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Nik's Emergency Medicine Story

by UPMC Susquehanna

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Preparing for his first marathon, Nik Barkauskas, 32, was arguably in the best shape of his life. After sending a “Happy Birthday” text to his wife, Stacey, around 4 am on April 1, he began his first-ever 17-mile run with his training group from the YMCA. At 6' 5" and 250 pounds, Nik had been a lifelong basketball and baseball player, but the father of two was up for a new challenge and had been running long distances for three months through subfreezing temperatures, wind and snow.

This was the first day he didn’t need to wear a jacket. Temperatures had spiked from the 50s to the 70s the previous day. Through most of the run, he pushed to keep pace with the group leader, but somewhere near the 16.5-mile mark, Nik stumbled. His friends say he picked himself up and began running again before collapsing and rolling off the Susquehanna River Walk path. When they reached him, he was unconscious. They called 911 at 7:22 am.

Susquehanna Regional Emergency Medical Services (EMS) arrived at 7:27 am. Though temperatures were in the mid-60s, Nik’s symptoms—loss of consciousness, vomiting and difficulty breathing— pointed to a heat-related illness. The EMS team worked quickly to insert a breathing tube, start intravenous fluids, and begin cooling Nik’s body.

“This is what we train for. Environmental injuries are rare, but with the paramedic mindset and progressive evaluation, we rapidly addressed the key issues to set him on a good path,” says Greg Frailey, D.O., Medical Director, UPMC Susquehanna Pre-hospital Services.

By 7:57 am, the EMS team had contacted the Emergency Department at Williamsport Regional Medical Center (WRMC) and had begun transmitting Nik’s EKG. He arrived at the emergency department at 8:06 am.

Nik’s body temperature was 106.1° F—dangerously high.

“It was pretty grim to be honest,” says Crystal Hanner, RN, the primary emergency room nurse at Nik’s bedside. “He had no neurological response whatsoever. His pupils were not reacting, and he was extremely hot to the touch. His skin was completely dry.”

Emergency physicians used MRI and CAT scans to rule out underlying issues with Nik’s heart or a blood clot in his brain stem as the root cause of his apparent heat stroke. He was placed on a ventilator to assist his breathing.

“Our goal is to get rapid stabilization and diagnostics so we can quickly initiate treatment,” says Michael C. Gerst, D.O., Director of UPMC Susquehanna’s Emergency Medicine. “He was one of the sickest patients that I have ever taken care of. In a case like this, when even 10 minutes’ delay can have a profound negative impact, the resources here gave us the upper hand in figuring out what was wrong and getting Nik on the path to treatment.”

Lab results indicated that Nik’s exertion and heat illness caused a rare, life-threatening condition called rhabdomyolysis, a breakdown of muscle and release of proteins into the bloodstream that can lead to kidney damage or failure. He also had early signs of a very rare condition, disseminated intravascular coagulation (DIC), which can disrupt blood flow to major organs or result in excessive internal bleeding. Less than two hours after arriving, Nik was transferred to the Intensive Care Unit (ICU) for a higher level of support.

With Stacey at Nik’s side, the Intensive Care Unit team of physicians, nurse practitioners, registered nurses and respiratory therapists worked to keep Nik’s vital signs stable as the extent of the internal damage from his condition became apparent. Critical care, kidney, liver, neurological, and blood specialists collaborated to give Nik the best possible chances for survival.

Because Nik suffered injury to multiple organs, the medical team was guarded with its prognosis. Continuous renal replacement therapy and a ventilator supported Nik through the weekend as Stacey remained by his side.

“The doctors and nurses were really amazing and attentive,” Stacey says. “They were straightforward, and I knew the odds were against Nik, but I was also confident that they were doing all they could for him.”

Registered nurses Sarah Matczak and Amy Bachle worked back-to-back shifts caring for Nik through the first crucial days to provide the continuity of care that would optimize the progression of his recovery.

“We were all pulling for him,” Amy says. “Almost instantly, all the nursing staff created a special bond with Nik and Stacey, and we were determined to get him back home to his family.”

Within 48 hours, Nik’s medical condition stabilized, yet he remained unresponsive, raising concerns about his brain function. His medical team had to consider the possibility that Nik might not regain full consciousness. By Tuesday, staff members were able to remove enough supportive equipment to perform an MRI scan, which revealed that Nik’s brain was functioning normally. That was the first of many positive milestones in Nik’s recovery.

A steady flow of family and friends visited, including members of Nik’s family who came from out of town and stayed on the WRMC campus in the Hospitality Inn. During these visits, when Nik’s room would get noisy, Stacey noticed Nik biting down on his breathing tube—the first sign that Nik’s coma was subsiding. Then, 24 hours after his MRI, five days after he collapsed, Nik’s breathing tube was removed, and he woke up.

“As he regained consciousness, it became clear we could take him off the ventilator and back off his sedation,” says Kevin Kist, D.O., ICU physician. “That’s when neurologic improvement began, and his recovery really took off from there.”

Weak and in pain from the rhabdomyolysis, Nik doesn’t remember much about his next few days in the ICU other than “kindness and care.”

“My time in a coma was very scary for my family, but it wasn’t for me. I woke up feeling that I would be okay because of the care all around me,” Nik says. “It was shocking to realize that, a week before, I could run 10 miles, and now I couldn’t reach, roll over or even adjust my glasses. I wasn’t depressed; I just felt the power of what had happened.”

Once Nik was medically cleared to leave the ICU, his care was transferred to a medical unit for several more days of general recovery. He continued to receive dialysis to support his badly damaged kidneys. Physical therapists, who had been involved since he was in the ICU to move his limbs and help him sit up, continued to work with him. Nik marveled at the skill and patience of his nurses and their easy explanations of his treatments.

After just a few days, Nik reached several recovery milestones, and doctors determined he was strong enough to move to inpatient rehab for three hours of therapy a day along with his three hours of dialysis every other day.

His life had been saved. Now, over three weeks, he would work to restore his lifestyle. Nik wanted to be home with his family and have the strength and stamina to care for and play with his children as well as the mental acuity to return to teaching and finishing his doctoral work in education. But his illness had taken a toll. He didn’t have the strength to stand without assistance. He couldn’t raise his arms to brush his teeth, comb his hair, dress, or feed himself.

“Really, we did a whole rebuilding of everything in my life,” Nik says. “I appreciated how each therapist made an effort to connect with me on a personal level. It made therapy easier, and I can’t thank them enough.”

Physical therapy was his favorite. At first he needed assistance to stand up, but with a goal of walking out of the hospital without support, he worked extremely hard, advancing to a walker and then crutches.

“From training, I was used to pushing and going that extra step. That drive is what helped me get back to where I am now,” Nik says.

In occupational therapy the focus was on rebuilding his upper-body strength so he could be independent for self-care. As he progressed through intense strength and balance training, he also began practicing skills like folding laundry and cooking. To combat mental fogginess, a typical side effect following a coma, Nik worked logic puzzles and was relieved to receive a nearly perfect score on a neurological test.

On April 30, the day he was discharged, Nik walked through the gym to say thank you and good-bye.

“He worked so hard. Every day we were adding reps or increasing weights, and every day he pushed himself,” says Rachel Ebeling, physical therapy assistant. “When he walked through here on his own, it was rewarding to see, knowing that he reached his goals and especially knowing they weren’t even sure he would survive.”

Nik’s kidneys are now completely healed, and, in July, he completed his outpatient physical therapy. He received a new bicycle for his birthday and plans to bike and swim to get back in shape.

The community support they received through this experience convinced Stacey and Nik to put down roots in Montoursville and buy a home there, because “life’s too short to put off your dreams.” And Nik says he is much more appreciative of the little things in his life, such as being able to get out of bed when he wants or enjoying a simple game of badminton with his family.

“I’m much more grateful for being alive,” says Nik, who will write his doctoral thesis this fall. “I don’t take things for granted anymore.”

Those who were involved in his care don’t take his survival for granted either. Doctors agree that Nik couldn’t have lived through his ordeal without having been in excellent health at the time of the incident. They also credit the support of the right people, making the right decisions, at the right time, with the right resources at hand.

“From start to finish, the team approach to Nik’s care—with good handoffs and appropriate consults—was critical,” says Dr. Frailey. “Without the support of everyone involved, from his friends who called 911 to nursing and ancillary services and all of our specialists, we would not have seen this outcome.”