In the face of a terrible disease, racing against death, in addition to the doctor’s superb medical skills, do you know what else you need? This true story tells us that the trust, support and understanding of patients and their families are also needed. Once you have these, there will be a miracle of life!
Severe a stream, life hanging a line
At the beginning of 2018, a text article “Beijing under the flu” was screened. For a time, many people realized that the flu was terrible for the first time, and Mr. Ding, 46, experienced it personally. On the New Year’s Day in 2018, he got a serious illness and he started racing at a speed of death.
That afternoon, Mr. Ding, who was in critical condition, was sent by his family to the Second Affiliated Hospital of Zhejiang University School of Medicine. At that time, the severity of the illness shocked the emergency doctor: high fever 41 degrees, shortness of breath, cyanosis, has been a fever for a week or so. The emergency department took the initiative and immediately gave the patient an emergency tracheal intubation to give the ventilator assisted breathing. However, in the case of pure oxygen inhalation, the oxygen saturation can only be maintained at 70%-80%. The situation is critical!
Mrs. Ding is a thin, intelligent woman. She saw her husband’s anger and the doctor’s grim expression, and immediately understood that her lover’s life was in jeopardy. However, the tears at this time were useless. She instinctively used 12 points of strength and clung to the doctor’s arm – this is the only force she can ask for: “Doctor, please be sure to save him!”
The emergency doctor immediately judged that Mr. Ding could not stay in the emergency department and immediately transferred to the comprehensive ICU (Intensive Care Unit). After receiving a consultation call from the emergency department, Hu Yuting, a comprehensive ICU doctor on a hurry, was surprised to see Mr. Ding’s critical illness. During the transshipment, everyone is very nervous. The ventilator and the rescue box are all carried around, because the patient’s breathing and heart can jump at any time. At 16:30 in the afternoon, Mr. Ding, who was on the line, was sent to the comprehensive ICU ward.
As soon as I entered the integrated ICU, the director of the integrated ICU, Huang Man, was on the verge of breaking the line: it is only possible to maintain Mr. Ding’s vital signs through ECMO support. ECMO is the English abbreviation of extracorporeal membrane oxy-genation, commonly known as artificial lung, which can temporarily replace the function of the lungs, allowing the damaged lungs to rest and function recovery, which is life-saving for patients with respiratory failure. However, at that time, there were many patients with critically ill patients, and all the ECMOs in the hospital were in use. Director Huang Man coordinated everywhere and finally distributed one, and transported it to the Binjiang District from the Jiefang Road District of the Second Hospital of Zhejiang University. 16 hours after Mr. Ding was admitted to the hospital, ECMO was in place with the weapon of death.
However, it is difficult to give Mr. Ding ECMO: his platelets are too low, and it is easy to cause bleeding when inserted into the instrument pipeline, and there are relatively few doctors and nurses during the Spring Festival. The doctor told the truth to Mrs. Ding, the seemingly thin woman, who had already dried her tears and forced herself to calm down. She said to Director Huang Man: “We fully trust and support you, and it is up to you to decide what to do!” Please do your best to save him!”
Director Huang Man, who has been struggling in the comprehensive ICU, has been dealing with patients who are dying all day. She is used to understanding the emotional excitement of family members in the face of pro-life, but she is restrained like Mrs. Ding and fully trusts. The family of doctors is rare. Director Huang Man, who is also a woman, was moved in a corner of her heart. She nodded and took the team to the fullest. At 19:00 that night, Mr. Ding used ECMO.
The only way to live: double lung transplantation
After examination, Mr. Ding was diagnosed as H1N1 positive for influenza A virus. The virus was very fierce and invaded the lungs, forming type 1 respiratory failure and septic shock very rapidly. The combination of ECMO and ventilator, as well as prone position treatment, can only barely maintain vital signs. After nearly 15 days of ECMO use, Mr. Ding’s lungs did not improve significantly, and the fibrosis, that is, the normal tissues of the lungs were almost broken, could not be used, and other organ functions began to fail.
“The only way out for patients is lung transplantation.” Director Huang Man asked Professor Wu Ming of the Department of Thoracic Surgery to consult and reach a consensus. The key point is that such an idea is only a theoretical way out. Mr. Ding’s physique at that time was likely to cause major bleeding, not to mention the double lung transplantation, and the necrosis and sudden death caused by pulmonary fibrosis were almost no precedent.
Director Huang Man and Professor Wu Ming told Mrs. Ding the results of the consultation. She looked at the eyes of the two doctors and firmly said something that made them extremely impressed: “Do it! Fight it, even if you finally work hard, you can’t. I will still thank you!”
Professor Wu Ming recalled afterwards: “I am not afraid of this operation, but I have not succeeded in setting a lung transplant after doing ECMO for a long time. I can’t help but worry. The trust and support of the patient’s family gave me great support. I suddenly felt like they were friends, I am sorry if I don’t try hard.”
Long and hard waiting
Determined to do a double lung transplant, Professor Wu Ming immediately began looking for a matching lung source. This is another process that needs to wait. This is the ultimate test for the team of Director Huang Man, Mr. Ding and his family.
The longer ECMO is used, the greater the risk of infection. First, the viral pneumonia caused by a stream of influenza, the time spent outside the hospital is too long (one week), the physical condition is extremely weak, and the use of hormones, antibiotics, etc., resulting in reduced immunity, easily lead to infection.
Second, various pipelines are prone to cause pipeline-related infections. ECMO long-term use, easy to cause bloodstream infection, coagulation system problems such as coagulation, bleeding: tracheotomy ventilator use, easy to cause ventilator suction-related pneumonia; lung exudation, pneumothorax and thus use chest drainage tube: catheter may Causes urinary tract infections, etc., any problem in one link will kill.
The bad situation still happened. During the use of EC-MO, Mr. Ding had a co-infection, and there was a barotrauma after lung injury, which suddenly caused spontaneous pneumothorax on the right side. What is the reason for this? The original viral pneumonia caused severe fibrosis of his lungs. Just like a balloon that lost its elasticity, it broke through a drum. If it broke, it would leak. If a person leaked, he would have to die. ICU emergency contact with thoracic surgery for bedside puncture closed drainage, drainage of a small amount of bloody fluid with a large number of bubbles, oxygenation improved. However, the appearance of pneumothorax indicates that the fibrosis of his lungs is already very serious.
Day after day, I don’t know when the right lung source will appear. At that time, several patients with a stream of patients admitted to the hospital were even better than Mr. Ding, and the situation of Mr. Ding was barely maintained, which greatly tested the confidence of everyone. Mr. Ding has always been conscious, and the family members of the ICU ward can only visit for ten minutes a day. Most of the time, doctors and nurses accompany him, and he is constantly encouraged to let him persist.
One morning, Director Huang Man saw Mrs. Ding sleeping in the corridor outside the ICU ward. Mrs. Ding was embarrassed to roll up and cover, saying that she would not hinder everyone. Director Huang Man asked her: “How do you sleep here, you can go to a hotel near the hospital.” Mrs. Ding was blushing and said softly: “I want to be closer to him.” Director Huang Man took this spirit. The power was transferred to Mr. Ding in the ward, and was deeply touched by this love from his family and his full trust in the doctor. All the staff tried their best to continue his life, protect other organs, and wait for the right lungs.
The integrated ICU has a dedicated lung transplant team. Once a patient has a lung transplant, the team is closely surrounding the patient, and the single room, specialist, and specialist management. They need to do a lot of work every day: First, monitor the patient’s vital signs, test and other results every day, and adjust the dose and type of antibiotics and antiviral drugs in real time according to the results. The second is to scrub the body chlorhexidine (a kind of spectral fungicide) every day to eliminate the colonization of the patient. It seems that there is nothing to hear about these tasks, but for a patient who is full of tubes and dying, it is necessary to scrub every corner of the body and ensure that each pipe is well fixed and works well but it is not easy. In particular, the ECMO is placed at the base of the thigh. This is a very thick tube. It has a thick pen and a slight movement. The ECMO machine will alarm. If the alarm is continued, it may affect the blood flow. It may cause adverse problems such as blood clotting and filter damage. Coagulation is directly life-threatening, and damage to the filter increases the burden on the patient’s family (a filter of around RMB 100,000). Therefore, in the process of scrubbing, doctors and nurses need to work closely with patients. One is that patients can’t move, and the other is that doctors and nurses should be very cautious. And such work, as long as it is a lung transplant patient, must be done every day.
In addition, each tube must be thoroughly disinfected every day, especially the ECMO tube, which needs to be cleaned immediately. Because the ECMO tube is thick and directly linked to the patient’s life, the fixation is also very particular. Instead of using a conventional film (the film is simply not attached), the gauze is wrapped around the entire thigh to prevent displacement. For the use of ventilator for tracheotomy, strict prevention of related pneumonia, such as raising the bed, using a bed that can measure the elevation angle, the angle of accurate elevation is 30 degrees. In addition, antibiotics must not be abused to avoid the emergence of drug-resistant bacteria, which is even more unfavorable for the patient’s prognosis.
Unprecedented double lung transplantation
It has been 45 days since the beginning of the ECMO, and it has been 30 days since Director Wu Ming began looking for lungs. These 30 days are the ultimate test for the team of Mr. Ding and Huang Man. They have to sustain their lives in the long wait. After 30 days of waiting, Mr. Ding is already on the verge of despair. The doctor nurse talked to him. He was indifferent and didn’t know if he heard it. This waiting seems to be able to hear the footsteps of death, and life may end in the next moment. Everyone is waiting, like a rubber band that is pulled long and long, and will break at any time.
Fortunately, on April 2, the right lung source appeared!
Compared with other organ transplants, lung transplantation is much more difficult, and it is more prone to rejection and infection. Professor Wu Ming urgently arranged for a double lung transplant, but gave Huang Man a difficult request: to give Mr. Ding a new EC-MO to ensure that he had a complete lung function during the operation. Mr. Ding is extremely fragile and may be in danger of danger during the replacement process. However, the team of Director Huang Man is still under great pressure and has replaced the new ECMO required for surgery with superb technology.
A step closer to the miracle of life, it is the turn of Professor Wu Ming to appear. It is extremely difficult to perform double lung transplantation for Mr. Ding: the risk of surgery to be overcome includes extensive adhesion of the chest, resulting in unclear surgical vision. A wide range of oozing blood in surgical wounds. The unstable function of the center of the surgical procedure makes it possible to face the risk of sudden cardiac arrest at any time. “The trust of patients and their families supports me to dance on the tip of the knife.” Professor Wu Ming recalled afterwards. After more than six hours, the double lung transplant operation has finally ended. Mr. Ding re-entered the integrated ICU and started a new life in a place where he was once desperate for death.
Difficult postoperative recovery
However, new life is not that easy, because after 46 days of this long ECMO support treatment, postoperative recovery is very difficult, such a weak body, to be extremely careful about complications, and the most difficult level is infection. At this time, Mr. Ding, like a fragile crystal cup, needs careful care. After transplantation, it is necessary to use anti-rejection drugs, hormones, etc., which is equivalent to interrupting the body’s own immunity and easily causing co-infection. At the same time, various pipelines increase the risk of infection. In addition, there are other organs to restore, rehabilitation and nutrition.
It is also the day and night of the 46 days. The hardships are hard to describe in words. Only the medical staff, patients and family members who are in it can feel deeply.
Start a quick recovery if the patient’s condition permits. On the second postoperative day, ECMO was removed; on the third postoperative day, the ventilator was removed; on the third postoperative day, the bed was seated; on the fifth postoperative day, the chest drainage tube was removed and the bedside was assisted by the rehabilitation engineer. Walk around. At the same time, taking the pre-infection anti-infection mode, still using a single-person special care, daily chlorhexidine body bath, using breathing exercise equipment, exercise lung diastolic contraction function. The lung transplant team doctor still has to do a fiberoptic bronchoscopy every day to observe the sputum traits and the healing of the airway anastomosis. On the 15th day after surgery, Mr. Ding became more and more stable. After the evaluation of Professor Wu Ming and Director Huang Man, Mr. Ding went to the thoracic surgery ward for further rehabilitation. From the beginning of the walk, tremble to the stagnation of the steady like a normal person, the doctor and nurse of the thoracic surgery accompanied him, further exercise in the lungs, the re-recovery of muscle strength, and the reshaping of social psychology. Finally, 15 days later, on the 75th day after the start of admission, Mr. Ding returned to his family and society in a normal state.
The miracle of life reappears! The disease is ruthless again, and ultimately the enemy, the family, the patient’s mutual trust and hard work!
The miracle of life created by doctors and patients goes down in history
During the entire treatment process, Professor Chen Jingyu, the first person in the domestic lung transplant, guided and participated in the rescue treatment. When he learned about the success of Mr. Ding’s rescue, he was pleased to say that this is the case in China and even the world’s longest preoperative ECMO waiting for a successful lung transplant. Professor Wu Ming and the team of Director Huang Man carefully inquired about the medical literature around the world. Sure enough, they inadvertently created the world’s longest in vitro support for EC-MO before viral pneumonitis.
Not long ago, the team of Director Wu Ming and the team of Director Huang Man jointly published a paper on lung transplantation for pulmonary fibrosis caused by influenza A pneumonia in the Yearbook of Thoracic Surgery (the TOP Journal of Thoracic Surgery). This is the field of industry in China. The affirmation of the lung transplant cause of critically ill patients also puts the world record created by China as the longest period of support for ECMO in vitro due to viral pneumonia before lung transplantation.
Nowadays, it has been almost a year and a half since the successful transplantation of double lungs, and Mr. Ding has been able to live and work normally. When he was discharged from the hospital, he made a promise to Director Huang Man and Professor Wu Ming: I will definitely come back to see you. He did it one year and two months after he was discharged from the hospital. When Mr. Ding and his wife stood in front of the two life-saving doctors again, a thousand words merged into one sentence: Thank you!
The joy of the two doctors is also in the words. They said: This miracle of life was created together. Thanks to the complete trust of the patients and their families, they were greatly supported by the difficulties they faced. They had no worries and let go.
This kind of trust and cooperation has successfully completed another case of a 57-year-old grandfather who had been infected with Nocardia before lung transplantation and still successfully transplanted.
In front of every disease, doctors and patients are comrades-in-arms. As long as they trust each other, support each other, and cooperate closely, I believe there will be more miracles of life.