For doctors at the Ho Chi Minh City-based Cho Ray Hospital, the smile on the face of Patient 91 on June 3 has brought great happiness to them, because this is the first radiant light after a three-month grey journey "scrambling in the narrow tunnel", struggling to save his life that once "hung by a single hair."
Resilience to consecutive upheavals
After about a month since Patient 91 was hospitalised, on April 8, Ho Chi Minh City Hospital for Tropical Diseases asked for a consultation when he was in a critical situation, falling into a coma with fibrosis of the lungs. The National Steering Committee for COVID-19 Prevention and Control urgently dispatched a team of elite and versatile young doctors from Cho Ray Hospital to the city’s Hospital for Tropical Diseases to provide technical support on extracorporeal membrane oxygenation (ECMO).
Over the past 100 days, hundreds of medical staff from both the hospitals have day and night resolutely handling consecutive upheavals related to the 43-year-old British. "When his lung function was too low, the consultation team indicated a lung transplant. We thought that his lungs were almost dead and the patient's chance of survival was extremely low," said Assoc. Prof., Dr. Pham Thi Ngoc Thao, Deputy Director of Cho Ray Hospital, as she slowed down the battle of wits to make vital decisions before an unprecedented medical case in the world.
Assoc. Prof., Dr. Pham Thi Ngoc Thao: "The only command from the heart of a doctor is to save the patient by all means".
All the highest technique, from dialysis to ECMO, have been applied on the patient to save him. The first complication occurred just after using ECMO for two hours as the filter solidified. The patient also has anti-heparin antibodies, causing heparin-induced thrombocytopenia (HIT) – an immune reaction in patients receiving ECMO. But the HIT syndrome in a patient with both ECMO and COVID-19 is a very special case that has not been reported much in the world’s medical records.
When his lungs were only 10% active, the male pilot also suffered from pneumothorax, combined with bacterial infection. Doctors assessed that his alveoli may have been invaded by viruses, causing necrosis, thrombosis, alveolar coagulation and inoperable lungs. His bacterial infection was an important pathophysiological component detected during the course of treatment, so Vietnamese doctors must further study this issue as well as COVID-19.
During treatment, the man's immune system overreacted when the viruses attacked, producing cytokines against the body, known as a “cytokine storm”. His lungs were also badly injured.
Consultations are held regularly to seek effective treatment regimens for Patient 91.
At that time, doctors had to decide to switch to a specific antibiotic, not heparin, but Vietnam has never imported this drug. A 10-day waiting period after that for the German-made intravenous anticoagulant to import to Vietnam was really stressful.
“Whether or not to use the new drugs?" Dr. Thao brought the concern to discuss with her colleagues. In the end, they agreed to use new drugs that have never before been seen in treatment regimens to conserve ECMO membranes, helping to save the patient. “We adjusted the dose by testing his blood samples every six hours to monitor ECMO membrane concentrations. It was just like we were the wire-walkers. If we tilted on this side too much, the patient may suffer from cerebral haemorrhage, but if the other side is too inclined, ECMO’s membrane would be solidified. In those 10 days, we were just waiting for the test results to focus on adjusting his blood clotting. We said to each other, in the circus, performers walking on the rope would be hurt if they fall, but if we fall, the patient dies,” Dr. Thao recounted the moments of pressure and stress.
This is the first case after two hours performing the ECMO method, the membrane was freezing, while the normal medical crew cannot replace the filter. Doctors must perform membrane replacement very quickly so that the patient does not have cardiac arrest or bleeding. In 57 days using ECMO, seven ECMO membranes were replaced.
Doctor Tran Thanh Linh, Deputy Head of the Department of Active Rehabilitation, Cho Ray Hospital recalled that taking the patient from the Ho Chi Minh City Hospital for Tropical Diseases to Cho Ray Hospital was not an easy task even though the two facilities were not far from each other. "If omission or negligence in attaching machines, it can affect the life of the patient," Linh said.
After overcoming the continuous upheavals, the next heavy task for doctors at Cho Ray Hospital was how to help the patient give up ECMO and mechanical ventilation. Dr. Thao looked at her colleagues and said "Is this an impossible task?" However, doctors and nurses in the Positive Recovery Department of Cho Ray Hospital did their best in the hope of finding light at the end of the tunnel for the male pilot. When he had hand movement and gave up ECMO and sedation, the greatest fear for the treatment team was that he might not wake up due to brain cell damage. Luckily, when he stopped using multiple drugs, he recovered his senses very well.
After days of hard struggle with reviving the patient, another brainstorm came to those who lived in the same quarantine room with him. “Language barrier, along with the fact that the patient after long-term isolation was seriously psychologically affected, making treatment cooperation more difficult. When the patient texted with his friends, hearing from his friends how Vietnamese doctors saved him, then he smiled more with us,” said Dr. Linh.
Experts in the Treatment Subcommittee under the National Steering Committee for COVID-19 Prevention and Control evaluated that the recovery of Patient 91 is a feat of Vietnamese medicine. This is also a special case of world medicine and can be written into international reports. From having only 10% of the lungs active, now he has fully recovered. From an immobilised body for nearly two months, being attacked by bacteria into the lungs and bloodstream, the patient has now escaped the critical condition of multiple organ failure. Each of his progress is an encouragement for Vietnamese physicians and specialists to continue striving and devoting their strength to best treating the patient.
Doctor Tran Thanh Linh, Deputy Head of Department of Active Recovery, Cho Ray Hospital, talks about the days of taking care of Patient 91.
Must save his life
Assoc. Prof., Dr. Pham Thi Ngoc Thao likened the journey to save the life for the British male pilot like a war in which all strategies are calculated in detail. In dealing with any patients, no matter who they are or where they live in the world, the only command from the heart of the doctors is to save the patients by all means.
Each doctor and nurse at Cho Ray Hospital has prepared a backpack with full equipment needed to be ready for any situation. The regular staff with Patient 91 are very young, some of them have young children, some of them are unmarried. But in the back, these young doctors and nurses are always supported by their leaders, who are always motivate them and create the best conditions for them. Thanks to that hard work, resilience and solidarity, doctors and nurses at Cho Ray Hospital have performed a miracle, which is the pride of every Vietnamese person.
For Le Thi Hong Tham, a 28-year-old nurse, the past month was perhaps the most memorable days in her five years as a nurse. When Patient 91 woke up, in order to help him cooperate with her easily, she had to further develop her English capacity. “At first I spoke unclearly, making the patient uncomfortable. I have to learn English more at home to communicate better with him.” And when she saw the patient smiled after her words and listened to her instructions, Tham felt her efforts had paid off.
When being asked about the pressures of treating Patient 91 as the whole world are looking into this case, Thao said: “We do not pay much attention to external pressures, because we only follow our best efforts to save the patient's life. At that time, we just thought whether we had the best treatment, or there were any better drugs or technical measures to help the patient better? We did not think of the pressure of making the world know that Vietnam has helped Patient 91 recover.”
Ho Chi Minh City People’s Committee Chairman Nguyen Thanh Phong was touched and surprised by the miraculous recovery of the British pilot.
Assoc. Prof. Dr. Luong Ngoc Khue, Director of the Medical Services Administration Department under the Ministry of Health cum Deputy Head of the Treatment Sub-Committee under the National Steering Committee for COVID-19 Prevention and Control, said that the recovery of Patient 91 is the clearest evidence for determination not to give up on treating COVID-19 patients from the Vietnamese Government, Ministry of Health and related hospitals. The COVID-19 fight has mobilised the intellect of all health workers across the country, with the best equipment and drugs, including those imported from abroad, to offer optimal treatment.
After over 100 days receiving medical treatment, and having regained his life from the hands of death, thanks to the support from Vietnamese doctors, Patient 91 has had a comprehensive recovery and is now healthy enough to repatriate as his wish as a normal passenger without quarantine on a normal commercial flight back home.
Patient 91 has had a miraculous 100-day revival journey.
On July 12, Patient 91 will return to his homeland in the UK. On this special flight, he will still have the companion of Vietnamese medical staff. It will be a special returning-home flight with full of peace and good luck.
