Emergency Transfers: Yale Medicine Specializes in Challenging Surgeries

When a routine surgery took a catastrophic turn, doctors at Yale Medicine were able to help out—and save the patient.

It was an infected gallbladder, the doctors said. It needed to be removed.

In August 2014, just after returning from a vacation, Vincent Drake felt a sharp, persistent pain in his stomach. It concerned his doctor, which is how Vincent and his wife, Rita, wound up in his local hospital’s emergency room.

Surgery would be quick and the recovery would be easy, the doctors said. They would use minimally invasive laparoscopic tools to make a pinhole incision. Drake could expect to go home the next morning. First, though, he needed to spend four days in the hospital while his medical team administered antibiotics, monitored his vital signs and prepared him for the procedure.

Drake’s surgeon seemed confident—he had done this hundreds of times, he said—so the Drakes agreed to the plan. They never imagined that what was supposed to be a routine procedure would turn their world around and leave the otherwise apparently healthy 57-year-old on the brink of death. This is the story of a surgery gone wrong, a desperate call for help and the surgeons at Yale Medicine who fought to save Drake’s life.

Monday Aug. 12, 4 p.m.

The date and time of Drake’s gallbladder procedure is embedded in his wife’s brain. She remembers her husband being wheeled into surgery about 4 p.m. She was told the procedure would take about two hours. 

“I gave him a quick kiss and said, ‘I’ll see you on the other side’—meaning when he was in recovery,” she says. Her husband remembers being in a good mood, too. “I’d been there for four days,” he says. “I was ready to get this over with and get home.”

Around 6 p.m., Rita Drake started to get nervous. “I went out into the hallway, looked around for his doctors, walked up to the door of his room, but I couldn’t find anyone,” she says. Several times she asked staff members on the floor if there were any updates on her husband.

She began to panic. “I called my sister who lives nearby,” she said, “and said, ‘I don’t know what’s going on. Something really bad must have happened. No one’s coming near me.’” Her sister and brother-in-law drove over to wait with her, and finally—about 8:30 or 9 p.m., she remembers—a nurse told her that Vincent was being sent to the intensive care unit.

“At this point I’m traumatized,” she recounts. “I think my husband’s dead. And now we’re sitting outside the ICU, still not knowing anything, still waiting for answers.”

9:30 p.m.

Finally, Rita Drake was called back into the operating room. There, doctors told her that during Vincent’s surgery, they accidentally severed an artery in his liver. He was bleeding profusely. They were unable to stop it.

“I asked if Vinny was alive, and the doctor said, ‘Well, he’s alive right now,’” she says. “Then, a kind of dead look came into his eyes while he explained that they were sending him down to Yale New Haven Hospital, where the doctors should be able to help.”

10 p.m.

Yale New Haven Hospital was a short ambulance ride away. And, fortunately for Drake, the hospital regularly receives transfer patients from other hospitals through a 24-hour call center called Y-Access.

Through Y-Access, doctors at referring hospitals can call a hotline and connect directly with an attending physician to discuss a patient’s case. Together, both sides decide on the best way to get the patient to Yale New Haven Hospital (usually via ambulance or helicopter), and what has to happen once the patient arrives.

Usually, patients transferred through Y-Access are in stable condition and do not need immediate treatment, or they are transferred from an emergency room before surgery takes place. Drake’s case, on the other hand, was much more serious. With an open wound and uncontrolled bleeding, his condition was rapidly deteriorating.

“This was one of the first times we did a direct operating-room-to-operating-room transfer—which, at the time, really pushed the limits of our transfer ability,” says Kevin Pei, MD, the on-call doctor that night for Yale Medicine’s Section of General Surgery, Trauma and Surgical Critical Care. “There are so many more moving pieces in the OR, and it’s a team effort. There’s a surgeon, the anesthesiologist and his or her team, nurses, scrub techs—and all of these people have to be mobilized and waiting for this patient to arrive.”

When Drake arrived at Yale he was immediately taken into surgery. Although Dr. Pei knew that Drake was in trouble, he was alarmed when he saw his patient on the operating table.

“It was shocking how dire his situation had become in such a short time,” he says. “His blood pressure was very low. He was essentially at death’s door.” Drake had received 12 units of blood and would require at least another 10 before the end of the night—the equivalent of replacing his entire blood volume more than once. Dr. Pei was not optimistic, but he kept one goal in mind: Save the patient.

Dr. Pei was new to Yale Medicine—it was his first month on the job—but he had been working as an attending surgeon for five years. His experience at major trauma centers similar to Yale had equipped him well to deal with emergencies. “Every surgeon has a different skill set and comfort level,” he says. “We, at Yale, probably see high acuity and high-risk surgeries far more frequently than the transferring hospital.”

The surgical team worked to slow Drake’s bleeding and find the severed artery. Dr. Pei used sutures (the medical equivalent of a needle and thread) to repair the artery. This was not easy because of the large pool of blood that had collected in Vincent’s abdominal cavity. “Plus, Vincent was overweight and his liver showed signs of scarring, which complicated things even further,” Dr. Pei says. But after a tense 90 minutes or so, the worst was over, and the bleeding had stopped.

Tuesday Aug. 13, 1:30 a.m.

Meanwhile, Rita Drake and her brother-in-law had driven to Yale New Haven separately. They were waiting anxiously in the operating room’s waiting room. Around 1:30 a.m., Dr. Pei met them with an update.

“I remember the look of fear in her eyes when I came out to discuss the situation,” Dr. Pei says. He had not had a chance to talk with Rita before rushing her husband into the operating room, he says. “I always try to put myself in the family’s situation,” he says. “All of a sudden, her husband is in an ambulance, and now he’s in an OR with a surgeon she’s never met. I felt very bad for her and definitely wanted to bring her some comfort.”

Dr. Pei told Rita Drake that they had stopped the bleeding, and that Vincent had been sent to the hospital’s imaging department for angiography—a procedure that uses X-rays to look at blood vessels—to make sure the damage to his liver had been fixed.

“He told me I could see him in the morning,” Rita says. “And he told me that the next two days would be very critical—that he might not survive—but that he was very hopeful.”

7:30 a.m.

After what felt like the longest night of her life, Rita Drake was finally able to see Vincent. Still under anesthesia, he was hooked up to what looked like a million tubes and machines. “The people in the ICU were fantastic,” she says. “They said, ‘If you want to sit in there the whole day, that’s fine. If you want to go home and call every 10 minutes, that’s fine. Whatever you want to do, we’re here for you.’”

11:30 p.m.

This time, Drake’s gallbladder removal went smoothly. When Rita called the hospital later that night, she spoke with a male nurse who had just begun the process of helping her husband come out of anesthesia.

“I was so relieved,” Rita says. “I said to the nurse, ‘He went into one hospital and he wakes up in another all tubed up and doesn’t know what hit him.” 

From Vincent Drake’s perspective, confusion was an understatement. “I was really in a fog,” he says. “I had some crazy dreams. I didn’t know what was going on or how bad I really was until maybe a few days later.”

Still, Dr. Pei remembers Vincent being in high spirits after he woke up. “He started cracking jokes with the nurses right away,” he says. “Once we explained what had happened, he was clearly very thankful. It seemed like he felt he was in good hands because he could see we had a good team taking care of him.”

Healthier than ever

Drake was not out of danger just yet. Before he could leave the hospital, he needed another surgery to insert a stent in his liver. He had also developed a blood clot in his arm, in addition to congestive heart failure, caused in part by the stress of the last few days. “The huge amounts of blood moving in and out of his vessels put quite a burden on his heart, which wasn’t the healthiest to begin with,” Dr. Pei says.

Finally, 15 days after his first hospital admission, Drake was able to go home. He entered Yale Medicine’s 36-visit cardiac rehabilitation program to strengthen his heart, which he completed the following July. He also started eating healthier, bought a bike and lost more than 100 pounds.

Now, says Drake, “I try to do as much as I can to stay healthy. We stay away from fried foods and eat more fruits and vegetables, and I try to ride between 15 and 20 miles a day. I don’t want to go down that road again, so I’m trying to take advantage of this second chance I was given.”

Dr. Pei, who saw Drake for several follow-up visits after his discharge, is thrilled with his recovery. “Going through these very traumatic experiences with patients, you form a bond with them,” he says. “And I’m so happy for him. The old Vincent would never have gone on a 17-mile bike ride, and frankly, he physically couldn’t have. Not only did he survive his experience, but he’s a real success story in that he’s now healthier than ever.”

Yale’s ‘never-say-no’ approach

Dr. Pei says that Y-Access—and the physicians on both ends of that phone call—saved Drake’s life. “We had a good team,” he says. “But to the other hospital’s credit, they recognized that they were in well over their head and needed help.” He is proud that Yale Medicine has a “never say no” policy about accepting transfer cases through Y-Access, too. “Vincent is really lucky. My partners, the interventional radiologist, the anesthesia and operating room teams, and nurses are all experts at taking care of patients who are rapidly deteriorating,” he says.

“We want physicians to be comfortable seeking additional help and support that they don’t feel like they have at their hospitals,” Dr. Pei says. “We say yes to everything.” That’s lucky for Vincent Drake, he says, noting that other hospitals may have refused to help.

Vincent and Rita are not worried about needing another emergency transfer to Yale Medicine. They know where they are going if they face any medical problems. 

Says Vincent: “I’m learning to take care of myself, first and foremost. But if I get into trouble again, I know now where I’ll get the best care.”