This article celebrates the 2018 recipients of the Society of Critical Care Medicine’s ICU Heroes Award.
Merriam-Webster’s Collegiate Dictionary defines hero as “one who shows great courage.” So, what is courage? Courage is a 4-year-old boy surviving 99 days in the pediatric intensive care unit (ICU). Courage is a 66-year-old man defying the odds and low survival rate of a rare lung condition to return to a healthy lifestyle. Jake LaRose and Ralph Gervasio are the 2017 recipients of the Society of Critical Care Medicine’s ICU Heroes Award. The two were recognized, along with their care teams, in February at the 47th Critical Care Congress in San Antonio, Texas, USA. Here are their stories.
In 2014 Jake LaRose was a happy and healthy 4-year-old boy. And then one day he wasn’t. In March, he came down with a stomachache that continued to worsen. A strain of Escherichia coli 0157:H7 led to hemolytic uremic syndrome—a combination of hemolytic anemia and renal failure—that quickly led to acute renal failure. He later developed peritonitis and a bowel perforation that led to severe septic shock and acute hypoxemic respiratory failure.
The team at Weill Cornell Medical College in New York City rushed LaRose into emergency surgery and discovered that his entire abdomen was filled with stool. What was supposed to be a multi-hour surgery ended up taking less than 45 minutes because the anesthesiologist did not think LaRose could survive the procedure. “They could barely keep him alive on the operating table,” said Kim LaRose, Jake’s mother.
That was one of three times LaRose almost died. The physicians left his abdomen open after the procedure, covered with what was, in effect, surgical-grade plastic wrap. This was the first of what would be a four-stage surgical repair that, besides the open abdomen, required an ostomy and mucous fistula.
A series of complications occurred during the next several weeks. His catheter dislodged. He had a seizure. He had delirium with active hallucinations. Each time, though, LaRose fought. He survived. The courage to withstand such ordeals says something about LaRose, but it also says something about the medical team at Weill Cornell. Chani S. Traube, MD, led a team of intensivists, subspecialists, nurses, and therapists, who surrounded LaRose with support and epitomized multiprofessional care.
In their care of LaRose, “Team Jake” never lost sight of the fact that they were dealing with a 4-year-old child. Nurses recommended that physician visits be clustered to help provide more time for uninterrupted sleep. Staff members partnered to pull LaRose and his younger sister around the hospital halls in a red wagon. They made sure he was surrounded by toys and games. It was a full team effort. “It was a spectacular example of cooperation between family and staff,” Dr. Traube said. “We pride ourselves on [offering] family-centered care. Jake’s story is a prime example of how this can be best operationalized. From day one to his day of discharge, and even continuing forward, it epitomized the best way to make the care family focused.”
According to his mother, today LaRose is an average 7-year-old boy. He plays the guitar—Jimi Hendrix and Metallica in particular. He plays baseball and basketball. He takes American Ninja Warrior classes, climbs rock walls, and does gymnastics.
Remnants of his hospital stay linger. Post-intensive care syndrome affected him for several years, Kim LaRose said His physicians found that his mental processing speed is significantly lower than his other intellectual abilities. He was also diagnosed with attention-deficit/hyperactivity disorder, which might be related to his experience in the ICU.
He takes medication for hypertension, bladder dysfunction, and ulcers. He continues to see a nephrologist, urologist, neurologist, endocrinologist, and gastroenterologist. But he doesn’t let any of that get in his way. In his eyes, he’s just a normal kid.
And that’s exactly how Team Jake wants him to feel. “I look at him and I see this funny, curious, silly, smart little boy,” Dr. Traube said. “He’s not wearing his sorrows on his sleeve. He’s a happy boy going through his life, which is exactly what our goal is as pediatric intensivists—not just get the kids through the illness, but have them thrive afterward.”
In 2017 Ralph Gervasio was a relatively healthy 66-year-old man who prided himself on completing three or four strenuous workouts per week. One January day, he started to feel more fatigued and, over the course of the next three weeks, became short of breath on a regular basis.
Gervasio was told he had pneumonia, but medications were not helping. On February 17, he drove himself to the Tennessee Valley Healthcare System VA Medical Center. He parked about 75 yards from the entrance but had to stop to catch his breath three times while walking from his car to the building. That is when it became clear something was wrong. Soon after he was admitted, he was intubated for a bronchoscopy and extubated less than 24 hours later. But he became critically ill. He developed steroid-responsive unspecified idiopathic interstitial pneumonia complicated by hypoxemic respiratory failure. The VA medical team never figured out what caused his illness.
Gervasio needed to be reintubated, and he remained mechanically ventilated for 14 days. The reintubation terrified him—but it also motivated him. He knew he could either give in and pity himself—or he could fight the illness. He chose to fight. “I had been intubated, restrained,couldn’t eat, couldn’t stand by myself,” Gervasio said. “It was terribly difficult, and it could have been disheartening, but I’m not that kind of person.”
The kind of person he is likes to move. He couldn’t lay around for 14 days. He began to walk around the halls of the medical center by leaning on a cart, his ventilator on top of the cart and a collection
of six or so team members behind him. He spent 15 days in the ICU and an additional week in the hospital. The recovery process was grueling and is one that Gervasio said is still ongoing. In order to fully recover, he wanted to give back. He wanted to help other veterans and their families who were going through similar ordeals. He wanted to be a model of what could be.
Gervasio attends the Nashville VA Hospital ICU Recovery Group almost weekly to help support ICU survivors and their families. “He was not content with getting better and doing nothing,” said Chris Hill, Tennessee Valley’s chaplain. “He wanted to give back to this community.”
Gervasio struggles with being called a hero. “My job was easy,” Gervasio said with a laugh. “I either had to lay in bed or walk. The other people worked hard for me.” The other people—the physicians, residents, therapists, social workers, and chaplains who made up his care team—are the heroes in Gervasio’s eyes.
“This is a life-and-death situation with these people every single day, but you would never know it by their demeanor,” he said. “That’s the quintessential sign of a pure professional.”