Celebrating Success: "Behind The Curtain" Wins Next Generation Indie Book Award!

I am thrilled to share some exciting news with all of you! "Behind The Curtain: Remarkable Stories of What Really Happens in Medicine" has just been awarded the prestigious Next Generation Indie Book Award (NGIBA)!

A big congratulations to Ashley Hannani for the well-deserved recognition. I couldn't be more excited to have my own story included in this remarkable book. It's an honor to have our voices heard and to shed light on the extraordinary experiences within the medical field.

The NGIBA award has granted "Behind The Curtain" a lovely gold seal that will make the story stand out even more. This recognition will undoubtedly encourage readers to delve into its pages, knowing that they will be rewarded with captivating and thought-provoking stories. It is a testament to the impact and resonance that these narratives possess, touching the hearts of those who have had the opportunity to experience them.

The story of Kristen's remarkable journey stands as a testament to the strength of the human spirit and the unwavering dedication of healthcare professionals. In the face of immense challenges, the power of faith, love, and resilience triumphed over the darkness of COVID-19. Kristen's story is a beacon of hope, reminding us that even in the most challenging times, miracles can unfold.

Find the story below…

A Miracle in New Orleans

By Donte Flanagan

Trumpets blared, beads rained down, and laughter flooded the streets as parades rolled through

the French Quarter for Mardi Gras. The Disney Wonder cruise ship had recently departed and

was gliding across the gulf. The mayor and other city officials stood shoulder to shoulder to

celebrate its launch with enormous fanfare, striking poses for photos. Cheers filled the air. Six

weeks of sold-out excursions, coupled with the annual parades and revelry, meant countless

people and parties and incredible jubilation. It was going to be an unforgettable spring.

Little did we know just how unforgettable it would be, or why. It was before the Grand

Princess cruise ship docked in Oakland, California, with over three thousand quarantined

passengers; before the Trump administration decided to suspend travel to the U.S. from many

European countries; and before the outcry over ventilator and PPE shortages began.

COVID-19 was cropping up in the news, but it was something relegated to Europe and

Asia. We in the U.S. had been assured by President Trump that it would not cross our borders. In

late February, patients began pouring into our hospital with unexplainable pneumonia and

elevated temperatures. Their decline was rapid. They had no known risk factors, diseases, or

injuries that could account for the struggling organs, respiratory failure, and circulatory collapse.

By the second week of March, everything had changed. New Orleans found itself in the

midst of the pandemic. The city was grappling with a disaster unlike anything current health care

professionals had experienced.

A heaviness settled over our hospital. The halls grew eerily quiet as our usual

appointments and activities dwindled. Departments began to close one after another, the once

busy spaces devoid of staff. It was like walking through a haunted house. Every person and every

resource had been diverted to the chaotic emergency room. Testing and treating COVID-19 was

the priority, and triage was the only possible approach. With alarms beeping, monitors flashing,

and scrubs rushing from patient to patient, the emergency room overflowed with respiratory and

cardiovascular crises. Every day, the number of confirmed COVID cases shot up, and then the

shortages began. Ventilators, staff, PPE—everything. The fear was palpable.

This was the atmosphere Kristen encountered when she was admitted to our hospital. She

was thirty-two weeks pregnant and had flu-like symptoms. “Am I going to be okay?” she asked,

panting. “How dangerous is the spinal or the epidural? Why can’t my husband stay with me?” I

answered what questions I could, but this was unknown territory for both of us.

Kristen had always been healthy, with no prior medical issues. But the rattle in her lungs

and her shortness of breath were telling. Every word was a struggle, every breath labored.

Despite it all, she remained friendly and appreciative to the staff. But what I remember most

about Kristen is the love, dedication, and compassion that she and her husband showed one

another. They were unwilling to separate despite the risk, still hugging and kissing in the midst

of the horror. We all hoped it was just the flu, and our instincts told us that if it was, she would

recover swiftly and easily.

But it wasn’t just the flu.

My heart dropped when her COVID-19 test came back positive. The situation was new

and uncertain, leaving us with difficult decisions to make. Should we use a non-rebreather face

mask to deliver a higher concentration of oxygen, even if it puts our staff at risk of exposure? Or

should we intubate her and risk the long-term effects of ventilator dependence? What if she never

gets off the ventilator? What if she never holds her baby? Making such decisions was both what I

was trained for and what I feared. But the quote “If not you, then who?” echoed in my mind,

reminding me of my responsibility.

After three days of treatment, Kristen’s fever remained, and I didn’t need a stethoscope to

hear her wheezing. Every moment, she was losing ground to COVID-19. We placed her in a

makeshift negative-pressure isolation room and donned full PPE to treat her: N95 masks,

surgical masks, face shields, goggles, waterproof gowns, and gloves. We reused the N95s due to

lack of supplies.

We wanted to keep Kristen stable and prolong her pregnancy another week or two if

possible, but the virus had other plans. On the fourth day, Kristen went into premature labor, and

we knew we needed to perform an emergency C-section. We calmly broke the news to her. As

lead anesthesiologist, I explained my role and assured her I would work to minimize stress on

her respiratory system despite the complications COVID-19 may cause during surgery. I told her

that we might have to intubate her but would only do so if absolutely necessary.

None of us could be certain of the outcome, but Kristen’s unwavering faith was a beacon

of hope. With a smile and a nod, she said, “I trust you guys. It’s in God’s hands. He’s with us!”

We knew our protocols had to change, so we got to work and began improvising. Our

entire team came together and agreed on a plan of care to ensure the safety of Kristen, her baby,

and our staff. We cleared all unnecessary materials from one of our labor and delivery operating

rooms and designated it the “COVID-19 operating room.” Then we created a handoff team to

limit contamination during transport. After delivery, Kristen would be transferred to a designated

COVID-19 unit and her baby would be taken straight to the NICU, where she would be isolated

from all the other newborns. There were no case studies on babies born to mothers with COVID-

19, after all. We had to be safe.

After a flurry of decisions, the time had come. “Kristen, here we go,” I said as we

prepped her for the C-section and administered a spinal anesthetic. “COVID might be new, but

I’ve done this procedure a thousand times. I promise I’ll be by your side every step of the way.”

I spoke to calm Kristen’s nerves, but also to reassure myself. I needed to remember that this was

just another routine C-section, despite the pandemic.

Together, we ventured into the unknown. The OBGYN performed an uneventful C-

section, and I provided anesthesia to a COVID-19 patient during surgery—a first in the history of

our New Orleans hospital.

Kristen was ecstatic when we presented her baby to her over the drapes. But due to the

uncertainties of the virus, she could only see her child, not hold her. As we’d explained prior to

surgery, we had to test the baby for COVID-19 first. Though Kristen could hear her baby’s

cries—a sign of a successful delivery—as a concerned new mother, all she wanted was to hold

her. Unfortunately, that moment was much further away than any of us could have anticipated.

Following her surgery, Kristen’s condition rapidly declined, leaving her unable to

breathe. After a rapid-fire consultation between anesthesia, internal medicine, and obstetrics, my

team and I intervened with an emergency intubation. Her deterioration had been too quick for

any other option.

Our limited experience had shown us that once a COVID-19 patient was intubated, their

odds of survival were extremely low. At that time, we had only seen three patients survive a

ventilator. Still, it was Kristen’s best chance for recovery, so we had to take it.

I cared for Kristen day after day in the ICU, visiting her every two hours on my rounds. I

managed her ventilator, and I helped lay her prone each night and supine each morning. Things

were not improving. Kristen began experiencing various heart arrhythmias, and her tongue was

enlarged. Every day, we added a new drug. Every day, we tried a new treatment. Every day, her

chance of survival shrank. But I held on to hope.

We remained vigilant as the weeks passed. While caring for Kristen, we were also caring

for countless other patients. We had become accustomed to seeing them die on ventilators. But

finally, after four weeks of intensive care, Kristen reached a turning point. Her blood pressure

improved, her oxygen saturation stabilized, and we decreased her sedation at last. Her eyes

opened and tracked us across the room. We began to feel optimistic. Perhaps a miracle was

underway. After four days without sedation, Kristen could blink and nod to communicate with

staff. However, we didn’t know if she was strong enough to maintain her own airway. We feared

that her swollen tongue would obstruct her breathing, so we decided to perform a tracheotomy.

Following weeks of gut-wrenching ups and downs, it felt monumental to finally extubate

Kristen. She had fought, we had fought, and a seemingly impossible turnaround had occurred.

No critical COVID-19 patient at our hospital had survived for this long.

She remained in her ICU room for another week. But after nearly two months in bed, her

arm and leg muscles were atrophied, her grip was weak, and she was barely able to move to a

chair. Her next stop was rehab, which would be pivotal for her recovery. Over the next two

weeks, Kristen relearned speech, one syllable, one breath, and one word at a time. She learned to

utilize her right side to compensate for the weakness she had developed on her left. By week ten,

Kristen was strong enough to walk a few feet without getting winded. It all seemed impossible.

But the greatest miracle was still to come.

It was a sunny morning, cold and crisp. The second line band was all set up, and the news

station was on-site. Kristen’s family waited under a banner of balloons by the hospital entrance,

and a red carpet stretched from the doors to a waiting car. Our entire staff was gathered outside.

Cameras flashed. The masked crowd cheered. And, after two and a half months, Kristen stepped

into the fresh air, finally holding her baby.

This was a celebration like no other, a light in a year full of darkness. I will always

cherish the memory of taking part of a miracle.

Written by Donte A. Flanagan, DNP, CRNA, FAANA

Nurse Anesthetist