Surgical Team Moves in Tandem at the Speed of Life

Something wasn’t right.

Morry Wasserman, 91, knew it the minute he woke up Aug. 22, 2012, and noticed his wife Betty had slipped out of bed to use the bathroom. She called through the door that she was fine, but moments later she stumbled into their bedroom, a sight he’ll never forget.

“She looked 15 months pregnant, her belly swollen, her face swollen, her tongue hanging out, and gasping for breath,” he recalls.

He dialed 9-1-1, and then hustled down the stairs, ignoring the pain in his back and the neuropathy in his legs, to open the door for paramedics. Once they arrived, the question was where to take her.

“VacaValley Hospital is the closest,” Morry reasoned.

Today, he considers it one of the best decisions he’s ever made. His best decision? To marry Betty 67 years ago.

An abdominal aortic aneurysm had ruptured inside Betty Wasserman that morning and was leaking at a steady pace. By the time she arrived at VacaValley Hospital’s Emergency Department, her blood pressure was extremely low, but she was conscious and alert, and able to answer questions.

She knew enough to tell Dr. Craig Dennis that if surgery was her only chance to survive, she wanted it.

“Most patients with this problem die within minutes to an hour,” says Dr. Dennis. “We figured out that her aneurysm likely ruptured in the early hours of the morning, and blood was slowly filling her abdomen. The fact that she was still alive at 7 a.m. when they brought her in to see me is remarkable.”

The team ran tests and stabilized her, but kept her blood pressure intentionally low, realizing it was the safest thing for her. Medically, it is called “permissive hypotension.” To allow the blood pressure to rise to normal levels would allow her to bleed faster. Then they loaded her into an ambulance and sent her to NorthBay Medical Center.

Cardiothoracic and vascular surgeon Seph Naficy, M.D., was already in scrubs at his Fairfield home, getting ready for work at NorthBay Medical Center when he got the call. He in turn called Joanne Jacob, R.N., and tasked her with assembling the surgical team. “If each member of the team is a branch of the tree, Joanne was the trunk” says Dr. Naficy. “I knew she was in a position to quickly connect everyone together.”

Then he hustled to the Emergency Department to meet Betty when she arrived.

Betty was conscious and breathing when she was wheeled in. “I asked her if she was willing to take some serious risks to save her life, and she said yes,” recalls Dr. Naficy. “I decided that there was hope and that she had a chance.”

Technically speaking, Betty’s odds were not good. Aneurysms are the 13th leading cause of death in the United States. Only a small fraction of people who suffer a rupture make it to the hospital, and only half of those survive the surgery. Fewer than that survive the prolonged recovery. At 86, and with a series of health issues including the recent placement of stents in coronary arteries, and on medication to prevent blood clots from forming, Betty’s chance of survival was 10 percent at best.

Morry Wasserman, a retired Air Force officer and pilot, faced formidable odds himself during World War II, when he flew 34 missions in a B-17 bomber over Germany.

When he came home in 1944, it was to a hero’s welcome. The 22-year-old carried with him the Distinguished Flying Cross, with a Purple Heart, and four air medals. His family threw a big party for him in Los Angeles. That night he met his future bride, a reluctant teenage guest who didn’t have any interest being at a party for a solider she’d never met.

He took one look at Betty and insisted on a date. “I couldn’t shake him,” chuckles Betty.

Dr. Naficy insists that credit be spread to the whole team, which covers both hospitals, a multitude of departments and even outside consultants.

Less than six months later, they married. He was 22, she was 18. “I promised her then that I’d always be there to take care of her, and I’m still taking care of her today,” says Morry. “It’s gotten pretty hard lately, but I’m not about to give up.”

As “board runner” that morning for the surgery department, one of Joanne’s first calls was to the blood bank, making sure they were prepared for a mass transfusion.

“Thank goodness we’re a Level III Trauma Center,” recalls Joanne. “New protocols with the blood bank now ensure that there’s always a cooler of O Negative ready at a moment’s notice. That’s the only blood type that can be given to anyone without issue. Being able to give her blood when she was ready for it made a huge difference in this case.”

When Betty was rolled into the operating room, there was no time for discussion. Dr. Naficy had to make the first incision in her groin, using only local anesthetic, while a team of two anesthesiologists hurried to set up an IV.

“It was very tricky,” explains Dr. Naficy. “Because she had stents placed in July, she was on blood thinners. We did not want to have to open her abdomen for surgery if we could help it. She also had a lot of blood pooling in her abdomen.”

The decision was made to use an endovascular procedure—running a catheter up her artery and using that path to place a balloon and later stents strategically, all the while paying close attention to her blood pressure.

“Betty was constantly bleeding, so her pressure was dropping,” explains Dr. Naficy. “If we had tried to raise it too quickly or if it dropped too low, she would not have survived. We had to move fast if we were going to save her.”

“It was organized chaos,” remembers Joanne.

In addition to the surgeon, two anesthesiologists, four nurses, a technician, and others came and went as needed, including three radiologists, blood bank staff and more.

Kevin Bowman and Richard Smith from Medtronic in Santa Rosa arrived just in time to deliver a quickly configured stent graft combination designed to fit Betty’s aorta.

“Think of it as making a custom-designed three-piece suit based on a phone conversation,” explains Dr. Naficy. “I barked a quick series of numbers on the line over a span of a minute while the patient was rolled into the OR. Usually, a rigorous computer-based process would design the stent.”

Dave Martel arrived to operate the Cell-Saver, a piece of equipment that allows a patient’s own blood to be recirculated into their system. “The Cell-Saver vastly improves one’s chance of recovery,” says Joanne. “It was one more thing we could offer to aid in her recovery.”

Looking back, everything flowed like clockwork, remembers Joanne. “All day, every one did their job, in harmony,” she said. “There were as many as 13 people in the room at one time and if you needed something, bam, it was there in an instant.”

“You’d think I would get calmer as we completed each step,” recalls Dr. Naficy, “but I wasn’t. Each positive step gave me faith that she could come out of this alive, but there was no room for error. It was even more important that we do every step right.”

During the four-hour-plus surgery, Joanne remembers that not only did the surgical crew function with perfect and precise teamwork, but other departments down the line also interacted flawlessly.

“We always have teamwork, but this was something more. It was so urgent and she could have died at any moment. It was a whole list of unbelievable conditions,” says Joanne. “She’s one lucky lady.”

Nurse/First Assistant Suzann Gourieux, Richard Smith of Medtronic and Dr. Seph Naficy were part of the surgical team that saved Betty Wasserman’s life.

Betty remembers very little about that day, or recovering in NorthBay’s Intensive Care Unit, where she stayed for 19 days, before being transferred to a convalescent care facility for another 55 days. She knows that she’s lucky to be alive, and is grateful for the gifted doctors she’s met along the way, whom she calls jewels.

“I know a lot of people look outside Solano County for help, but I’m here to tell you we have amazing doctors right here. I couldn’t have lived through it anywhere else,” says Betty. “It was just a miracle.”

Dr. Naficy insists that credit be spread to the whole team, which covers both hospitals, a multitude of departments and even outside consultants.

And he has strong words of praise for Morry, who made all the right decisions when it mattered most.

During Betty’s long recovery, Morry was there, sleeping in the chair at her bedside for hours, holding her hand, stroking her hair, or chasing away family members if he decided she was too tired for a visit.

“I was her pit bull when I needed to be,” Morry admits gruffly. “Here I am, coming up on 92; it wasn’t easy. But I think we have an angel looking out for us. I call her the miracle kid.”

Betty beams at him, so pleased to be recovering at their Vacaville home, comfy in her own recliner.

“In 67 years, we’ve never uttered an obscenity to each other, never slammed our door in anger,” says Morry with pride. “And I played golf, so I do know all the bad words.”

“We’ve had a wonderful life,” says Betty, with a contented sigh. “I probably would have just thrown in the towel when this happened, but now that I’m breathing again, I think there must be a reason. There’s something I’m meant to do, and I’m going to figure it out.”

For Morry, just having her by his side is reason enough.

“I told her all those years ago I was going to take care of her, and that I’d always be there for her,” he says. “That’s what I’ve done, and what I’m going to keep doing.”

Answers About Aneurysms

  • An aneurysm occurs when the walls of a blood vessel balloon outward, creating weakness in the vessel wall.
  • An aneurysm can contain lipids, calcium clots, fatty deposits and cell debris.
  • The aneurysm itself is not the danger, it’s the weakness it creates in the vessel wall. If the vessel ruptures, blood can leak
  • Aneurysms are the 13th leading cause of death in the United States.
  • Only half of patients who suffer a ruptured aneurysm make it to the hospital for surgery. Of that number, only half survive the surgery.
  • It is not clear what causes aneurysms. Sometimes aneurysms are present at birth. In many cases, an aneurysm can exist for years without an individual knowing it’s there.
  • Treatment is based on the size and location of an aneurysm. Physicians often monitor the growth of an aneurysm, which can exist for years without causing the patient any discomfort.

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