H1N1 Survivor

Thanks to quick action by Children's Hospital clinicians, in Ocotber 2009, Jordan Bernd survivied a bout with a deadly combination of H1N1 and staphylococcus aureus.

With millions of doses of H1N1 vaccine about to be discarded because their expiration dates are arriving, the H1N1 pandemic can seem so 2009.

But for healthy teenagers—like Jordan Bernd—who became critically ill almost overnight, the fall of 2009 is hard to forget. The H1N1 pandemic was aflame in Northern California when the first flu symptoms hit her during an early October weekend.

Jordan was a healthy sophomore and competitive volleyball player at Ursuline High School in Santa Rosa. But in five days—the way lightning ignites dry brush—her immune system became fully involved.

She was so sick, she remembers nothing from the first of her four weeks in intensive care at Children’s Hospital Oakland. The last thing she remembers is the helicopter ride that brought her there.

During her first visit to the Emergency Room at Santa Rosa Memorial Hospital, Jordan was given vicodin for her viciously sore throat. But by the time she visited the same ER, about 36 hours later, she was so short of breath that after her vital signs were recorded, she had to be wheeled back to the waiting room.

As soon as Jordan’s chest x-ray was read, an ER physician told Jordan’s mother, Stacey, that her daughter needed to go to Children’s Hospital Oakland right away. “Why can’t she stay here?” asked Stacey.

Helicopter ride to Oakland

“We just don’t have the proper facilities for what she may need,” replied the doctor. Jordan’s father, Matthew, joined her for the helicopter flight to Oakland. Meanwhile, Stacey and Jordan’s grandfather drove down.

At Children’s, Jordan was taken immediately to the Pediatric Intensive Care Unit (PICU), where she was evaluated by intensivist Sharon Williams, MD, Critical Care Services division chief. Jordan’s chest x-ray revealed severe pneumonia, and Dr. Williams determined that Jordan had a collapsed right lung. She immediately placed a chest tube.

Dr. Williams promptly consulted Brian Lee, MD, co-director of Infectious Diseases at Children’s. “As soon as we evaluated Jordan it was very clear she was getting worse very quickly,” he said. “She needed to be intubated and put on a ventilator.”

Though it was the middle of the H1N1 pandemic, Dr. Lee knew he couldn’t assume Jordan had only H1N1. Her symptoms indicated possible influenza infection; but he suspected this was a case of influenza with a bacterial superinfection. “Influenza can make you very sick, but influenza plus Staphylococcus aureus really can kill you pretty fast,” he said. “You kind of have to do everything at once.”

Four-drug anti-disease cocktail

Concerned about bacterial superinfection, Dr. Lee started Jordan on three antibiotics at once, plus oseltamivir for suspected influenza. “We threw a lot at her because we needed to stop the disease process as fast as possible,” said Dr. Lee. “We essentially threw the kitchen sink at her.” It was later confirmed Jordan had both H1N1 and Staphylococcus aureus pneumonia.

During the first 24 hours, Jordan required aggressive respiratory suctioning efforts. With suctioning, ventilation and a chest tube all going on, Dr. Williams said Jordan—like other children with severe respiratory congestion—needed a carefully modulated dosage of sedation plus an analgesic. When a child may be feeling sensations of drowning or suffocation, it’s important to reduce their discomfort and anxiety.

“Jordan didn’t get much sleep that night,” said Dr. Williams. “And neither did we.”

The “we” included what Stacey called a “dream team”—Dr. Williams; Critical Care attending Natalie Cvijanovich, MD; Critical Care fellow Jennifer Plant, MD; and Dr. Lee.

“I think the PICU team did a great job,” said Dr. Lee. “It was a team effort. Critical Care took care of all Jordan’s breathing issues, and we in Infectious Diseases had to make sure she was on the right medications to stop the disease process. We discussed her condition together, reviewed the chest x-rays together, and did everything in concert.”

Jordan also got lots of support from her family. Stacey was at her daughter’s bedside for 29 of the 30 days Jordan spent in the PICU. To give Matthew time to drive down every day after work, Jordan’s younger sister, Preston, split her time between her grandparents and the family home. Every day she carried everything she needed in her backpack.

By the second day—though Dr. Lee arrived at Jordan’s bedside worried about what he’d find—Jordan seemed tohave stabilized. “Within a week I felt she was going to make it,” he said. “Jordan was really a fighter. Even when she was intubated she understood what I was saying. She was scared at times, but she was definitely a fighter. She didn’t give up.”

At the 72-hour mark, Dr. Williams was also encouraged. She had considered switching Jordan to a high-frequency oscillating ventilator to improve the girl’s oxygen intake. But Jordan’s improved condition convinced her to hold off.

Coming off the ventilator

After 10 days in intensive care, taking Jordan off ventilation was a dramatic milestone. “We were all holding our breath,” said Stacey. “Everybody was like, ‘Please, just work!’ Even Rachel, who’s been a nurse at Children’s for a long time, started crying. And I thought, ‘How incredible, we know how much they all see, but Rachel cared so much it made her cry.’”

After weeks in a hospital bed, Jordan’s disused muscles were losing strength. As she became healthier and able to breathe properly, Jordan did physical therapy to regain muscle tone and cardiovascular capacity. She quickly relearned how to use her arms and legs.

After a month at Children’s, Jordan was healthy and ready to go home. She wanted to catch up on her schoolwork and get back on the volleyball court. She wanted to pay forward the support she got from friends, family and volleyball teammates.

Varsity players wore Jordan’s number, “3,” on their shoes and cheered her name during every game. But support for Jordan and her family didn’t end there.

All Jordan’s former elementary school teachers sent letters; her high school vice principal tutored her doing the Christmas break, and family and friends filled her parents’ Oakland hotel room with cards, blankets, balloons, food and get-well cards.

“The community we live in has been incredible,” said Matthew. “It restores our faith in mankind. It was really kind of a blessing.”

Jordan’s parents also felt blessed by the care Jordan received at Children’s, even when they were trying to make suggestions about how to deliver it.

“Because of how well the nurses had taught me, I heard things coming out of my mouth about what medications she should be on,” said Stacey. “And I thought, ‘Who am I to be telling them?’ But they were all great, they would all say, ‘You know what she needs, you tell us and we’ll do everything we can to help her.’”

This story, written and photographed by senior writer Tom Levy, was first published in the April 2010 issue of Children’s Hospital’s PEDSnews magazine.