Nothing Short of a Miracle

UC Health Patient Makes Remarkable Recovery After Cardiac Arrest, Weeks-Long Seizures

By Alison Sampson

When Mary Cooper walked back into the UC Health Neuroscience Intensive Care Unit (NSICU) in April with a heaping plate of cookies to thank her care team, almost no one recognized her.

The petite blonde with a huge smile on her face didn’t get much of a reaction until the doctors, nurses and staff saw her husband, Mark, with her. Then they remembered him, a familiar face here through all of December, even on Christmas, who waited patiently for his wife Mary, unconscious and hooked up to tubes and machines, to wake up.

Mark with Mary Cooper, presenting cookies to Dr. Simona Ferioli ( at her patient reunion visit in April)

On Dec. 5, while walking through Fountain Square in downtown Cincinnati after lunch, the seemingly healthy 51-year-old experienced cardiac arrest and collapsed. Emergency crews rushed to her side and worked quickly to restart her heart; she was taken to the nearest hospital.

After a panicked call from a friend and a sheriff’s escort to Christ Hospital, Mark arrived to the emergency department bewildered. “I didn’t know what was going on; she looked comatose,” he remembers.

After two days, Mark says there was still no response from Mary. An EEG, a test of the brain’s electrical activity, was performed and he says, “The doctor immediately grabbed me and said, ‘Your wife needs to go to UC.’”

The doctor recognized that Mary was in status epilepticus, a state of constant seizure activity and a medical emergency, because of her cardiac arrest. She needed to be continuously monitored by EEG in order to stop the seizures, and in the region, University of Cincinnati Medical Center is the only hospital able to do this.

Time Will Tell

“When someone has a cardiac arrest, their heart stops, and blood supply to various body parts decreases, including the brain,” says David Ficker, MD, a UC Health neurologist with the UC Epilepsy Center, part of the UC Gardner Neuroscience Institute. “The lack of oxygen could lead the brain cells, called neurons, to fire abnormally, generating seizures which could leave the patient in a comatose state.”

In patients with brain injury, seizures don’t always cause shaking—something called nonconvulsive seizures—and patients can appear comatose, until continuous EEG monitoring shows the brain is firing away.

“In some cases, we can see that seizure activity is going on for hours or even days on EEG, and this abnormal electrical brain activity is often resistant to initial treatment. In Mary’s case, it took more than two weeks to get her seizure activity under control,” Ficker adds.

Brandon Foreman, MD, assistant professor of neurology at the University of Cincinnati College of Medicine and UC Health neurologist, was the physician who accepted Mary’s transfer from Christ Hospital.

“At UC, we know a lot about post-cardiac arrest seizures, so when we got the call and heard what was going on, we made room for her,” he says.

“If a patient is in a coma, it can be hard for a standard EEG to determine what is going on inside the brain; that is where the continuous monitoring becomes critical.”

Foreman says when Mary arrived, they started anesthetic medications to try to stop the seizure activity and improve neurologic recovery, and despite what most think is a marker of an inevitable bad outcome, the UC neurocritical care team told Mark to hold on to hope.

“We knew that time was also going to be critical to her recovery,” Foreman says.

 

Brandon Foreman,MD, Mark and Mary Cooper, Wendi Fox, RN, and Simona Ferioli, MD. (Left to Right)

 

Simona Ferioli, MD, an assistant professor of neurology at the University of Cincinnati College of Medicine and neurologist in the Neurocritical Care Program at UC Health, also began to think about Mary’s long road to recovery.

“The brain was without oxygen for some time due to the cardiac arrest—we don’t know how long for sure,” she says. “This condition, called post-cardiac arrest syndrome, can be very challenging to treat for intensive care doctors and neurologists.”

Ferioli says the UC neurocritical care team has a lot of experience treating cases like Mary’s, where neurons become dysfunctional but not irreparably damaged, and that it takes time before they are able to determine how much the brain will recover.

“In this case, we performed several tests, in addition to the EEG, that made us cautiously hopeful that she had a chance to recover,” she says.

A Long December

Mary spent 25 days hospitalized in the NSICU with family and friends sitting by her side, hoping for some response or reaction. She required a tracheostomy and a GI tube to assist her breathing and eating while comatose. Mark got really good at reading the EEGs after all that time.

“That’s exactly what I would look at as soon as I came in to see Mary,” he says, making big squiggles in the air with his fingers, “and I would get hopeful and every day I‘d see it.”

Mary stayed through Christmas until her seizures were under control, and she was moved to UC Health’s Daniel Drake Center for Post-Acute Care on Dec. 30 to begin rehabilitation. Finally, she started to wake up and make progress little by little, coming off the ventilator to breathe on her own and beginning to eat. She was quickly able to walk without assistance and was back at home by Feb. 2, 2018, nearly two months after her heart stopped.

As is typical with patients who have been in the NSICU, Mary has no memory of the whole ordeal: “I don’t remember anything from Thanksgiving (2017) to February 2 (2018)! That’s when I felt like I really woke up,” she says.

Ferioli credits Mark and Mary’s children, sisters and friends for their patience and devotion.

“It takes a lot of strength from the family,” she says. “Sometimes I feel like my job is not just the medical expertise but to get my patients and their loved ones to keep fighting. The brain may take time to heal after a cardiac arrest, so we need to give it the time.”

During those difficult December days, Mark started to see small signs of hope. “Like when I would tell her I loved her, she would cry—and she did it over and over,” he says.

“That was a really good, huge sign,” says Ferioli.

Foreman agrees and says that patients like Mary are lucky to have Ferioli. “Brain injury takes so long to heal that often people leave the hospital without regaining consciousness,” he says. “But at UC, we give people that chance, and Dr. Ferioli guides patients and families through that process past the ICU stay. There is no other resource in the region like her and our partners with Drake/HealthSouth.”

And Mark echoed those sentiments about Mary’s journey.

“All the people here—the nurses, everybody—were fantastic; they took good care of her,” he says. “I don’t know if you could do any better, honestly.”

The Coopers

Patience Yields Progress

Mary left UC Medical Center still on five medications to control her seizures. Ficker has been working with her to wean her off, checking in every three months, with the goal of being off seizure medication completely. So far, she is seizure free since her hospital stay and has come off of two seizure medications.

“Despite her having this life-changing event, she has done remarkably well,” says Ficker.

Mary says she is still working on building up her strength and stamina, which Foreman noted is quite common after an ICU stay.

Mary does daily brain games to improve her cognition and is taking yoga and pilates classes to increase her flexibility and strengthen muscles. “We are lucky to live very close to Devou Park, so I take walks in the park as often as possible. Hopefully, these steps will help alleviate some of the daily pain I’m experiencing,” she says. She has also taken up baking, which the NSICU team appreciated with her surprise delivery of cookies.

There are still some struggles with daily activities that come with any long recovery from a traumatic incident, but overall, Mark says her recovery “has been nothing short of a miracle.”

“Although every day is a challenge, I am blessed to have the support of my family and friends to pick me up and carry me through the rough days,” Mary says. “I am positive that things will continue to keep getting better, although I’m not sure where my road to recovery will lead me. I try to keep a positive attitude. I try to find the beautiful side to every day and everyone I encounter, and I never, ever take anything for granted.”

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