H1N1 stunned Emory doctors

She was in respiratory failure, meaning she could no longer breathe on her own, and doctors had discovered a blood clot in her lungs. So the LaGrange doctors rushed her to Emory, with its infectious disease specialists and advanced equipment.

The woman's identity has not been made public, at her request, but this week eight of the Emory doctors and staff recounted their monthlong struggle to save her.

Gathered at the request of The Atlanta Journal-Constitution, with the approval of the woman, they included her main physician, her primary bedside nurse and the specialist who treated her infectious disease.

They called the case extraordinary, among the most medically significant of the people who have contracted this new strain of swine flu.

The severity of her illness has proven a medical anomaly, since experts say this strain is generally mild. Still, it has killed 170 people across the United States, the Centers for Disease Control and Prevention said. There have been an estimated 1 million cases in the United States. The virus has spread to more than 120 countries. In a change from the common seasonal flu, the majority of cases have occurred in people from age 5 to 29, the CDC said.

When the woman arrived at Emory in early May, she was the state's first confirmed case and medical experts were still figuring out this new variety of influenza. Researchers at the CDC were beginning to assert that the disease appeared to be generally mild. But that assessment was often drowned out by people's worry. People were clearing hand sanitizer off grocery shelves and talking of tightening the border to Mexico, considered the epicenter.

The fear did not escape the health care workers at Emory, who asked: How contagious is it? If I catch it, can I pass it to my kids? What precautions do we take?

"It was the unknown" that concerned people, said Pam Cosper, Emory's director of critical care nursing.

Hospital officials determined that nurses, doctors and her visitors should not only wear gloves, special masks and gowns, but also goggles. Pregnant nurses would not participate in her care.

The woman was placed in a special intensive care room sealed off from the rest of the hospital and the air filtered. She was sedated and kept unconscious.

Early on, Dr. David Schulman, the woman's chief physician, saw the existing treatment was not working. Even after about 10 days in the other hospital, she still had swine flu virus in her lungs, and her lungs were stiffening. He ordered her breathing machine changed to a special respirator that would transmit more oxygen into her blood.

Schulman also sat down with her family, including her husband, mother and sister. They said they were afraid she was going to die. They kept asking him for signs of recovery. They wondered why she got sick and they didn't. They had been in close contact with her.

Schulman told the family members that a week or more could pass without any sign of improvement.

For long days, the woman's mother stayed at her bedside. The nurses told her to talk to her unconscious daughter. Her husband had to return home to Kentucky after a few days to get back to work, as the family was concerned about keeping their medical benefits.

Schulman and the family decided to largely keep away the woman's 5-year-old daughter. The woman's body had begun to puff up and look distorted, and, Schulman said, "she looked deathly ill."

Doctors suspect she had contracted the swine flu during an trip to Mexico on April 17, since she started feeling chills, fever and headaches about a day later.

The woman later drove with her daughter from Kentucky to Georgia in late April for a wedding. The woman had done some shopping in Atlanta before the April 26 wedding in LaGrange, after which she was hospitalized.

As her hospital stay slogged on, her case received attention from the media and the public health community. The CDC sent workers to obtain tests and samples.

"She was certainly one of the sickest early patients," said Dr. Bruce Ribner, an infectious disease specialist at Emory. "There was a lot of public health interest in this lady."

Aubrey Marrazzo, a nurse who cared for the woman, said those slow days of waiting were difficult for all involved. The woman was so sick that family members were afraid to touch her, and Marrazzo found her so fragile that it was difficult to turn and move her.

Family members showed Marrazzo pictures of the woman on the beach, taken just weeks before. Her mom kept asking questions, especially one: She's going to make it, right?

The nurse tried to reassure her.

We're doing the best we can, Marrazzo told her.

Weeks passed. When progress came, it came slowly. When the woman's blood oxygen level increased a little, the family thought the news was wonderful.

The day she was brought back to consciousness should have been a happy one, but in some ways it created even more stress, said nurse Marrazzo. The woman awoke confused and upset, but she couldn't talk because of a breathing tube. Her distress spread to her family, Marrazzo said.

The woman spent 24 days in Emory's intensive care unit.

Ray Snider, the new director of the intensive care unit, wondered when he would see a sign that she would be OK. When he saw the woman using her laptop, e-mailing friends on Facebook, he said, "I realized we had a success."

On June 6, the woman, out of harm's way, had to start to regain her personal independence. She was transferred to a separate Emory facility to receive physical therapy to rebuild her strength. In all, she spent 41 days at Emory.

Doctors are still at a loss to determine why the virus hit her so hard. She had no underlying health issues.

The woman was sent home June 16. She recently sent Marrazzo an e-mail, saying she was feeling better. She's still not well enough to do many household chores, but she's managing.

"I started physical therapy on Wednesday and looks like I will be going three times a week," the woman wrote. "I'm getting stronger day by day, and overall feeling much better than I did in ICU. I am very happy to be home."