Case Study #2
“Those little things mattered so much”
Sarah Baker’s tummy was doing flips. She felt like she was going to throw up. Again. Perhaps it was something she’d eaten, or maybe she was just paying the price for too much fresh air and excitement. Sarah and some friends from Fairview Junior High School had spent the afternoon at a farm near Halifax enjoying one last, late winter sleigh ride through the snow-covered forest.
San Diego seemed like a dream! The youngest of four daughters of Charles and Olga Baker, Sarah had spent her early years in sunny California. But then her parents split up, and Sarah and her sister Jo returned to her Halifax birthplace with their mother. Olga had recently married a naval officer named Dick Neal and they’d all settled into a new condo in Clayton Park on the edge of the Halifax peninsula.
Though Sarah was at that awkward teen age—fourteen-going-on-fifteen—she had adjusted well, thanks in no small measure to a bubbly, outgoing personality and, of course, to her passion for sports. Field hockey, volleyball, basketball… name the sport.
But tonight, all she wanted was to crawl into bed.
Babysitting! She’d almost forgotten. She’d agreed to take on a babysitting job tonight.
“Jo,” she asked her sister. “Could you do it for me?”
Sarah was still throwing up a few hours later when her mother returned home after an evening of bridge with friends. Olga wasn’t especially concerned about Sarah’s stomach bug; they were common enough, but she was careful to remind her daughter about keeping her blood-sugar levels in balance. Not that she had anything to worry about, Olga knew. Sarah was just seven when she was diagnosed with diabetes. She had learned how to inject needles into oranges as a prelude to administering insulin to herself.
Olga did the “mother-comfort-thing,” and then they both went to bed.
Anxiously, Olga dialed her sister’s number. Her sister was a nurse; she would know what to do.
It was shortly before seven the next morning, and Olga had woken up to find her youngest child, passed out, on the bathroom floor.
Her first thought was that Sarah must be in a diabetic coma. A little orange juice and she’d be fine, Olga told herself, trying to calm her own rapidly rising anxiety. She tried to lift Sarah from the floor, but she was limp, lifeless.
Call the ambulance, her sister told her, I’ll be right over.
It would be OK. A little orange juice and it would be all OK.
Eleanor Lindsay was happy for the break; perhaps she would finally get to catch up on all that paperwork. There were only two patients in her intensive care unit this morning. On typical days, there were from four to six; on bad days, all nine beds might be occupied.
Even the call from the nurse in the emergency department at around 9 a.m. this morning seemed routine. They’d just admitted an unstable diabetic, the nurse told her, and wanted to alert ICU to be ready. Just in case. Lindsay figured the girl would likely end up being stabilized in the ER and sent home to recover. Of course, the doctor might decide to admit the girl to the ICU and keep her for observation for 24 hours. Lindsay assigned one of her nurses to prepare a bed. And went back to her paperwork.
Then, all of a sudden, the phones began to ring. All of them. All at once.
The doctor from ER. Urgently letting his ICU counterpart know what was heading his way. And a nurse from ER, calling to tell Lindsay she’d better prepare an isolation bed. Now!
Sarah Baker was not in a diabetic coma. She was suffering from meningococcal septicemia, a voraciously infectious, swift-moving and deadly disease.
The problem with meningococcal septicemia is that—initially, at least—it isn’t easy to diagnose. Fever, vomiting, headache, cold hands and feet, fatigue, perhaps even convulsions. Those could be signs of any one of dozens of ailments.
But then the meningococcal bacteria, having stealthily wormed their way into the patient’s bloodstream, begin multiplying geometrically, uncontrollably, smashing through the walls of the victim’s blood vessels and causing bleeding into the skin. As soon as the patient breaks out in that distinctive bluish-purple blood-rash all over her arms and legs, the diagnosis is—suddenly—obvious.
Meningococcal septicemia victims are often “well at breakfast—and dead by dinner.” Ten per cent will die, most within hours. One in five ends up with some form of permanent damage—from vision problems to kidney or liver failure, to the loss of toes or fingers, sometimes arms or legs.
Worse, the meningococcus organism is highly contagious. Which explains why the doctors needed to get Sarah out of the far-too-public emergency ward into a controlled, isolated environment immediately.
Within minutes—even before Eleanor Lindsay’s team of nurses had finished readying an isolation room—the third-floor elevator doors slid open and a gaggle of masked doctors and nurses emerged, some pushing IV poles, others carrying charts, all surrounding a rolling trolley. Inside their circle, Eleanor Lindsay caught a glimpse of her new patient. “She was this desperate looking girl who had already erupted in these black spots,” she would remember years later.
“Perhaps,” the doctor suggested to Olga as gently as he could, “you might want to contact Sarah’s father and tell him the situation, ask him if he wants to be here too.” Sarah could die.
It was shortly after 6 p.m. on the night of March 6, 1975, about twenty four hours after Sarah had arrived at the IWK’s emergency room, and the day had seemed to tumble from bad to worse to… worst.
Bruce Morton, Sarah’s pediatrician who happened to be in the hospital that morning, had given Olga the initial diagnosis of meningococcal septicemia. Olga had known him since their undergraduate days together at Acadia University. Even there, Bruce’s career path had been so clear other students would refer to him as “Doc.” His mere presence seemed calming, reassuring. He hadn’t understated the risks, but he made them seem manageable. “The worry,” he told her, “is her circulation.”
That, it turned out, was but one of many worries.
By mid-afternoon, Sarah’s condition had worsened. So many things that could go wrong had gone wrong that the ICU doctors had assembled—not once but twice—an in-house group of experts in the unit’s small case room to discuss what to do next. She was, Richard Goldbloom would say later, “about as sick as a child could get.”
Why not?… What do you think? What if?… What about?… John Donaldson was far from the only member of the IWK’s medical staff desperately seeking the magic bullet that might save young Sarah Baker. In part, of course, it was simply the unusualness of her case that piqued so much professional interest. But there was also the human reality. Just a few days before, Sarah had been a beautiful, healthy, coltish teenager, full of life and love and vitality. And then, suddenly, out of nowhere and for what seemed like no reason…
Surely, there must be something they could do.
John Donaldson was convinced there was. He was the new resident, a brash young ear, nose and throat specialist. Officially, he had no role in Sarah’s case, but that didn’t stop him from thinking about how to save her. In his previous career in the Royal Canadian Navy, Donaldson had spent time as a flight surgeon at CFB Shearwater in Dartmouth, where he’d served as the medical officer for the Fleet Diving Unit Atlantic and its small diving tender, the Granby.
That experience prompted Donaldson to suggest to Phil Bagnell, a young gastroenterologist who had become one of the consultants to the pediatrician-in-charge of Sarah’s case, they call in the navy.
The Granby’s six-person recompression chamber—designed to allow navy divers to recover from the “bends”—had occasionally been used to treat adult hospital patients, Donaldson explained. Those patients were suffering from a variety of ailments, including gas gangrene, another potentially lethal bacterial infection that can produce gas bubbles in gangrenous tissue.
Sarah had been diagnosed with extreme vasculitis of her lower extremities. Her blood vessels had become inflamed, making it difficult to get enough blood to her tissues and organs. Since she was failing to respond to conventional therapy, Donaldson suggested, why not try her in the Granby’s recompression chamber? Placing her in the chamber would enable the doctors to deliver more oxygen to her dying tissues and perhaps, save her arms and legs.
Donaldson’s navy contacts were eager to help. They told him they would do whatever they could. But… The Granby’s recompression chamber was too big and permanently nailed down to transport to the hospital. If Donaldson could bring Sarah there… Sarah was far too sick to risk transporting her to the chamber.
That they wouldn’t be able to use the recompression chamber was devastating for her doctors and nurses. And sobering. Finally, just before seven o’clock at the day’s last case conference, one of the doctors dared to raise the issue that had hovered, silently, dangerously, at the edge of all of their conversations from the beginning.
“You know, folks,” he said finally, “we have to step back and ask ourselves what we’re doing here. She’s a beautiful girl, and she’s losing all her limbs. Is there a point? Do we want to go any further?”
There was an awkward, uncomfortable silence. It was a legitimate question. A question without an answer.
“Oh my goodness!” Eleanor Lindsay was horrified. “Not another disaster…” As she arrived at the hospital for her shift the next morning, she couldn’t help but notice the dozens of police officers and firefighters hovering around the entrance to the building. “My first thought was that there must have been a fire overnight. I was thinking, ‘Now, I’ll have to figure out how to cope with this on top of the girl—‘“
If, that is, the girl had even survived the night…
Lindsay had left the hospital the night before, “feeling shattered and very sad. I knew it was highly unlikely I would see this girl when I arrived in the morning.”
But as she got closer to the hospital entrance this morning, Lindsay began to notice green uniforms among the those of the police officers and firefighters.
During the night, some can-do officials in the military had managed to find a flatbed truck capable of ferrying the recompression chamber across the harbour bridge, discovered a generator powerful enough to operate its compressors and then convinced officials at the Halifax-Dartmouth Bridge Commission to shut down one of the city’s two bridges long enough to allow the bulky, awkward, overloaded, police-escorted caravan safe passage across the harbour span from the base to the IWK.
But getting the unit to the hospital was only one of the hurdles. The decompression unit’s compressors needed water—and lots of it—in order to operate. So John Donaldson called the Halifax Fire Department. “I explained our problem to a series of firemen who all wanted to help. Remember,” he adds, “it was winter and freezing).” By the time the recompression unit, still on its flatbed, sat squat in the middle of the hospital’s emergency room parking lot, firemen were scrambling over the roof of the hospital running hoses to bring water to it. But the fire department’s hoses couldn’t connect with the navy’s hoses. “HFD and navy ingenuity solved these problems with a series of connectors and pressure adjustments well beyond my surgical mind,” Donaldson would joke years later.
And they still weren’t done. Getting the unit to work mechanically was merely a prelude to the larger task of getting Sarah into it.
“Uh, excuse me,” John Donaldson began awkwardly, knowing he’d woken up yet another nurse. “Are you having your period?…” It wasn’t the smoothest opening line, he knew—“’perv’ of the month, if not the year” came to mind, he says—but Donaldson didn’t have words to waste on pleasantries. “No? Great! Can you come into work right away?”
Donaldson knew they would need plenty of volunteer pediatric residents and ICU nurses to accompany Sarah inside and outside the chamber. The plan would be to bring Sarah, who was still in a coma, into the chamber for treatments once every eight hours for twenty minutes. During each “dive,” she would have to be accompanied inside by a doctor and a nurse with another doctor-nurse team on standby outside the chamber, ready to go in immediately if Sarah suffered a cardiac or pulmonary arrest.
None of the doctors or nurses who volunteered to go inside the chamber—and there turned out to be plenty—could be allowed to do very many dives because of the potential effects of “repetitive diving” on their bodies. And not everyone willing to volunteer made a good candidate. Pregnant women, women having their periods, anyone with asthma or lung troubles, even those who’d had root canals all had to be crossed off the list in case the pressure changes in the chamber created air emboli that could go to their brains.
“The poor nurses,” Elinor Lindsay remembers. “None of them had a private detail to their names that day.”
When she wasn’t recruiting nurses—like Donaldson, Lindsay was often greeted with a, “Have you gone off your rocker?” when she started her question checklist—Lindsay was on the phone to other hospitals’ supply rooms. Sarah still had multiple intravenous lines running into her body. All were attached to glass bottles. The glass would have shattered inside the pressurized chamber. Few hospitals were using plastic bottles. The IWK wasn’t. “Do you have any plastic IV bottles?” Lindsay would ask. If the answer was yes, her immediate response: “Send us everything you’ve got. Now!”
Although he wasn’t on the case, John Donaldson offered to do the first dive. “I was able to devote full time to this project without anyone noticing,” he explains today, because Arthur Shane, who was head of the ENT department at the time, gave him permission to disappear. “He just growled, ‘Do what you need to do… Call me if anyone gets in the way.’”
The first dive went, “as expected. There were lots of glitches to solve.” For starters, the chamber was still sitting outside in the frosty late winter air. “We froze our asses off,” Donaldson recalls.
Someone found someone—everyone in the city, it seemed, was eager to help—to install the chamber inside the ambulance garage. But that didn’t make it easier for support services, like members of the dive unit, who still had to remain outside the building during the dives.
Each dive, in fact, was a team effort. Crews from the hospital’s maintenance department would carry Sarah to the chamber with all of her equipment and supplies. Members of the dive unit assisted her in and out of the chamber, and waited outside in case they were needed. Everyone—doctors, nurses, lab technicians, cleaning staff, cafeteria servers in the laundry room workers, even other patients’ families—took a proprietary interest in Sarah’s well-being.
“I still remember some of the hard-ass chiefs and petty officers [on the dive team] making calls to ‘contacts’ in the dockyard to get something they needed,” Donaldson says. “Every day they wanted to know how ‘their patient’ was doing, and each of them had a tear in their eye from time to time… But then we all did.”
She opened her eyes? Where was she? And what was with all the water? She was in a submarine, obviously, being taken down under the sea. But why?
There was her dad staring in at her through the window. He was smiling. How did he get here? He was supposed to be home in San Diego? Had he swum all the way from San Diego just to see her?
She tried to remember where she was, how she’d gotten here. The last thing she remembered—but only vaguely—was just after the ambulance arrived. She could remember the attendants. They’d carefully put her on a stretcher and then had to struggle to carry her down the staircase at her mother’s house.
But what had happened after that? How had she gotten here? And where was here?
Suddenly, she was out of her strange water world and into an even stranger world of unfamiliar faces and uniforms. Strangers. Then she saw her dad! He was still smiling. But his hair was dry! How could his hair be dry? He’d been swimming under the water to see her… He had, hadn’t he?
The end came suddenly, and not in the way anyone had predicted, or hoped, or even considered. Sarah had seemed to be responding well to the recompression treatments, but then she began to menstruate, and the doctors were faced with the choice that was no choice. “Could we have saved her legs if we’d been able to treat her longer?” Eleanor Lindsay asks rhetorically. “Maybe. But there was no issue there. We could have lost her completely if we’d gone ahead. So it was the lesser of two evils to stop treatment.”
“The first thing I heard was a couple of toes,” Olga remembers. “She might lose a couple of toes. I thought, ‘what a shame?’ And then it was more toes, and then a foot, and…” The doctors now informed her that the best, perhaps only way to save Sarah’s life was to cut off parts of both legs.
Olga Neal couldn’t help where her mind led her. Her daughter was just fifteen. Girls that age are especially sensitive about how they look. And how would she look with two missing legs? How will she cope, Olga Neal asked herself? How will she cope?
She must put those thoughts out of her mind, she told herself. She pushed open the door to her daughter’s hospital room, smiled at the sight of her. She would have to tell her the truth.
“Gidday there,” Sarah Baker-Horne begins a cheerful, upbeat email from down under. These days, she lives in Ahaura, a small town on the west coast of New Zealand, with her husband Ian and their two teenaged sons, “tall, strong beautiful young men.” When she isn’t mending fences on their hobby farm, Sarah works at her local school, in the library and as a teacher’s aide, helping children having trouble learning to read. In her spare time, she paints watercolours. “I love nothing more than finding a spot, usually my kitchen table and trying to create a beautiful painting.”
She may now be nearly thirty-five years and a world removed from the events of 1975 that changed her life forever, but she keeps the memories close at hand. “As I write,” she notes, “on my wall is a certificate from the Diving Unit noting my success going down to a depth of sixty-six feet. It’s dated 15 April 1975… Though being treated with the chamber didn’t, in the end, save my legs, it did save my life and I will be forever grateful to those involved.”
Her road to recovery was long and bumpy. After the initial operation to amputate parts of her lower legs, Sarah spent five weeks in the IWK. There was another operation, more recovery time and rehab time.
Surprisingly, Sarah’s most vivid memories of her time in the hospital are positive ones. Soon after the first operation, while she was still in the ICU and the doctors were in the middle of making “really difficult decisions about circulation in my feet,” Eleanor Lindsay broke a few hospital rules so Sarah’s sister Jo could make Mexican tacos to celebrate her fifteenth birthday. “I’ll never forget that taste, or how wonderful it felt to be doing something so normal in such a unique environment. Thank you Eleanor!”
She remembers the time one of her sisters visited “with a hickey on her neck,” and a nurse covering it with a bandage so the visiting doctor wouldn’t see. “We just thought it was hilarious.… Who would’ve thought that the IWK was a place where humour was rife? There was still much to be enjoyed and, serious as the situation was, there was humour, and hope.”
And time. “I have memories of my hair being totally matted at the back and of a lovely nurse taking the time to wash it and then spend hours getting rid of the tangles. Those little things, they mattered so much.” Like John Donaldson, the doctor who wasn’t even supposed to be treating her, “coming in and playing chess with me. There was no rush, he just allowed me to voice my fears and reassured me that all would be okay, in time.”
She needed that. “I also have memories of blood red bandages being soaked off in a bath, and tears and tears flowing. This was the first time I had seen my amputated limbs. I was held close and allowed to cry, probably even encouraged to cry.”
How did she end up living in New Zealand? That story too begins at the IWK. “During my rehabilitation, a physio by the name of Wendy Oliver took me under her wing and introduced me to Coach Doug Wright and sport for the disabled. She took me down to the gym where the Nova Scotia Flying Wheels wheelchair basketball team was practicing… I was always an athlete, and just because I’d lost my legs didn’t mean that this side of my life needed to end. I spent many years involved with sport for the disabled, and was able to travel all over Canada, to Europe, to parts of North and South America. It became a huge part of my rehabilitation as well as my social life.
“Travel became a joyous part of my life and led to me heading to New Zealand to experience life here with another sister Libby. As a result of my travels, I met and fell in love with my future husband, Ian Horner. I had two gorgeous children, Sam and Bevan. I worked in a tearoom, skied New Zealand mountains, worked in schools, became an artist, farmed, owned our own business… and even lived through breast cancer.
“Life is full of surprises. You learn so much from life’s experiences. My experience in losing my legs, dealing with loss and knowing that life is good, and worth fighting for, made me a perfect candidate to deal with breast cancer as well.”
Today, she says, “I think I’m right smack dab in the middle of life’s next challenge, having two big ol’ teenage sons who think they know it all. I need all the resources I can put my hands on to handle this challenge.”
Published: October 2009
Paperback • 212 pages
7 x 9 inches
Copyright 2009 Stephen Kimber, Website