On September 8, 2019, West Michigan Air Care (WMAC) received a flight request originating from Ascension Borgess Health (ABH) in Kalamazoo for a patient transport to Spectrum Health Butterworth in Grand Rapids. Upon arrival in the Cardiac Intensive Care Unit (CICU) the duty crew, consisting of Communication Specialist, Craig Nixon, Flight Nurses Sara Sturgeon and Darby Brauning, and Pilot Brian Vanderberg, made contact with the sending facility staff. As the medical crew was obtaining report from Dr. Richard Lovy on 56 year old Ken Fouts, an immediate personal connection was made between two of Ken’s family members, who were among several people gathered outside of the room, and Brian. Ken’s sister in law, Joan (his wife, Jan’s, sister) and her husband John, greeted Brian after recognizing him as their former neighbor.
Mr. Fouts initial complaint, that began the cascade of necessitating critical care air medical transport, was shortness of breath that he noticed on September 6th. Ken had always been healthy and active as a runner and avid cyclist. His previous medical history included viral pericarditis, cardiomyopathy, and hypertension. Despite his bout with pericarditis, Ken enjoyed being active and was out for an anticipated three mile run on September 7th when he realized his difficulty in breathing had become more debilitating. After resting once he’d arrived home Ken realized his symptoms were not improving and he took himself to a local urgent care.
Upon arrival at the urgent care, Ken was given steroids and a nebulizer treatment, and sent to ABH Emergency Department (ED) where he was admitted after he was found to be hypoxic and required supplemental oxygen. A chest computed tomography angiography (CTA) was completed. This test was performed as a way to rule out a pulmonary embolism (PE), which was confirmed as negative for a PE, but he was diagnosed with right upper and lower lobe loculated pleural effusions and multi-lobular pneumonia. Ken was placed on bi-level positive airway pressure (BiPap) at that time which aided in maintaining his oxygen saturations in the mid 90% range. He was admitted to the CICU where treatments included antibiotic therapy, removal of over 100 ml of fluid via thoracentesis, and chest tube placement in interventional radiology under fluoroscopy. During this procedure, tissue plasminogen activator (tPA) was instilled to attempt to deloculate the area. After the procedure, Ken’s respiratory status continued to deteriorate to the point of requiring endotracheal intubation. The goal was to improve his oxygenation and ventilation status, and take away the work of breathing that was taxing Ken’s heart and lungs.
When WMAC arrived at ABH and took over Ken’s care, he was sedated and chemically paralyzed while on the ventilator with 100% fractured of inspired oxygen (Fi02) and pulse ox readings of 84-86%. After some adjustment to Ken’s ventilator settings including increasing his positive end-expiratory pressure (PEEP), and a change in position to maximize lung aeration, Ken’s oxygen levels were again up to the mid 90’s. His lung sounds were coarse throughout all lung fields. His chest tube that was attached to a chest tube drainage system was maintained on water seal during the transport. Pain and sedation medications were continued, along with ventilator support, and the transport was completed to Spectrum.
Shortly after arrival to Spectrum, Ken was placed on extracorporeal membrane oxygenation (ECMO) therapy as a bridge to support his oxygenation needs during his treatment. It was determined during this time that Ken had a ruptured mitral valve and he underwent surgery to repair his condition. Ken does not remember anything until he “woke up in ICU a couple weeks after surgery” on September 23rd. After surgery, he was weaned off the ventilator recalling that is was “not a fun experience”. Ken shared that he didn’t know where he was and waking up every day, he thought he was in a different place which was “the most bizarre thing”, as he also tried to remember all that had happened to him.
Ken had to go through the whole process of learning how to eat and walk again and said, “The first steps I took were with a walker on the cardiac floor and took 10 steps. It was furthest I had walked but was hard for me with my background”. Ken was quite a conditioned athlete and states he was mostly running and walking just prior to this illness, but in the height of his physical fitness in 2004, he had been an Ironman triathlete, and his training regimen included swimming 10 miles a week, biking 200-250 miles a week, and running 50 miles a week. He continued to maintain a high level of fitness and also enjoyed backpacking and for him, “completing an 18-mile hike with a 30 pound pack on my back was no big deal”. All of these things Ken now believes served him well as his condition unfolded. Ken was eventually transferred from the ICU to the cardiac floor for a week until he was discharged to Mary Free Bed (MFB) to begin rehabilitation, crediting his Cardiothoracic Surgeon, Marzia Leacche, MD and the excellent care he received from the cardiac team as a whole during his time at Spectrum.
The staff at MFB were also instrumental as they guided him through his occupational, physical and speech regimen. Ken said the “first two weeks were very tough” but he went from being “barely able to walk to being 100% independent in my room the last week I was there.” Ken stayed at MFB for three weeks and was discharged home on November 13th.
Once back in the Kalamazoo area, Ken continued cardiac rehab three days per week initially at Bronson Athletic Center with a primary focus on biking and treadmill that was enjoyable for him.
Mentally and emotionally, Ken said overall he was, “Pretty good when I was in hospital because I was really motivated to get better. I wanted to get back to what I knew. The challenge was really when I first got home – because I was still very weak”. Ken’s overall muscle strength had been impacted as well as a weight loss of over 40 pounds (to date he has gained back nearly 30 pounds that were lost). “I am a pretty busy, active person and I couldn’t do stuff. I have everything I need to work out at home but it was a huge effort to just get down the stairs to the treadmill, and only being able to walk 5-10 min at 1.5 mph was a challenge, and then to get back up the stairs. I just didn’t have strength or endurance, which caused a lot frustration.”
Ken’s daughter was in graduate school at the time for rehabilitation counseling that provided him with some much needed help, “It was hard and I was happy to have her there in retrospect, because she got me off the edge a few times. She slowed me down and said ‘one step at a time, dad’”.
Ken’s routine now includes walking five days per week, cycling 2-3 days per week, and lifting three days a week. After four months off work, Ken went back full time to his position as a commercial banker after the first of the year in 2020. His company was very flexible and accommodating working with his needs as he transitioned back, even allowing co-workers to donate their sick time while he was off on disability. Despite the onset of COVID only months after Ken returned to work, he was able to continue working in the office two days a week and from home the other days.
After the transport, John expressed to Brian the family’s gratitude for the care and safe transport WMAC provided to Ken that day, and offered occasional updates on Ken and his progress. Several months into his recovery, Ken himself reached out to Brian with the message “Thanks for the ride!”. It was at that time they realized they had a lot of mutual acquaintances through the local cycling circuit, in which Brian is also very active. A reunion with the crew that was involved in Ken’s care (not pictured is Air Communication Specialist, Craig Nixon), and a tour of the hangar and helicopter was arranged in July 2020. Ken has had an interest in aviation from a young age and despite some personal experiences, he has never pursued it much beyond that, which made a visit to WMAC intriguing.
In spite of the unorthodox way they crossed paths, Ken and Brian share a passion for the outdoors, and recently were able to enjoy time together on a two hour hike at Al Sabo Land Preserve in October. Other than some residual neuropathy in his toes and feet as a result of his prolonged illness that gives him some balance issues from time to time, and is anticipated to continue to improve, Ken has made a remarkable recovery. We are grateful for the opportunity to reconnect with him, and wish him well!
By Sara Sturgeon, Flight Nurse, West Michigan Air Care