Saving Two Lives with One Surgery
MADISON - When Stephanie White had some recent photos taken with her new baby, Charles Baskaya Zeinert, she dressed in white, and they both wore angel wings.
It symbolized their near brush with death, and the fact that they're both lucky to have made it to his birth last spring. White, a 26-year-old certified nursing assistant in the birthing center at Ministry Health Care's St. Clare's Hospital in Weston near Wausau, was 16 weeks pregnant when she felt a sharp stabbing pain in her right temple and felt the side of her head begin to swell. Fortunately, she was just finishing a shift and was still at the hospital. And fortunately for her, her co-workers did everything right.
Her obstetrician, Dr. Earl Zabel, was on call that night and recognized she might be having a stroke. Her co-workers wheeled her to the emergency department. On the way, she started to slump, and by the time she reached the ER, she was unconscious and needed to be intubated to keep breathing. A CT scan showed significant bleeding deep in her brain.
No one in the area could attempt surgery, so she was transported via helicopter to UW Hospital and Clinics in Madison, where the on-call neurosurgeon summoned Mustafa Baskaya, MD. Dr. Baskaya began directing the Weston medical team by phone from his home, telling them to begin IV medications to reduce the swelling in her brain.
"The ER doctor in Weston called my boyfriend (Jay Zeinert) and my sister and told them to say their last goodbyes because they didn't have much hope," White said. "I was pretty much clinically brain dead at the time. My left pupil had blown."
The helicopter took off, and Dr. Baskaya assembled his team for surgery while giving instructions to the helicopter medical team as they flew. As with any type of stroke— whether caused by bleeding or a blockage— minutes matter when it comes to saving the brain.
When White arrived in Madison, both of her pupils had fully dilated, indicating tremendous pressure in her brain caused by the bleeding. First, Dr. Baskaya drained some of the bloody fluid to reduce the pressure inside her head. Meanwhile, his resident consulted with an obstetrician about how to care for the unborn baby during surgery.
A CT angiogram showed that an arteriovenous malformation (AVM) deep in her right temporal lobe had ruptured. The AVM is a tangle of blood vessels that was probably present in her brain since her birth.
In the operating room, Dr. Baskaya removed the skull bone to evacuate the large blood clot from the brain. He then micro-surgically tracked down each small artery feeding the AVM, closed them off, then removed the tangle of blood vessels.
In the waiting room, White's family was deeply fearful. She has two other children, Christopher, 8 and Olivia, 3.
"We are a mess," her eldest sister, Sara Smith, wrote that day, the first of her daily blogs, entitled 'Stephanie's Fight.' "She is a daughter, a sister, an auntie, a mother, a girlfriend, a co-worker and a best friend to all of us in one way or another. We all want her back."
Smith, an obstetrics RN at St. Clare's Hospital, described the long hours of surgery as torture for the family. They had been told that White's bleed had increased by 30 percent during the helicopter ride. The pressure in her head was enormous. "We were told that the chances of her survival were low and that if she did survive the surgery, she would most likely need a feeding tube and probably not be able to do much for herself," Smith wrote. "What kind of a life would that be and what about her babies?"
White says that Dr. Baskaya later told her that most doctors wouldn't attempt emergency surgery so deep in the brain, "but he was determined because I was so young and had two little kids."
The surgery lasted about eight hours, and then the family had to wait to see how much damage had been done and whether the baby had survived. Her sister Sara described the wait:
"Her room is full of monitors that I have never seen, there are sounds that I have never heard, her long pretty hair is gone, her head is wrapped like a mummy and she is still the most beautiful girl I know! Keep fighting Steph!"
There were many touching moments during her recovery. Smith wrote, "Dr. Baskaya comes to see her several times a day. Our mom said she looked up at him and he introduced himself as the doctor that did the surgery to save her life. And then, she said Stephi gently touched his face. This group of neuro doctors and nurses has been incredible here."
As soon as White came to, she began worrying about the baby. But an ultrasound and regular OB checkups while she was at UW Hospital showed that the baby's heart was beating strongly. Months of rehab followed, and White went home to her children with little, if any, lingering disability.
The baby was born at the end of March via a planned C-section to avoid putting any more stress on her brain. White's sister Sara Smith and Zabel, who was there the night of her AVM rupture, helped deliver him.
"My sister put him under my gown and I bawled for a couple of hours afterward," White said. Smith added, "There were tears shed by everyone."
White and Zienert named their baby Charles Baskaya Zeinert, in honor of the surgeon who saved both mom and baby.
Date Published: 11/06/2009