Back from the dead
The mercy flight that saved Brett Goodban’s life
if not for AN aerial ambulance fitted out weeks earlier, Brett Goodban would not have made it back to Queensland for life-saving treatment after catching the flu in Japan. A travel insurance policy was his other ticket to survival.
It always seems impossible until it’s done. The words of the late former South African president, Nelson Mandela, are printed on the back of the business cards of Marc Ziegenfuss, the intensive care director at the Prince Charles Hospital in Brisbane’s north. Ziegenfuss looks after patients at their sickest. Of those who survive, few are as dire as Brett Goodban, the father of three boys from Cairns, in Far North Queensland, who he calls the “miracle man”. Goodban was in an induced coma and on life support in a Japanese hospital, just outside Tokyo, when Ziegenfuss was alerted to his case.
Days earlier, Goodban’s heart stopped as he lay in Chiba University Hospital with viral pneumonia, triggered by an aggressive strain of influenza. Every year, for reasons scientists fail to fully understand, a small percentage of young, and apparently healthy, people develop life-threatening complications after contracting the flu. Some die. The northern hemisphere flu season was particularly savage. In Goodban’s case, the virus attacked his heart. He developed a blood clot that travelled to his lungs and blocked an artery, causing a cardiac arrest. Japanese doctors resuscitated the 41-yearold and connected him to a ventilator, to help him breathe. They also hooked him up to a sophisticated heart-lung bypass machine, known as ECMO, for extracorporeal membrane oxygenation. The device sucks blood out of the body, removes the carbon dioxide and re-oxygenates it, before pumping it back to the patient.
The quick actions of the Japanese medical team saved Goodban’s life. But as he teetered between life and death, relying on machines to keep him alive, his family were in no doubt they needed to get him back to Australia, a world leader in intensive care, to give him a fighting chance. His heart function was assessed at less than 10 per cent, he might have needed a transplant to survive and his only chance of receiving a donated heart was at home, given the worldwide shortage of donor organs. Goodban had exhausted his medical options in Japan.
Sitting in his office more than 7000km away, Ziegenfuss had to weigh up whether Goodban was well enough to be transferred back to the Prince Charles Hospital, Queensland’s leading ECMO facility and only heart transplant service. Australia had never repatriated a patient on ECMO over such a long distance. Few aero-medical retrievals of its kind had been attempted anywhere in the world. Ziegenfuss needed to know Goodban was capable of waking from his coma. He needed evidence that the devoted husband of Japanese-born Ami, 34, and father of Senna, 6, Luca, 3, and baby Kimi, was not brain-dead.
That evidence came as he talked to Tania Lyon, Goodban’s older sister, who was in Japan with her brother, and their families, for what was supposed to be a “trip of a lifetime” almost 12 months in the planning. Their dream was to spend time with Ami’s family and to celebrate Christmas in the snow with their boys, including Lyon’s sons, Joshua, 14, and Callum, 12. But the dream turned into a nightmare.
As Goodban lay in a coma, his organs shutting down, Lyon, 43, from Karratha, in Western Australia’s north-west, sat talking to the brother she also calls her best mate, hoping he could hear her. When she said his name, he turned his head slightly towards her voice. She told Ziegenfuss she had also noticed tiny tears trickling from her brother’s eyes as she spoke. They were the signs the South Africanborn doctor was hoping to hear. “That’s when I said, ‘Okay, let’s give this a go’,” he says. “That’s when I knew that his brain was working, that there’s still a person in there, that he’s alive. We can try to save him. It’s not futile.” But first they had to get him back to Brisbane.
Ziegenfuss worked with Queensland air ambulance service CareFlight, the Alfred Hospital in Melbourne, which runs one of
Young, fit healthy adults in the prime
of their lives can succumb to this microbe. Marc Ziegenfuss, intensive care director, Prince Charles Hospital
Australia’s leading ECMO retrieval operations, and Goodban’s travel insurance company, Woolworths. Before flying out of Cairns on December 11, Goodban had spent $130 on a travel insurance policy with unlimited cover. It was his ticket home.
Weeks earlier, CareFlight had taken possession of a leased Challenger 604 jet, paying $400,000 to fit it out as an air ambulance. Without it, says CareFlight chief medical officer Dr Allan MacKillop, Goodban would not have made it home.
“We wouldn’t have been able to do it,” MacKillop says. “We wouldn’t have had the room inside for the medical team, plus the medical gear, for that long distance. It’s fair to say, Brett would have run out of options over there. I don’t like to be over-dramatic, but that’s a fair assessment.”
The jet had to be big enough to fit Goodban, a medical team of four, plus the pilots, and 100kg of equipment. For more than ten hours, much of it over the Pacific Ocean, it would become an airborne intensive care unit. They needed backups for every piece of equipment. If a malfunction occurred, they had to be able to deal with it mid-air. “There wouldn’t be much use landing because most of the places we’re flying over – Papua New Guinea, Micronesia – wouldn’t have the capability to look after a patient this sick,” MacKillop explains. “He’s much better in the aircraft than a lot of places we’re flying over.”
CareFlight Coordination Centre staff on the Gold Coast spent 48 hours organising the flight. Their planning had to be meticulous. Goodban’s life depended on it. They had no other Australian case studies to guide them in transferring a patient so far on ECMO. The only other retrieval of its kind MacKillop could find was from Japan to Hawaii, but in that case a much larger C-17 military aircraft was used and a specialist team of 12 cared for the patient in flight. Getting Goodban back to Queensland “may be the longest civilian transport of a patient by air on ECMO that’s ever been done”, MacKillop says. More than 300 phone calls and 250 emails were made in its organisation.
Key to the emergency transfer was the inclusion of retrieval doctors, Steve Philpot and Paul Nixon, from The Alfred Hospital, which has some of the world’s most highly trained intensive care specialists. Although Queensland has nine ECMO machines in public hospital ICUs, the state has no aero-medical ECMO retrieval service. “The Alfred is one of the few Australian facilities with the medical specialists able to provide the management of ECMO machines outside a hospital,” MacKillop says.
Philpot and Nixon have highly technical training in connecting patients to ECMO, typically done by surgeons, as well as in running the machines and in caring for such a critically ill patient. They joined CareFlight’s Dr Pirjo Kangas and nurse Michelle Black on the mission to bring Goodban home. Kangas managed his breathing, while Black was responsible for his medication. “If Brett had been a tiny bit sicker than he was, he wouldn’t have survived,” Philpot says without hesitation. “Even though we do a lot of ECMO at The Alfred, and a lot of retrievals, we’ve never done anything like this. It’s nothing that I’ve ever seen before. When you’re that sick, there’s a lot of things that can go wrong.”
Black later wrote about the journey. She sent Goodban a copy of her account to help him fill in “the missing hours”. “I will never forget the tears and look of distress from your wife as we started to wheel the stretcher out [of the hospital in Chiba],” she writes. “I gave her a hug, fighting back my tears, and promised her I would look after you and bring you home.” THE FLIGHT, WITH ITS FRAGILE CARGO, TOOK off from Tokyo’s Narita airport just after 3.30pm, Japanese time, on January 19. Goodban’s retrieval team had to take special care to ensure he was kept warm and did not develop hypothermia, a dangerous drop in body temperature. “Because the ECMO machine takes blood out of the body, the blood tends to get cold,” Philpot explains. “Usually we have a heating device attached to the machine, but it was too big for us to take on the plane. We had to do other things to keep him warm. We wrapped all of his ECMO tubes in Alfoil to try to prevent heat from being lost, as well as covering him in a lot of blankets.”
They also regularly checked the tubing on his machines to make sure nothing dislodged during the flight. Although his blood pressure plummeted
mid-air, doctors managed the drop by increasing the dosage of some of his drugs. He arrived safely in Brisbane at 2am local time on January 20.
Goodban’s last memory of Japan is riding in the back of an ambulance en route to Chiba University Hospital. The next thing he recalls is waking up in the Prince Charles Hospital ICU on February 8, about six weeks later. “I had no idea what was going on,” he says. After his arrival in Brisbane, surgeons cut through his sternum to remove the clot in his lungs, which had caused his cardiac arrest in Japan, and to connect him to more machines, designed to take pressure off his heart.
About three months after he was admitted to hospital in Chiba, Goodban walked out of hospital in Brisbane on March 24 and flew home to Cairns last month. His heart function is back to near-normal levels, although his doctors say it will take up to a year for him to fully recover. He hardly recognises himself in the mirror. He’s lost 32kg, trimming down to 94kg. “I’ve been told how much of a miracle it is that I’m actually alive,” he says. “I’ll just be sitting here watching the boys play and just lose it, because I know how close I came to losing my life.”
This season’s flu vaccination has been available only since last month after a delay in production caused by two strain changes from the 2014 jab. Ziegenfuss says Queensland hospitals are bracing for a severe flu season, based on the northern hemisphere winter. “I’m a great advocate for vaccination and I feel that people’s reluctance to be vaccinated is unfounded,” he says. “Vaccination is one of the great medical marvels of the world. Brett’s case highlights that even though you think you’re in peak health, and not at risk from the flu, you’re not immune. Young, fit, healthy adults in the prime of their lives can succumb to this microbe.” Goodban is not one to preach to others about what they should and shouldn’t do based on what has happened to him. “But there are certain things I definitely would change now that I’ve managed to pop out the other end of this hell,” he says. That includes ensuring he gets a flu vaccination.
Goodban wants his story told to salute the dozens of people – locally, interstate and internationally – who saved his life. “It’s hard to put into words how grateful I am,” he says. “When I was in hospital in Brisbane, I had a tsunami of people turn up at my bedside and say: ‘I was the anaesthetist who looked after you’, or ‘I was the theatre nurse’. I felt like telling them: ‘Just for a second, can you take down the wall of “I’m just doing my job”? They’ve given me the greatest gift of all. I’m alive to watch my beautiful boys grow up and spend the rest of my life with Ami. It doesn’t get any better than that.”
After emerging from his coma, Goodban was told he had lost his job as a trade assistant with regional airline Skytrans, which collapsed while he was in hospital in Japan. Although the airline has been reborn under new ownership, less than half of its former workers have been re-employed. Lyon has started an internet crowdfunding page to raise money for her brother and his family while he recuperates. Donations can be made at gofundme.com/brettsta-s-battle
I’ll just be sitting here watching the boys play and just lose it because I know how close I came to losing my life.
Mercy dash … The CareFlight team boards a critically ill
Brett Goodban at Tokyo’s Narita airport on January 19.
Clinging to life … Goodban in the ICU at Brisbane’s Prince Charles Hospital with his sister, Tania Lyon; ( opposite) with wife Ami and sons Luca, 3, Senna, 6, and Kimi, 9 months.