Scott Marshall: Family Matters
A human voice is like a fingerprint; no two are exactly alike. Voices are so distinct that we can immediately identify others by voice alone. Medical professionals who care for unconscious patients have long believed that these patients can hear sounds in the room, and so they often talk to them while providing care, and encourage families to do the same. Recent research tells us that hearing a familiar voice can actually help a comatose patient awaken and even lead to a faster recovery.
When Scott Marshall, 68, was in the Intensive Care Unit (ICU) at St. Clair, fighting for his life as sepsis, a life-threatening complication of an infection, ravaged his body, he was incapable of responding to his environment. Critically ill, sedated, and in shock, he had no perception of his situation. But as his condition began to stabilize and improve, he became vaguely aware. He had no idea of where he was or what had happened to him; at times he wondered if he was dead or alive. In that state, Scott longed for one thing: to hear the voice of his beloved wife, Pam. “I needed to hear Pam’s voice,” he recalls. “I knew that if I heard her, I was alive, and if she was here, then I was going to be okay. All I wanted was to hear her voice.”
The illness that nearly took Scott’s life had a mild beginning. A former sales executive, Scott lives in Baldwin Township with Pam, a retired registered nurse, and enjoys the simple daily routines of life in retirement: rising early, making coffee, watching the news and catching up with the lives of their three children and four grandchildren.
“I wasn’t very sick,” Scott recalls about the day his life changed. “Pam, who was still working when this incident occurred, was at St. Clair and I was home. It was a normal morning. But in the afternoon, I suddenly felt very tired. I wanted to take a nap which is unusual. Things went downhill quickly — I became dizzy and weak, like I was going to pass out, and I began having trouble speaking. I thought I was having a stroke. I called Pam at work and she called 911. The paramedics found me on the floor of the garage. I have no memory of anything after that.”
Pam’s memories, however, are clear and strong. “Scott never calls me at work. I happened to see the caller ID, and I answered because it was him. All I could hear was him struggling to breathe and trying to say, ‘Help me.’ I knew something was terribly wrong. I left work and when I got home, the ambulance was there and I could see that Scott was very sick. That morning, when I left for work, he seemed fine; he waved goodbye to me. He didn’t say anything about feeling sick.”
Upon arrival at St. Clair’s Emergency Room (ER), Scott was in shock and respiratory failure. Chest x-rays and bloodwork indicated he had pneumonia. The ER physicians, including ER Medical Director Jason M. Biggs, M.D., intubated Scott, placing a breathing tube into his airway and giving him extra oxygen. Suspecting that Scott had developed sepsis, Dr. Biggs summoned Gregory J. Fino, M.D., a pulmonologist and Critical Care Intensivist who is Chief of Critical Care Medicine at St. Clair, to the ER.
“Scott was a very sick man, in critical condition. He had overwhelming pneumonia due to pneumococcus,” Dr. Fino says. “This led to Acute Respiratory Distress Syndrome (ARDS), shock and multiple organ failure; in addition to severe respiratory failure, he went into kidney failure and moderate liver failure. He was hyponatremic, meaning his blood sodium levels were abnormally low. The chance of surviving such bad pneumonia depends on the early initiation of treatment: antibiotics, ventilation, oxygen and fluids. Scott was given antibiotics within three hours, which is what we aim for. Scott’s illness evolved quickly and was atypical, as he had only had slight shortness of breath the day before. Most people with pneumonia will have more symptoms and will have them for a few days.”
The ER experience was emotional and frightening for Pam, but she found enormous comfort in the care and support of the staff. “I’m a nurse and I had worked at St. Clair for years; it’s my professional home. I know some of the ER staff. Their competence and behavior calmed me. Even though I understood the meaning of the bloodwork, I was there as a wife, not a colleague, and I wanted them to explain to me what was happening. They understood that. Dr. Fino came to the ER and spoke to me frankly. He said that Scott was very, very sick; the bloodwork revealed that he had sepsis. He said they would do everything possible, but he wasn’t sure Scott would survive. I appreciated his honesty.”
“All of the staff in the ER made me feel confident that Scott was in good hands; they were the utmost professionals. I believed that if Scott had a chance to live, these people were going to give it to him.”
In the ICU, Scott was a challenging patient for Dr. Fino, his Critical Care Medicine colleagues Maxim Bocharov, M.D. and Kevin Kane, M.D., and Infectious Disease specialists Jeffrey S. Burket, M.D., and Amanda Michael, D.O. With the critical care team in constant attendance, they gave him fluids and medications to raise his blood pressure and maintain circulation. They tweaked the ventilator settings and obtained frequent blood gases to monitor the effects. They continued to administer antibiotics, and they kept Scott sedated in order to facilitate management of the ventilator.
“For the first few days Scott was very unstable,” Dr. Fino recalls. “We gave him nutrition through a nasogastric feeding tube and we provided vigorous physical therapy. PT in the ICU is important and improves survival: caring for a patient like Scott in the ICU is not only about treating the symptoms and the condition but also preventing complications of treatment. We had many talks with his wife; we had to let her know how bad this was. The patient is the one in the ICU, but the family is also experiencing the trauma. We support the family, too.”
The Marshall children — daughters Erin and Christine, and son Scott — came to the Hospital every day, as did Scott and Pam’s niece Kelly Kyle, R.N., who lives with them and works on St. Clair’s Unit 6E. The children brought their Dad’s favorite Frank Sinatra tapes to play for him. The children were included when Dr. Fino and his colleagues met with Pam. “The ICU staff took time and shared details about the ventilator,” Pam says. “They gave us tremendous emotional support.”
Scott spent a total of 24 days in the ICU, 14 of them on a ventilator. “Scott was cared for by our entire team,” Dr. Fino says. “He was in the ICU the entire time; he never went to the stepdown unit. He developed what we call ICU myopathy — muscle mass loss due to illness and inactivity — and was too weak to even swallow. After discharge, we transferred him to a high-level rehab facility because he needed ongoing PT and had the potential for long term pulmonary problems.”
When Scott finally woke up, he was in the rehab facility, with no recollection of what had brought him there. “All I know is what Pam told me. I was very weak, and had to learn to walk again. I went to PT every day, and did more PT on my own. It took longer than I expected, but I was deeply motivated, and my goal was simple: home. My family needed me.”
Scott made it home. Today, he says he is 100 percent recovered and feels great. “I travel, I drive, I do everything; Pam and I watch our grandchildren four days a week. I feel indebted to St. Clair and the ICU doctors and staff; I would have died without them. I’m grateful for the support I had from many people, but mostly from Pam. When I was beginning to wake up, hers was the first voice I heard — and all I wanted was to keep hearing her voice. Pam is more than my wife; she is my everything.”
That comes as no surprise to Dr. Fino. “Pam’s voice became a lifeline for Scott,” he says. “We don’t know if a patient in a coma can hear, so we talk to them and encourage the family to do so. Critical care is more than clinical management; there is a spiritual aspect. Scott’s desire to live and his family’s support were as essential to his recovery as the ICU’s medical care.”
Pam recently telephoned her children and told them to pray for everyone at St. Clair: “An experience like this gives you a new appreciation for life and for all the blessings you have. St. Clair Hospital gave me back my husband of 47 years. The ICU has a great reputation and they lived up to it.”
GREGORY J. FINO, M.D.
Dr. Fino specializes in pulmonary diseases and critical care medicine. He earned his medical degree at the University of Pittsburgh School of Medicine, where he also completed a residency and fellowship. Dr. Fino is board-certified by the American Board of Internal Medicine, including pulmonary disease. He practices with St. Clair Medical Services.
To contact Dr. Fino, please call 412.942.2025.