentanyl and five of midazolam." My flight nurse actually administered smaller doses. She thought it was a bit aggressive and she was correct. I was trying to maintain composure, but it was hard.

The emergency medicine physician volunteered to fly with her, so I called back medical control in desperation: "This doctor's willing to fly. Let him take her."

They told me apologetically, knowing my agony, that he was not trained to fly and therefore could not do so. I sat down in the ambulance bay crying, waiting for the second helicopter to arrive.

When we got Ali onto AirCare 2, my nurse then told me I couldn't fly with her. I said, "I'm flying with her." She said, "No, it's not safe." I said, "I'm not leaving her. I'll sit in the front. What do you think I'm going to do? Jump out of the helicopter?" I think they realized there was no other option that I would agree to. I rode up front.

It was the fastest flight to the trauma center that I had ever experienced. They did a hot offload, meaning they didn't even shut down the blades. We got her to the trauma center. And then it was a whole other layer of chaos.

Alison Delgado: Taylor's presence may have delayed my transfer, but the University emergency department was prepped and waiting for me. Radiology was on hold, surgery and neurosurgery were there waiting. Everyone was in the trauma bay.

Taylor Delgado: My younger sister was a social worker in that emergency department, and she was on shift. She and my residency director went to CT with Ali. As the images from Ali's CT scan showed up on the screens, everyone in the room gasped. She had a non-survivable head injury.

The AirCare 2 doctor collapsed into our director's arms and cried, "She's going to die tonight." He responded: "I know. But we've got work to do." Then he asked my sister how close she was with me. She told him we were extremely close. "Good, because we have to break the news that she's going to die tonight."

But the doctor never told me. I was in the consultation room. He came in and told me that she had a lot of bleeding around the brain, but he couldn't find the words to tell me the true severity. He didn't have to.

Alison Delgado: I was in a coma for five days. Shift by shift, they were amazed that I was still there. I had a broken jaw, broken vertebrae in my spine, a broken clavicle and sternum and contusions to my heart and lungs. I was later found to have a dissection of my carotid artery as well as an aneurysm to the carotid artery. These were both caused by the accident.

My jaw was wired shut and a tracheostomy was placed. They coiled the aneurysm and put a stent in the dissection. I was placed on dual antiplatelet therapy to prevent stent thrombosis.

When I initially woke from the coma during my hospital stay, I could not speak, but I remember being told why I was there. My first two thoughts were: Was it my fault? and I need to get back to work.

Two and a half weeks later, I was stable enough to go to an in-patient rehab facility.

I was very motivated. I made a lot of good progress, because Taylor was there with me. We looked through pictures, trying to jog my memory and help with my vocabulary. I'd look at a bird and know this is a flying animal but couldn't think of the word bird. I couldn't remember my mom's name.

Taylor Delgado: She was becoming more fluent with her speech each day. Her right arm was working more normally. We started going on walks outside. Within 14 days she was discharged home.

When we left the rehab facility, I took a couple extra tracheostomy tubes and supplies, because I didn't know how long Ali would have her trach. The emergency medicine person in me just thought, always have these things on hand.

A few days later, her ENT doctor decannulated her tracheostomy tube. In our minds, we were done.

The next night, she had the intracranial hemorrhage.

Return to the Hospital…

Taylor Delgado: The aneurysm they had coiled had ruptured. Ali had a recurrent subarachnoid hemorrhage and an intracranial hemorrhage, and she was still bleeding. So, they took her to IR to try to embolize it and accomplished as much as they possibly could.

She had hydrocephalus, the ventricles in her brain were enlarged. Normally, they would put in a drain, but they couldn't because she was on aspirin and Plavix [clopidogrel]. That would risk her having a bleed around that insertion site, which would cause a brain hemorrhage.

Alison Delgado: I was like a ticking time bomb. We knew I would have to have surgery as soon as possible to open my skull and clip the aneurysm. But I had to be on the Plavix and aspirin for at least 6 weeks before it would be considered safe to discontinue them. It was another 3 weeks before they could proceed with the surgery.

The second hospitalization was scarier than the first, because I was much more aware. I knew that I might not be able to return to my residency and do the thing I had dreamed of doing. There were risks of me becoming blind or paralyzed during the surgery. I might not even leave the hospital.

Taylor Delgado: It was mid-December by then, and my dad asked her, "Ali, what do you want for Christmas?" She looked at him deadpan and said, "normal brain."

Alison Delgado: The surgery was successful. I went home a few days later. But I'd lost everything I had gained in rehabilitation. My speech was back to square one.

None of the doctors really expected me to go back to work. But from my standpoint, I thought, I could have died the day I was hit. I could have died when the aneurysm ruptured, or at any point along the way. But I'm here and I'm going back to work.

Taylor Delgado: In January, I went back to work and I had to fly on the helicopter. They were worried about how I would react. My flight director flew with me on my first shift. Our first flight was an inter-facility STEMI transfer. No big deal. The second one was a car accident outside of Batesville, Indiana. We were in the back of the ambulance, and I looked at this woman. She was 27 years old, thin, with long hair. She looked exactly like Ali.

Ali flashed into my mind, and I was like, Nope. Ali's at home. She's fine. This person is right here, right now. Do what you do. I intubated her in the helicopter. We gave her hypertonic saline. I started a blood transfusion. Afterward, my flight director came up to me and said, "You're released back to full duty. That was the hardest test you could possibly have on your first day back flying, and you nailed it."

Alison Delgado: I finished my residency in December of 2012 and passed my pediatric board exam on the first try, almost exactly 3 years after my accident.

The spring before I started medical school in 2005, I had won the Cincinnati Flying Pig marathon. In 2011, a few months after my accident, they invited us to be the starters of the race. When we stood at the starting line, I decided right then I was going to run this marathon again the next year. In spring 2012, I returned and finished in fourth place, beating my previous winning time by two minutes.

I have a different level of empathy for my patients now. I know what it's like to be scared. I know what it's like to not know if you're going to leave the hospital. I've lived that. The process of writing my book was also cathartic for me. I told my story to try to give people hope.

Taylor Delgado: I have a tattoo on my wrist showing the date of Ali's accident. The idea was to remind myself of what we've come through and everyone who went above and beyond. To show gratitude to them and remember everything that they did for us. It's also to remember that every patient I see is somebody else's Alison.

Taylor Delgado, MD, is an emergency medicine physician at University of Utah Health in Salt Lake City. She is a transgender woman and was formerly known as Tim Delgado.

Alison Delgado, MD, is a pediatrician at Wasatch Pediatrics in Park City, Utah. Her memoir about her accident and recovery is titled, My Race for Life: Finding New Strength After Tragedy.

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Sudden Bedtime Aneurysm Turns MD Couple Into Doctor–Patient

One Month Earlier…

Return to the Hospital…

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