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Health Matters: Providence Mission Hospital | 5 Michael Neveux Photography "I was pleading, 'Just save his life,' " recalls Denise Erkeneff of the night her husband, Rick, was rushed to the ER at Providence Mission Hospital. "That's when I met the A-team of Dr. Gomez and Dr. Rao." Rick, 56, and Denise had enjoyed a pleasant day in their Dana Point neighborhood, doing Pilates together in the morning. An avid surfer and creative director who works in the surf industry, Rick had watched a live stream of World Surf League action and then gone for a walk. Not long after he returned, he called out to Denise, "My head is coming off. Call 911!" Denise yelled to her daughter to make the call and, she remembers, "when I turned around, Rick was slumped over. It was incredibly scary." Dana Point paramedics responded within a minute and a half and delivered Rick to Mission's ER within six minutes, factors that contributed to his surviving what turned out to be a subarachnoid hemorrhage, a brain bleed caused by a ruptured aneurysm. The paramedics had called ahead to Mission's ER to activate the code stroke protocol, which is why Denise was met by cerebrovascular surgeon Vikas Rao, MD, pulmonologist Gabriel Gomez, MD, and neurologist Basit Rahim, MD. UNDER PRESSURE Rick was comatose and not breathing well when he arrived, so the first step was to intubate him so a ventilator could breathe for him and stabilize his condition. "We use a grading scale for the patient's neurologic condition after an aneurysm rupture," Dr. Rao says. "Rick was a 5 out of 5, which is the worst prognosis." A CT scan showed Rick had a ruptured aneurysm and that pressure in his brain was building to life-threatening levels. "The doctors were measured about Rick's hope of recovery," Denise says. "They were managing his life and I put my trust in them." As a comprehensive stroke center (the highest accreditation of specialty care for stroke), Mission is the only hospital in South Orange County with the state- of-the-art equipment that allows minimally invasive treatment of brain aneurysms. The first night, the doctors performed a short procedure to control brain pressure. The following day, Dr. Rao threaded a catheter through Rick's femoral artery into his brain to place a tiny metal coil to plug the rupture. The aneurysm that had caused the problem was small but, because of the bleeding, catastrophic in its impact. While they were closing the aneurysm, it burst again, causing even more pressure in the brain. Dr. Rao was able to control the bleeding, but the new blood caused the pressure in Rick's brain to rise over the next few days. The two neuro ICU doctors now faced a dilemma, Dr. Rahim recalls. "We had to think outside the box. We could remove part of the skull, cool his body down or use a powerful sedative to shut down activity in the brain." They chose to administer the sedative, pentobarbital. "It's a very specialized approach. Not all neuro teams Saving a Brain and a Life From the ER to the acute rehab unit, the Mission team made all the right moves to save the life—and quality of life—of Rick Erkeneff after a catastrophic brain bleed.

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