When a Pandemic Hits, But So Does a Heart Infection

June 16, 2020 11:11 AM

Other health emergencies didn’t stop for COVID-19. One man who needed heart surgery right before the crisis shares his story.

husband and wife near a waterfall
Dan and Pat Bober, courtesy of the Bober family.

It’s scary to watch your husband get diagnosed with a deadly infection that requires heart surgery. But it may be even scarier to only hear about how he’s doing over the phone, an alternative Pat Bober never thought she’d face when her husband, Dan, became critically ill this past winter.

Now social distancing back in their West Bloomfield home, they reflect on the surprisingly eventful start to their first year of retirement.

Late February:

Dan and Pat Bober kicked off retirement with a trip to Hawaii.

Weeks later, they had to change a few plans: Dan had had a low-grade fever for a few days. It wasn’t a huge concern. But when Pat couldn’t wake him up one night, she called an ambulance.

“Everything hadn’t been closed down for COVID-19 yet,” she remembers. “We knew about COVID, but we really just thought it was the flu.”

It turns out, he’d gone septic and his organs were already shutting down. Bober, who got a new heart valve in 2017 for an infection called endocarditis, was given the same diagnosis a second time. The infection was on his new heart valve so he’d have to get it fixed again, but his condition was already deteriorating quickly.

SEE ALSO: Keeping Our Patients Safe During COVID-19

This time, the route back home would include several surprises and require visits from specialists in cardiac surgery, cardiology, interventional radiology, gastroenterology, ophthalmology, infectious disease, physical therapy and more.

March, part I: Cardiac surgery

“It was minute-to-minute to keep him alive until we could get him to U-M,” Pat says. “Every 15 minutes we were hoping he’d make it to the next 15 minutes. His heart rate was racing over 140 beats per minute, his blood pressure was low, he was confused and incoherent, and he couldn’t even open his eyes.”

With the transfer set to go on March 10, Bober faced his first complication while en route to Michigan Medicine: a gastrointestinal bleed. First, surgeons would fix his heart to keep him alive; then, they’d address the bleeding.

“He was in septic shock and multiorgan failure, and with gastrointestinal bleeding,” says cardiac surgeon Bo Yang, M.D., of the Michigan Medicine Frankel Cardiovascular Center. He told Pat there was a 50/50 chance of her husband surviving this operation.

“I took the previous artificial valve out, and had to cut out all of the dead and infected tissue around it,” Yang says. “There wasn’t much tissue left for me to reconstruct.”

“I was trying to make sure my expectations were in order, given how sick he was,” Pat remembers. The cardiac surgery was successful. But whenever they thought the gastrointestinal bleeding was improving, it would start coming back.

“He scared the living daylights out of me,” nurse practitioner Courtney Clark, N.P., remembers. “I can’t describe how much GI bleeding he had.”

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Eventually, they found the source of the bleeding – an artery to the bowel– and interventional radiologists embolized it to get it to stop. His other, smaller, bleeds would eventually stop, too.

Bober’s wife never left his side. She was taking copious notes, and staying out of the way but close enough to keep watch through all the twists and turns.

“I had the luxury of knowing what happened the shift, the hours, the days before. I knew the sequence,” Pat says. “It was really good to be an advocate for him. I never left.”

March, part II: COVID-19 arrives in the Great Lakes

But on March 23, Michigan Medicine decided it could no longer allow patients to have visitors, in order to slow the spread of COVID-19. That meant Pat Bober had to go home, in order to best keep herself, her husband, and the other patients safe.

“Pat was in the room every minute of every day,” Clark says. “Then I had a few days off, and when I came back, it was the pandemic.” She recalls Dan being moved to a different floor and no longer able to have his wife by his side.

“Continuing to be an advocate for my husband was really tough,” Pat says. “That’s where people like Courtney really helped. She had been there through the heat of it.”

Clark and Pat Bober switched to phone calls to coordinate Dan’s care, and her check-ins on her husband.

Dan himself remembers little until right before his wife had to go home.

“What struck me was, as the pandemic started, things were changing two, three times a day at least in terms of the rules and adjustments staff were having to make,” Bober remembers. “It was amazing that everyone was able to rally and stick to the knitting, as they say. I was grateful they were sticking to my knitting!”

April: Slowly ‘able to participate’ again

When Bober looked around his new hospital room after he was “able to participate in the world again,” as he describes it, it seemed like his left eye was looking through sheer curtains. His left retina had holes around his blood vessels, another target of the bacteria that had been dining on his heart valve, and had to be lasered closed with retinal surgery at the Kellogg Eye Center. His right knee was swollen, too, but x-rays showed no breakage or infection, so they decided to just keep an eye on it.

For Pat, being able to keep getting updates from many of the same providers, who told her they’d asked to keep taking care of her husband on each shift they returned to work, meant so much given that she couldn’t be there with him anymore.

SEE ALSO: Seeking Medical Care During COVID-19

“For his health to have that consistency, for my peace of mind, them wanting the challenge of someone as interesting as Dan was says a lot about the staff,” Pat says.

His new dry cough made things even more interesting. Providers had to act like he had COVID-19 until a test came back negative.

Physical therapists, whose own unit had closed, then came to Dan’s hospital room to get him moving around a bit until he was ready to be discharged. In most cases, this would be the time to head to rehabilitation for more work. But during the peak of a pandemic, every interaction with another person has to be carefully considered.

“I’ve seen families wanting to take care of their loved ones on their own so they can control how many people they’re around, and they feel safe using telehealth,” Clark says.

They decided he’d leave the hospital for rehab at another hospital before returning home.

May/June: Joining the quarantine

The Bobers finally joined the rest of the state in following Governor Gretchen Whitmer’s stay-at-home order together. They had a new reason to make sure COVID-19 wouldn’t hit their household: Dan himself, still recovering and getting his strength back.

“It’s been one long quarantine. I’m just glad I can be able to participate in it,” Bober says. He’s taking walks and getting as much activity as he can, while still monitoring his swollen knee.

“He’s a warrior,” Yang says. “He survived all of this and he’s doing amazingly well.”

The Bobers say they’ll always remember this unique start to their first full year of retirement together, although it played out in a way neither would have imagined.

“We had plans to travel, golf, rent an Airbnb in northern Michigan,” he says. “At no point did it involve life-threatening surgery or pandemics or quarantines.”

Dan plans to head off any future infection with a longer term course of antibiotics, a rare approach that’s the right fit to avoid a third emergency heart surgery. And he’s very happy quarantine-limited FaceTime calls with their grandchildren have now been replaced with live visits.

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