Back from the dead

The Courier-Mail - QWeekend - - CONTENTS - by Janelle Miles

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.

Brett Good­ban

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.

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