At age 37, Bethany Liefer was very much alive.
She excelled in the outdoors, running 15 miles a week and hiking up to 20 miles a week. She had climbed 16 of Colorado’s famed 14ers and reveled in the joy of reaching each summit.
Without warning, on a random day in June 2021, her heart stopped, and she wasn’t breathing.
As she lay lifeless on a gurney in the emergency room at UCHealth Memorial Hospital North, a team of doctors and nurses swarmed around her. Initially, they could not find a pulse.
A team of nurses and EMTs began doing chest compressions. Dr. Clinton Fouss, an emergency room physician, placed a tube down into her trachea and connected her to a machine that delivered oxygen, to help her breathe.
Fouss’ message to his team was crystal clear: Keep trying. Don’t give up. Keep going.
For five to six minutes, the mother of three girls, now ages 11, 8 and 6, was “coding,’’ in hospital parlance, meaning her heart had stopped and she wasn’t breathing.
“I never saw the light …,’’ Liefer recalled months later. “Aren’t you supposed to go to the white light when you die? I don’t remember any real come to Jesus moment when I died.’’
Finally, her caregivers detected a faint pulse. Her heart started beating again and once stable enough to be loaded onto a helicopter for a short flight to Memorial Hospital Central, she was in the air. At Memorial Central, she went straight to the operating room, where a surgeon performed a six-hour open heart surgery.
From there, she spent the next nine days in a coma as a ventilator breathed for her in the intensive care unit. Despite being unconscious, she felt her mother’s hand touch her face. She heard her soothing words.
“You are safe, and you’re going to be OK.’’
A seemingly normal Saturday morning in summer
A week before that fateful Saturday, June 19, 2021, Liefer had been climbing Mount Big Chief, elevation 11,224 feet. Liefer and her friends had reached the trailhead after 2.5 hours on a four-wheel drive road, southwest of Colorado Springs in Teller County. At the summit, it’s 360 degrees of splendor, with views of Pikes Peak, the Spanish Peaks in the distance, the Sangre de Cristo and Sawatch ranges.
Oddly, Liefer couldn’t make it to the top.
“I felt so bad, but I had never not summited a mountain, not including weather. But I have always been able to finish, I just thought I was being lazy, that I was not working hard enough,’’ she said. “And my friends were like, ‘this is not you.’’’
Feeling fatigued, Liefer went on with her life and a week later was doing yard work at her home in Monument. That morning she’d sent humorous texts to her friends.
“I was with my dog that morning, and I was really slow that morning, out of breath, just moving slowly,’’ she said. “And then I thought, maybe I’m just being lazy. Maybe I’m just not pushing it.’’
In time, she could barely breathe. She managed to call 911, and her daughter, then 10 years old, ran for their neighbor and called her grandfather. Her daughters were terrified to see their mother whisked away in an ambulance to Memorial North.
Her life had forever changed. She had a bilateral pulmonary embolism. Three out of four people who have a pulmonary embolism and require CPR die.
“So my heart, my pulmonary artery and my aortic artery, all of that was clotted and then that clot broke free and pushed into my lungs, and that’s when I had real respiratory distress,’’ Liefer said. “It’s a really, rapid decline, so I am so lucky.’’
Where the clot originated remains a mystery.
“Clots form in your legs or your abdomen, and so you have a little bit of warning, and it is painful to have a blood clot in your leg or in your abdomen because there are sensory neurons there. And they couldn’t ever find one, they scanned my legs and they scanned my abdomen, and they couldn’t find any source,’’ said Liefer, a pulmonary nurse at Children’s Hospital Colorado.
Liefer’s hematologist told her that a combination of birth control medication, which has a small risk for blood clots, dehydration, being at altitude the week before and stress, could have “pushed me over the edge,’’ she said.
In retrospect, she wonders if the clots had been forming at least a week prior, when she couldn’t make it to the summit of Big Chief.
“We were 2.5 hours in on a four-wheel drive road, and I would have been dead. That’s what I always think. If it hadn’t happened when I was at my house with medical care at hand’s reach, I would have been dead,’’ she said.
Liefer has no memory of texting her friends that Saturday morning, the helicopter ride, the operating room. She only remembers the sound of her mother’s voice. When she awoke nine days later, it took a few days for her to gather herself.
What is pulmonary embolism?
Pulmonary embolism (PE) occurs when a blood clot goes to the lungs and blocks blood flow into one or both lungs. There are many causes for PE including any condition which causes a person’s blood to be prone to clot including the postoperative state, long periods of inactivity, birth control pills or cancer. Pulmonary embolism is responsible for 50,000 to 200,000 deaths per year in the United States alone. Acute massive PE has a 25% mortality rate. Someone who requires CPR in the setting of massive PE (as Bethany did) will have a 75% chance of dying.
When recognized early and treated early, the outcomes are vastly different. Memorial Hospital has an acute PE response team (PERT) to respond to this deadly disease and vastly improve the outcomes for our patients. The team is comprised of emergency department physicians, pulmonary critical care physicians, interventional radiologists and cardiac surgeons.
Because the treatment algorithm is complex and there are various ways to treat patients based on the severity of the PE, patients benefit from having the input and expertise of all team members in real time. This multidisciplinary effort assures timely diagnosis and treatment of this deadly disease.
Dr. Peter Walinsky, the chief of cardiac surgery at Memorial Hospital and the driving force in the creation of the PERT said: “Patients like Bethany are the reason we instituted the PERT at Memorial Hospital. She was in the highest risk category of PE and received the most aggressive treatment (open heart surgery). In centers without a PERT it is highly unlikely she would have survived.”
“I woke up, and I was really confused. I had big chest tubes, and I had a tracheotomy, and I had a G-tube (feeding tube), and I was just really confused and frightened. And they slowly filled me in, and I couldn’t see at the time, my vision was severely impaired.’’
When Liefer’s heart failed, blood did not reach the occipital part of her brain, which controls eyesight. Despite impaired vision, she was startled after emerging from her coma to see her father and her new boyfriend conversing in her hospital room.
“I was just divorced, and we had been dating three or four months, and I thought, ‘I’ll just take this really, really slow.’ And he just kind of bullied his way into the ICU, and he met my father for the first time at the foot of my hospital bed. He hugged my dad, who is a stodgy old German man, and I was like, ‘Woooooooo. Oh my God.’’
Dr. Fouss, her physician in the emergency room, also visited her twice while she was in the ICU. She said words cannot adequately express her gratitude for him.
“Thank you. Thank you. Thank you,’’ she says.
Recovery from a bilateral pulmonary embolism in your 30s
Fouss said Liefer’s recovery from the bilateral pulmonary embolism was the result of teamwork among many people.
“The common theme to any great outcome in medicine is the team effort put into the care of the patient,’’ Fouss said. “As the physician, I’m an extremely small cog in a very large wheel of people who take pride in what they do on a daily basis.
“From the ED (emergency department) tech, her nurse, advanced practice provider, CT tech to EMS transport and the helicopter pilot, none of what we do would be possible. Without ‘things’ happening the way they did that day, I don’t believe we would have had the outcome we had. I’m lucky to be surrounded by incredible people on a daily basis.’’
Liefer knows that in a life-and-death scenario, the actions of all team members matter. Years ago, she had been working in an emergency room in Texas when a physician stopped doing chest compressions on a patient. Liefer wasn’t ready yet to stop those compressions just yet, and the patient died. Fouss and the team kept them going for her, and it worked.
“I want to hug every person who did compressions – some nurse, probably an EMT,’’ she said.
She ended up spending more than 20 days in the hospital and then enrolled in outpatient cardiac rehabilitation, which lasted another 8 weeks and gave her the courage to resume her life.
“It’s mostly gratitude because it took the team in the ER, it took my surgeon who worked on me for 6 hours, and it took the ICU nurses. And I think of all of the things that could have gone wrong. …And the rehab people at Memorial Central and then I went to cardiac rehab, which is outpatient. There are probably no fewer than 250 people that touched my trajectory.’’
Returning to life, nursing and climbing after a pulmonary embolism at age 37
In the months since her hospitalization, Liefer has returned to work. She uses a giant computer monitor so she can see, and has a phone that talks to her when she receives a text message. She’s completed driver’s training aimed at helping people who have medical challenges and is driving again, though not at night or in inclement weather.
She says she is a more compassionate nurse who better understands fear in medical situations.
“Having been a patient and having felt out of control and frightened, I am a much more compassionate nurse, and I have a lot more patience for a little guy that comes in terrified of his flu shot. ‘You know kid, I get it.’’’
Her daughters are doing well, and together, they have run in a few 5K races. On the one-year anniversary of the event, June 19, 2022, Liefer and her boyfriend intended to summit Mt. Sneffels, a Colorado 14er near Ouray, Colorado. The weather held them back, so they headed up the mountain the next day with their dog, a husky.
Near the summit, there’s a “notch,’’ that requires people to climb up on all fours. A slip-up there, and a hiker could plunge 500 feet down the side of a rock-face mountain. The dog wanted nothing to do with traversing the notch, so Liefer’s boyfriend stayed with the dog, and she summited the 14er by herself. Triumph.
Later in the summer, they all took a backpacking trip – their first — into the wilderness. They carried two tents, a hammock, rations and water. They carried marshmallow fluff for s’mores since fire restrictions prevented the girls from roasting them over an open fire.
The three sisters stayed up most of the night, keeping the adults in the next tent over from getting any sleep.
At 2 a.m., Liefer heard her girls giggling and squealing. One of them shouted: “Tickle fight!’’