Tuesday, August 23, 2011

Life's No Beach After Paralyzing Accident

EDITOR'S NOTE: This is the second in a three-part series about Good Samaritan Medical Center emergency room Dr. Gary Witman, who last August was paralyzed by a wave during a day at the beach in Rhode Island.
Click here to read the first article...
To follow Dr. Witman's personal blog, "The Life & Spines of Dr. Gary Witman," click here...
By Lisa E. Crowley
BROCKTON—On Aug. 31, 2010, Good Samaritan Medical Center emergency room Dr. Gary Witman and his wife Dianne, better known as Dee Dee, visited some friends at a private section of Narragansett Beach in Rhode Island for his once-per-year visit to the ocean.
“Gary doesn’t like the beach. I love skiing. You don’t know how many accidents we’ve had (skiing),” Dee Dee said. “There’s so much irony in all of this,” she said.
Gary doesn’t particularly care for the beach and only goes once a year. Dee Dee loves the ocean and her friends had a cabana on a private section of Narragansett Beach that the Witmans once visited regularly until the town banned those not living in town from the privilege about 6 or 7 years ago.
The Witmans hadn’t been back to Narragansett Beach since the Town of Narragansett excluded non-residents from the section with cabanas.
Gary agreed to what was expected to be a fun Tuesday visiting with beloved friends from Pittsburgh, gabbing about family triumphs and disappointments, and splashing around in the beach’s waves that children and adults alike grab bogey boards and surf boards to ride the surges to shore.
It never crossed their minds one rogue wave, a day at the beach, would turn their lives upside down.
“Never, never, never take anything for granted,” Dee Dee said.
In many ways the Witmans were living the good life, an upper middle class, bordering on wealthy, American dream.
Gary, a much respected emergency room doctor at Good Samaritan Medical Center in Brockton since 1997, worked as a resident at Brown University, and put people back together as an overnight shift emergency room intern--when he met Dee Dee also a working student. Witman worked the overnight shift at Good Samaritan until his accident.
His salary and private investments, and Dee Dee’s position as a political consultant afforded the family a beautiful home in Providence, the opportunity to send all three of their adult children, Samantha, 32, Zachary, 29, and Amanda Rose, 26, to college, and watch them build families of their own.
The couple enjoyed traveling and dinner parties and Dee Dee’s involvement as a volunteer in Rhode Island made the pair—both down-to-earth and funny-- an admired and well-liked two-some.
While there are still parties and the Witmans still travel—some for therapies and some for family events like oldest daughter Samantha’s wedding in Los Angeles—it is all much different, much more difficult, and much, much slower.
“It was such a freak accident, but we are living with it, we’re adjusting,” Dee Dee said after a recent physical therapy session at Braintree Rehabilitation Hospital, where Gary visits two or three times a week and travels 60-90 minutes from their home in Providence to Braintree or Boston University Medical Center for therapy unavailable in their home state.
“One day at a time,” Dee Dee said.
A year later, as Gary fights to regain some of his old life, now without the use of his arms and legs and confined to a wheelchair, and Dee Dee attends him 24-7 helping him eat, drink, bathe, change clothes, and nearly every other daily activity the vibrant couple once so easily enjoyed—they wonder why it all happened and have been spooked by some ironies and coincidences.
“It was a quiet day. The waves were quiet. They weren’t surging,” Dee Dee said, unusual for a beach with an ever-present instructor who offers surf lessons by the half-hour and hour.
Gary remembers the moment the wave crashed into him and sent him sprawling wildly. When the wave hit, Gary was bent over as he stooped to pick up Dee Dee’s hat that had accidentally fallen into the water.
The wave hit his upper body and he immediately knew he was paralyzed after hearing a “pop.”
Due to numerous reasons we posted yesterday Dr. Witman slammed his head on hard-packed sand. That did not happen--to the astonishment of family, friends and every medical person who has treated Witman--an added irony to the tragedy.
The injury was caused by the power and surge of the wave.
Unable to move or yell for help, Witman said he knew he was paralyzed and, while not a religious man—it’s never too late to learn he said--prayed someone would notice he was floating face down in the water quickly drowning.
“The lifeguards did nothing. They just sat on their butts,” Gary said. “It was Dee Dee and other doctors from California who happened to be there who saved me. The lifeguards just sat there on their chairs and none of them came to my rescue,” he said.
Before help arrived Gary nearly drowned in about 3 feet of water, about 50 feet from shore—no sharks, no power boats, he wasn't miles out to see in a 100-year storm. There was no apparent danger, except that Witman was paralyzed, face-down in the water helpless to help himself.
Dee Dee, who had been knocked over and washed up on shore by the same wave, turned around and looked for her husband of 36 years after recovering from her own spill.
She saw Gary face down in the water. She began to yell for help and raced toward Witman.
Other beachgoers also began to run to help the face-down floating doctor.
“Thirty-seconds of my life seemed like forever,” Witman said.
Torrents of thoughts ran through his mind as he waited for help. He envisioned himself like a rubber duck floating in a bath tub. He prayed for help. He had a darkly cheerful thought his life insurance policy would be ample for his family if he died. He didn’t want to die. He wanted to live, he thought as salty water filled both his lungs.
He passed out before rescuers reached him and he remembers nothing about being dragged to shore.
Dee Dee and the other beachgoers turned over Witman, allowing the water to clear and opening air ways to his seawater-filled lungs. Dee Dee and four others dragged Gary's motionless body to shore.
Still showing the sense of humor that has won them many friends, Witman said he and Dee Dee still joke about the tell-tale sign, that indeed, he had been paralyzed.
“What was most impressive to my wife was my presentation of priapism,” Witman said, using the medical word for an erection.
Dee Dee called 911. Fifteen minutes later a rescue team from Narragansett arrived at the beach. Witman was immobilized, placed on a board with his neck in a collar and was to be raced by ambulance to Rhode Island Hospital--a Level I trauma center 30 minutes away.
While in the ambulance and having regained consciousness, Gary said—along with asking Dee Dee to tell ER Chief Rick Herman he wouldn’t be able to work that night--he made the first demand of a long list of demands—often lifesaving--based on his medical knowledge.
Witman said he couldn’t breathe and knew he was having respiratory distress—a life-threatening condition-- and did not feel he could survive the 30 minutes to Rhode Island Hospital.
Upon his request, Witman was taken to South County Hospital, the closest hospital of any kind to the beach. Witman requested the attending emergency room physician perform an urgent intubation—the insertion of a tube down the throat to open air passages.
The procedure saved his life, but he lost his voice for about eight months because the tube harmed his right vocal cord.
It was the first in many gaffes by doctors and others that has left Witman with a less than exemplary opinion of some medical personnel and procedures, and a gloomy vision of what life is really like for a patient when it comes to medical care and paying for that medical care.
Within 24 hours he was stabilized at South County and Gary was eventually transferred to Rhode Island Hospital where he suffered more complications—including a barely-won bout with highly dangerous pneumonia that developed in both lungs from the ocean water that filled his lungs while he was floating upside down and helpless.
In his weakened and traumatic state the pneumonia could have, and almost did, kill him.
At Rhode Island Hospital, Dee Dee and son Zachary were told it was likely Gary would never be removed from a ventilator.
After three weeks in the ICU unit where he barely beat the pneumonia, lived on a feeding tube, had no bowel movement for nine days and his testicles grew to the size of tennis balls, Witman wanted out.
“Get me to Boston,” Gary told his family and friends, and they requested he be transferred to Boston’s Brigham and Women’s Hospital.
Transferring was not an easy process.
A medical helicopter was available, but he had to wait 18 hours before a pilot could be found to fly him to Boston.
Once in Boston, Witman said he has no memory of the first three days at Brigham and Women’s where he spent 21 days in the Surgical Intensive Care Unit.
While at Brigham and Women’s the worst thing that happened—besides some visitors having their belongings stolen--was he caught a fever of 104.6 degrees—a volatile situation that could have killed him.
A cooling blanket could have helped, Witman said, but the resident who was working had no experience using one and only provided Tylenol which did little to bring the fever down.
“My son spent the entire night putting ice on my head,” Witman said.
There had to be a reason for the fever, Witman said, and it began to dawn on him the cause of the fever was an allergic reaction to an antibiotic he was prescribed to control infections.
Outside help was needed. Witman’s son Zachary worked the telephone lines until they could reach Good Samaritan’s Dr. Dan McQuillen, an infectious disease specialist and Dr. Derrick Crook, chairman of the Infectious Disease Department at John Radcliffe Hospital in Oxford, England.
As fever poured from Gary, Zachary iced his father’s head and the telephone lines buzzed in the darkness of the wee early morning hours between England, Boston and Brockton, and the group came to the conclusion Witman’s fever was triggered by the antibiotic.
The trio insisted it be cut-off and another administered in its place. The change was made, Gary’s fever broke, and with the fever’s departure went most of the life-threatening medical situations he faced during the two months after the injury.
Gary continued to recover and medical discussions shifted from fighting for survival to rehabilitation and physical and occupational therapies.
The next phase would perhaps be the worst: barring a medical miracle, the family would have to prepare mentally and physically for Gary’s life in a wheelchair, the household needed to be reorganized, work schedules juggled, and the war with health insurance representatives would be waged.
“When I was an emergency room doctor I never thought about the financial consequences of saving a patient—how much it might cost them later,” Gary said. “We’re learning,” he said.

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