Moore than patients: How personalized care helped save a teenager’s life
Call it gut instinct. Something simply didn’t feel right to Drew Moore.
A physical therapy assistant at NovaCare Rehabilitation in Benton, Illinois, Drew had known Benton High School junior Carlie James for a few years. She was part of the school’s Career Explorations program and had shadowed Drew and other therapists at NovaCare for class credit.
Carlie, a high school wrestler and softball player, also is a patient at the center: last year with a strained hamstring and this year due to a concussion during wrestling season.
On March 3, Carlie had a dual purpose at NovaCare. She was there to shadow Drew, but also to be cleared from concussion protocol so she could attend her first softball practice of the season that afternoon. The high school’s top pitcher, it was an important day for Carlie.
When she arrived at the center around 10 a.m., she felt overwhelmingly tired and her heart was pounding. She decided to say something to Drew even though she figured it was anxiety and, “I was just being dramatic.”
Drew checked her vital signs. Her blood pressure was normal, but her heart rate was 141, excessively high for a 16-year-old athlete at rest. He had Carlie lay down for about 20 minutes, putting her shadowing on temporary hold. He took her heart rate again and it was 124, a drop but not a significant one. Maybe anxiety or an energy drink was causing the spike, Drew considered. But it just seemed like more.
“She’s is usually a pretty high energy kind of girl,” Drew said. “And she was acting different. The only thing that really alarmed me was that something seemed off with her.”
So he told Carlie to call her mother to let her know what was going on and to go to the nurse as soon as she arrived back at school.
Drew never imagined those simple instructions would save the life of one of his favorite patients.
An unexpected life scare
Carlie struggled with the trek from the high school parking lot to the building that day. She was breathing heavily and her backpack felt loaded with lead.
She went directly to the school nurse’s office, recorded a heart rate of 145 and was sent back home to meet with her mom and head to the local hospital.
Initial tests again showed nothing unusual besides the elevated heart rate. A panic attack, she guessed. After a CT scan, doctors had a different diagnosis.
A blood clot was discovered between Carlie’s lung and heart. It needed to be treated immediately before it shifted and caused significant damage. She was given a clot-busting shot and placed into an ambulance for a 100-mile trip to St. Louis Children’s Hospital.
Carlie and her family were shocked, scared, overwhelmed.
“When you’re a kid, you don’t really know what (a blood clot) is. You don’t really focus on that much. I was more scared of the needles,” she said. “Then, once I had seen my family’s reaction, I realized it must be bad, so then it started scaring me.”
When she arrived in St. Louis, Carlie was rolled into the intensive care unit, where she was met by “20 doctors coming in and introducing themselves. That was definitely scary, because I had no idea who these people were.”
She was supposed to be practicing her favorite sport. Instead, she was beginning a three-day stint in an intensive care unit in another state.
She endured multiple tests: echocardiograms, CT scans, a sonogram of her veins. No specific condition was discovered. The best explanation is the medication Carlie was taking for migraines reacted poorly with the heightened estrogen levels of a teen girl.
What doctors knew for sure was the clot was large and likely would take six months – double the typical length – to fully dissipate. And that Carlie is exceptionally lucky it was found before she exerted herself.
“If she would have gone to practice – because she would have pushed herself, she wouldn’t have stopped – the least amount of a health emergency she would have had would have been a stroke,” her mother, Julie James, said.
Leaning into physical therapy and instincts
Physical therapists are trained in a holistic approach to care. They’re versed in the entire musculoskeletal system and not just one body part. Additionally, therapists spend an hour multiple times a week with patients, getting to know their personalities as well as their ailments.
When Carlie exhibited an elevated heart rate, Drew didn’t dismiss the warning sign because it was unrelated to her concussion condition.
“Drew knows his patients. Young or old, he knows them,” said Kevin Griggs, the center manager in Benton. “She wasn’t her normal self and that’s what triggered things for him. The heart rate was a trigger as well, but he knew, in conjunction with how she was acting, something was wrong.”
After Carlie left, Drew focused on his other patients at the busy Benton center. He went home that night, went out for a run and came back to a message on his cell phone: a picture of Carlie in the hospital dealing with a potential pulmonary embolism.
His mind spiraled. Should he have done more? Should he have made her go directly to a hospital? What if they had been a slight bit busier, would he have taken her vitals twice? What if he had made her do some exercises like he normally would have?
“It really hit me, like if it would have gone the other way around, just how awful that would have been,” said Drew, who is also a former prep athlete who spent a lot of time with physical therapists during his high school football career. “As everybody here has gotten to know her and built a good relationship with her, we all love and care for her.”
It’s that extra level of care that impressed his boss.
“Drew definitely deserves a big pat on the back. I really feel like he saved a life and Carlie’s parents feel the same way,” Kevin said. “That’s a positive difference you’ve made in a family’s life that will go on for a long time.”
Not an easy road ahead
Carlie’s return to full health will be uphill. Due to the clot’s size, it will disintegrate slowly, parts periodically breaking off into her lung for months. Each time it occurs, she’ll encounter that same anxious, heart-pounding sensation.
It’s just one of a series of physical woes she has faced since the unexpected diagnosis.
The morning after she arrived home from St. Louis, she woke up screaming in pain. Carlie had kidney stones, an unrelated and cruel coincidence.
The physical toll on her body has sapped much of her stamina. She missed a couple weeks of school and then went only half days before returning full-time in May.
She’s also eased back into her first love, softball. She’s the team’s ace, but was used mainly as a reliever and pinch-hitter initially.
“Sitting there and watching all my friends play,” she said, “the one thing I could think of is wanting to be out there for them to help them.”
Slowly, Carlie was cleared to play more. In one, mid-May game, she pitched and homered twice. But in between the blasts, she injured her knee on the mound. During her second home run trot, Carlie limped around the bases while her teammates screamed and surrounded home plate.
She since has been diagnosed with sprains of the medial patellofemoral and medial collateral ligaments and was told she shouldn’t risk further knee damage by continuing to play this season. Carlie laughed and reminded the doctor she is already playing with a blood clot in her lung.
Point made. She’ll be using a knee brace to pitch in the postseason.
One gut decision changes everything
Two days after Carlie’s clot scare, a woman came into the Benton center for therapy and mentioned she was having symptoms that could have been a heart-attack warning. Drew sent her straight to her doctor; no hesitation.
“If anything, this gave me more confidence and trust in myself to make those calls,” he said of Carlie’s experience. “When you take a right direction like that, it gives you more confidence in continuing with that and trusting your gut.”
The Benton center prides itself in creating a family atmosphere. That took on extra meaning with Carlie’s story. While she was in the hospital, the Benton clinicians sent Carlie flowers and a teddy bear. Kevin invited her to hang out in the center while she was recuperating and not yet cleared for full-time school.
There’s an unbreakable connection now between the James family and the Benton clinicians.
“I’m just so thankful for Drew,” Carlie said. “If he had just ignored it, then I probably would not be in such great shape.”
“Or be here at all,” her mother added.