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Ginger
Best FriendOctober 1, 2002
Submitted by Susan H.
In addition to asking for emotional support for the patient's family and for myself, I am telling this story to alert people as to how dangerous untreated sleep apnea is.
My name is Susan Hackett. I am Ginger Brewster's friend. I am posting this on her behalf so that her story can be told and so that she will be remembered. Also, I hope that by telling Ginger's story I can prevent what happened to her from happening to someone else because I feel that what happened to her could have been prevented if things would have been done differently both prior to her surgery and immediately after her surgery. Sadly, Ginger passed away on March 4, 2002 due to complications after she had weight loss surgery.
Ginger Lawrence Brewster, age 41, underwent Open RNY on February 13, 2002 at the recommendation of her primary care physician. She had struggled with weight most of her life and she was in constant pain due to her weight. The last couple years of her life her breathing was labored even when she was sitting down resting. During those last two years, she constantly felt drained and tired and had no energy. She continuously fell asleep during the day while at work and while she was driving. She rarely felt rested when she woke up in the morning. She would wake up at night sometimes gasping for breath with her heart pounding. She had to sleep sitting up in a recliner because she got to the point that she couldn't breathe lying down. Also, she frequently had terrible headaches when she woke up in the morning.
Ginger had untreated obstructive sleep apnea which had been diagnosed as "probable sleep apnea" at the time she had her pulmonary function test done prior to her surgery. However, she did not know that the condition was life threatening nor was she told that because of it her risks were higher than that of the the average patient seeking this surgery. Neither her surgeon nor the pulmonary doctor sent her for a sleep study test. Consequently, she was never placed on CPAP prior to surgery nor did she know that she needed to be on CPAP. Additionally, she was not scheduled to go to ICU after surgery, but to a regular room. Since Ginger carried most of her weight in her upper body she had a very thick neck with a narrow airway. Her intubation was extremely difficult due to this.
Although the RNY procedure itself went fine, Ginger began having breathing problems already during the surgery. After her surgery was complete, she spent over six hours in the recovery room trying to get her breathing stabilized and wound up having to be re-intubated during that time. After she was stable she was sent to a regular room with an oxygen mask, but not hooked up to any monitors or alarms. Early that evening when she fell asleep she went into respiratory arrest and Code Blue. The combination of the anesthesia and narcotic pain medicine (morphine) depressed her already impaired respiratory system (impaired because of her untreated sleep apnea) even more. It is not known how long she had been "out", but a nurse found her unresponsive. She was successfully revived with CPR. She again had to be re-intubated at this time. THEN she was put into ICU and on a ventilator. (If she had been put into ICU after the recovery room and closely monitored instead of the regular room she most likely would not have gone into respiratory arrest, or if she had, it would have been caught immediately.) Her diagnosis now became "Respiratory Failure". She had to be very heavily sedated in order for her to be able to keep the tube down her throat. They kept her sedated and on the ventilator for the next six days in a comatose state. Obviously, she was not able to get up and do the walking that is so important after surgery to prevent blood clots. On the sixth day after her surgery it was decided that a tracheotomy would be necessary since she was still not breathing adequately without assistance. Ginger was never told that she could be at risk for needing a tracheotomy. The tracheotomy was extremely difficult to perform due to the thickness of her neck and her narrow airway. (The tracheotomy most likely could have been avoided if Ginger had been sent for a sleep study and had been on CPAP prior to her surgery.) A day after the trach was in place they started to wake her up and give her less sedation. She began to slowly improve. She became alert. She was able to sit up in a chair and even walk very short distances. On the 18th day after her surgery they decided that she was well enough to be taken out of ICU and put into a regular room despite the fact that her unassisted breathing oxygen levels were still below normal. On the morning of the 19th day after surgery, March 4, 2002, she got up to go to the bathroom and complained of shortness of breath. She again went into respiratory arrest. This time she could not be revived despite all the CPR efforts being made by the hospital staff. The cause of her death was not known for certain until the autopsy revealed 11 blood clots in her lungs.
This surgery would have been so positive for Ginger. It would have dramatically improved the quality of her life. Instead it dramatically shortened her life! Ginger was one of the most generous and kindest people I had ever known. She was always there to lend a helping hand to anyone in need. When I think of Ginger I think of the active, healthy, pretty, vibrant woman that she could have become after having this surgery. It is so sad that this will never happen for her. In my opinion, the clues were there prior to her surgery that she was going to have respiratory complications. She had all the symptoms of severe sleep apnea. If only those clues had been acted on, if only she had been sent for a sleep study, been put on CPAP, been put in ICU immediately after surgery instead of being left alone in a regular room, she would most likely be alive today and be enjoying the wonderful benefits of her weight loss. I miss her so very much!! Comments to me or Ginger's family are welcome on my e-mail. Her family and I really need support because we are having a very difficult time dealing with her death. Thanks.