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Coming Back from the Brink of Heart Failure

VAD patient Ruth Bevis.

May 13, 2019

Ruth Bevis, 56, has a reputation for sharing her heart with others. She’s been a Christian missionary, a kindergarten teacher and a loving mother of 3. But on May 8, 2018, something went terribly wrong with her previously healthy heart.

Due to severe chest pain, Ruth took an ambulance to a local emergency department. According to Ruth, she was told nothing was wrong – maybe some acid reflux. Ruth went back to work despite extreme discomfort. A few hours later, she requested another ambulance.

Between her first and second hospital visit, Ruth suffered a massive heart attack. She was admitted and treated at a local intensive care unit (ICU), but the damage had already been done. She was in cardiogenic shock and her left ventricle muscle was dead.

Ruth needed advanced care. Some might say she needed a miracle.

To the rescue

Kansas City advanced heart failure cardiologist Nick Haglund, MD, was on call that night at The University of Kansas Health System. The referring hospital described Ruth’s condition and asked for help. Dr. Haglund and the team accepted the challenge.

"Ruth was near death. If we were going to take extreme measures to save her, we needed to know the family was on board," says Dr. Haglund. "So, we scheduled an urgent family meeting."

The family assured Dr. Haglund that Ruth loved life and would have their complete support during the difficult weeks ahead.

That's when the cardiothoracic surgeon stepped in. He consulted with the health system's interdisciplinary team of intensivists, anesthesiologists, nurses and respiratory therapists. They wanted to put Ruth on a more advanced life-support system to give her heart and lungs a chance to rest. It's called extracorporeal membrane oxygenation, or ECMO.

"We have a lot of experience with mechanical circulatory support," the surgeon explains. "We know how to match the right therapy with the right patient. ECMO is not for everyone. But with the right patient, it can be a tremendous tool."

The cardiothoracic surgery ICU team connected Ruth to the ECMO machine and monitored her vitals around the clock. After several days, her condition was still dire, but she had stabilized enough for surgery.

Lifesaving surgery

What Ruth really needed was a new heart, but she was too sick for a heart transplant. The surgeon gave her the next best thing – a battery-operated left ventricular assist device (LVAD). It pumps blood to the body when the lower left chamber of the heart no longer functions.

During the 4-hour surgery, the surgeon and his team implanted the LVAD in Ruth's chest. The operation was a success, but Ruth was not out of the woods yet.

Her body was still frail from the initial heart trauma. Transitioning her from the ECMO machine to her new LVAD was touch-and-go. To improve her chances of survival, the team performed a temporary tracheostomy and placed a feeding tube in her stomach. Ruth remained in a medically induced coma in the cardiothoracic surgery ICU for 3 weeks.

"There were many days we all questioned whether Ruth would make it," the surgeon says. "We were willing to take the risk because she was an otherwise healthy lady, she had great family support, and the entire team of nurses, doctors, surgeons and cardiologists felt if we worked together, we could get her through this."

For the family, it was difficult to see Ruth's limp body attached to a multitude of tubes and monitors. They missed her effervescent personality and beautiful smile. But they felt blessed she was still alive.

The awakening

Then, after 28 days, Ruth began to open her eyes. She nodded. She tried to talk. And finally, she smiled.

Ruth's daughter, Bianca, had traveled from Israel to care for her mother. She explained what had happened, "You had a massive heart attack. You almost died."

Ruth found it hard to believe. She did not remember anything.

Every day, Ruth's hero, her surgeon, checked on her. She told him, "I give the glory to God, but he used your hands."

When Ruth no longer required life support, she was moved to the cardiothoracic surgery progressive care unit. Bianca was able to stay with her mother 24/7, and Ruth continued to improve.

Next, Ruth graduated to Acute Inpatient Rehabilitation. Because her muscles were weak and in poor condition, she had to learn once again to talk, walk and take care of herself. She received speech, physical and occupational therapy.

Physicians expected her to stay in rehab 3 weeks, but Ruth had other plans. "She really pushed herself. She's a fighter," says Bianca.

Instead of 3 weeks, Ruth was released in just 10 days. "I think it's because I used to exercise and eat right," she says. "That helped me get my strength back."

Before Ruth could leave the hospital, she and her family had to become LVAD experts. The pump implanted in her chest connects to an external battery pack and controller. Ruth wears the bag of equipment like a purse strapped over her shoulder.

The hospital's VAD coordination team instructs and monitors many patients equipped with these high-tech pumps.

"It can be scary for the patient and family when they first get a device," says Ashley Manning, RN. "We teach them how to change the dressing, take care of the line and manage the batteries."

"I learned really fast," says Ruth. "I carry this bag everywhere, 24 hours a day. I sleep with it. It keeps me alive. Amazing!"

Back to life

On July 9, just 2 months after her heart attack, Ruth went home.

Bianca helped with daily living activities, as well as blood pressure and anticoagulation medications. She also powered through wound-care duties that sometimes made her cringe.

"This made me realize how much my children love me," laughs Ruth. "I would not have made it without them, especially Bianca."

Ruth's youngest daughter Natasha and son, Micah, also flew in from near and far. Her sister and brother-in-law live in the Kansas City area and were an integral part of the family care team.

The surgeon says her transformation is nothing short of miraculous.

"This is not the kind of case we see every day, but Ruth shows us what is possible," the surgeon says. "She was hanging on by a thread, yet she’s night-and-day different now. She’s totally recovered and living a normal life."

Waiting for a transplant

As much as Ruth appreciates her LVAD, she hopes it will be replaced by a new heart.

"Transplant offers the best chance for long-term survival," the surgeon explains. "LVADs have come a long way and they can last 10 years, but there are potential issues."

Near the end of December, Ruth suffered an ischemic stroke, a known complication following LVAD placement. It was a minor setback and she recovered quickly.

As of February 8, 2019, Ruth was back on the heart transplant list and eagerly awaiting a donor heart in Kansas City.

"I have never seen a hospital like this," says Ruth. "The doctors and nurses give me such good care and so much encouragement. We are so grateful."

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