H1N1 Cases: Healthy to Death's Door in One Week

Nov. 11, 2009— -- On one floor of the University Hospital Case Medical Center in Cleveland, the H1N1 virus is showing just how random, powerful and destructive it can be, even for healthy adults in the prime of their lives.

Walter Savitts, 44, depends on a machine for every breath. His wife, Margaret, is constantly at his side. Nearly three weeks ago, he came down with what seemed an ordinary case of the flu.

"I just figured you're going to get the 24 hour bug or something like that. I never thought that it would turn out to be something like this," Margaret said.

The truck driver had been in excellent health until that October morning.

"Just a fever, small cough. Not a big thing," Margaret told "Nightline." "By Monday, he started saying his chest was hurting so he went to the emergency room. ... They told him he had the flu and sent him home. ... By Thursday, he was in so much pain at 3 a.m. that he went back to the hospital and they said that he had full flown pneumonia ...and by 2 a.m. Monday morning he was in full respiratory failure."

In the next hospital room, 34-year-old Robert Bradbury floated in and out of consciousness. Except for an asthma attack six years ago, he, too, had been healthy and strong before the virus took hold.

"We are young people, young healthy people, athletic," said Robert's wife, Candice Murton-Bradbury. "He plays volleyball. We are out a lot, we walk, and he's a nonsmoker, you know, all the things that they tell you to take care of yourself."

Slightly more than three weeks ago, after a night of celebrating with his wife and colleagues, the Ohio restaurant manager fell asleep at work.

"I guess he lay down at work and never got up again," Murton-Bradbury said. "And was just very incoherent and not with it."

Co-workers took Bradbury to an emergency room the morning of Tuesday, Oct. 20. Due to the severity of his illness, doctors decided to send him to Case Medical Center for more advanced treatment.

Doctor: 'He Was Pretty Much Dead When He Came In'

Bradbury and Savitts were airlifted from smaller hospitals to Case Medical Center, where they arrived in critical condition, barely able to breathe.

Dr. Arie Blitz, a surgeon and medical professor, treated both men. He said when Bradbury arrived, his vital organs were failing.

"He was pretty much dead when he came in," Blitz said. "He developed something that I have never seen before in medicine ... four things at once. ... He had H1N1 flu. He developed a big pulmonary embolism, which is a clot that was sent off to the lung. He had a heart attack, and he had a stroke all at the same time."

Blitz told Bradbury's wife that her husband had a 1 percent chance of survival. "They pretty much informed all of us that he wasn't going to survive," Murton-Bradbury said. "One of the vascular surgeons came out and gave me his wedding ring, which was terrible, to say the least."

Savitts wasn't doing much better. His lungs were so badly damaged, according to Blitz, that it was as if they'd been torn to pieces. Both men were beyond the help of ventilators, so doctors performed emergency surgery, called extracorporeal membrane oxygenation, or ECMO.

"The goal of ECMO is to do two things. One is to rest the lungs so we can let it repair itself and two, provide the oxygen needs of the body and get rid of the carbon dioxide waste product of the body," Blitz said.

ECMO has become a vital tool in the battle to save critically-ill flu patients when ventilators alone can't help. Blitz has used it on only his most dire cases.

"They were dying, they were all on death's doorstep, would not have survived no matter what," he said. "Some of these patients would not be around today without that technology."

In some cases, ventilators alone can't help patients breathe. Doctors say that ECMO is needed in about a third of the most serious H1N1 cases. At first, the patients must be induced into a coma to let the body rest and the lungs recover.

Strain on Hospital Staff

Patients like Savitts require round the clock nursing care. In his case, the nurse is ex-Marine Madison Edge, who Savitt's wife Margaret calls her "partner in crime."

"I've been doing this nine years, and I've never seen an influx like this year," Edge said. "I've never seen a flu season like this one here."

The flu is straining the hospital staff, with as much as 20 percent of the nurses out sick here. Pregnant doctors and nurses, those most vulnerable to the virus, have been reassigned. To protect themselves and the patients, the staff must constantly don sterile masks and gowns.

Registered nurse Molly Zerbini takes care of infected children in the pediatric intensive care unit.

"These masks are not the most comfortable thing ever. They're very hot, they're very sweaty, but to protect ourselves and [avoid] transmittal to, particularly, other kids, is priority, so we're dealing with the discomfort of them," Zerbini said.

Influx in Adult Cases of H1N1

At first, in mid-October, the emergency room at Case Medical Center, like others across the country, was flooded with infected children. But now, those pediatric cases have tapered off and the hospital is seeing an increase in the number of adults who have the virus.

"H1N1 for most patients is a relatively benign disease and doesn't progress. But a small percentage of patients can have very, very severe disease and can die from this," Blitz said. "The unfortunate thing about it is that it's not in patients that we can predict with any reliability who gets really sick from it. The ones that we've been seeing here are quite young, in their 30s and 40s, and otherwise very healthy and previously healthy, who come down with H1N1, and within a week's time are on death's door."

Most recover quickly, but experts estimate that in 1 percent of H1N1 cases, the virus attacks the lungs so viciously that vital organs are robbed of oxygen.

"Almost every patient that we have put on artificial support has had not only failed lungs but also failed livers, failed kidneys and even strokes and heart attacks," Blitz said.

Next Step: Recovery, Prayer

Walter Savitts is fortunate that only his lungs were damaged. But nine days after his emergency surgery, he remains in a coma, unable to breathe on his own.

"It gets hard. Some days you just want to cry and cry, but I've got to keep telling myself that he's doing well and it could have turned out a lot worse," Margaret Savitts said.

Blitz said that Savitts' prognosis is good. He estimated a 75 percent chance of survival.

"I think when he came in, without having ECMO, he would have died within 24 hours," Blitz said.

Next door, Bradbury emerged from a deep, induced slumber two weeks after doctors told his wife that he had only a one in a hundred chance to make it.

"He looked at me and made real eye contact, and then the look on his face was, first, awe and then it was relief and he slid over in the bed and put his head against my head," she told "Nightline." "That was the day that I knew that he was going to be OK."

Not entirely. A kidney failure has left her husband on dialysis, but he is grateful to be alive.

"I can guarantee they saved my life here. If it wasn't for them, I wouldn't be here right now. That's for sure," Bradbury said.

To the Savitts family in the room next door, Bradbury's case is an inspiration.

"I had a pretty slim chance at survival there," Bradbury said. "I wasn't really supposed to make it. But I guess ... you believe in God now."

On Monday night, Bradbury, his wife and mother prepared for his move out of surgical intensive care to another ward of the hospital. That same night, Savitts suffered a setback: attempts to wean him off mechanical breathing faltered.

In one room, a man fighting for his survival. In the next, another man on the path to recovery. Both struck down, in their prime years, by a fast and furious virus that works in ways so random that no one fully understands it.