Her husband Chris was out for the morning, and Hannah Holt, 28, was to go for a walk with her friend Lexi and their toddler daughters. The first day of June 2019 shaping up into a nice one. They would circumnavigate Bingham Lake in the Pinery south of Parker. Hannah checked the contents of the diaper bag, plopped daughter Raegan into the stroller, and stepped out into the sunshine.
Raegan was three months shy of 2 years old, and her presence was a blessing in more ways than one. She had been born with gaps in the walls separating the right and left sides of her heart. Those gaps had denied her blood of oxygen and had left Raegan breathing hard and sleeping a lot. Hannah, a cardiothoracic nurse, had more or less diagnosed the problem herself before a pediatric cardiologist finally did two weeks later.
Two sleep-deprived months of keeping close watch and feeding high-calorie formula later, the young parents would spend six nervous hours in a hospital waiting room as their baby’s blood flowed through a heart-lung bypass machine while surgeons patched up her tiny heart.
That surgery had been a success, and Raegan was now walking faster and adding words every day. It had been a rough start, but Raegan’s life was that of a perfectly healthy toddler. Hannah and Chris were thinking about adding to the family, in fact.
Hannah and Lexi walked along North Pinery Parkway, each with a daughter in a stroller. Hannah slowed down for a moment. She didn’t feel right.
“It’s really dark all of a sudden,” she told her friend, now a couple of steps ahead.
As Lexi parsed a sentence that made little sense on a bright Colorado morning, it felt to Hannah as if a vise had clamped around head. Then she felt nothing at all. She collapsed into the road, taking the stroller and Raegan with her.
Lexi leapt into action, pulling mother and the stroller back onto the sidewalk. A passerby stopped to help – a paramedic, as it turned out. An ambulance arrived minutes later. Inside, Hannah said, “My head hurts really bad.”
“You’re probably dehydrated,” the emergency responder said.
“I’m going to die,” Hannah said, though she wasn’t quite sure why she said it.
The ambulance rushed her to a community hospital. When the scans came back, she was transferred to another one. Hannah had an aneurysm in the internal carotid artery behind her left eye. That artery is a major supplier of blood to the brain.
There was brain bleeding, doctors told Hannah and Chris. She had had a stroke, and it had been a stroke of luck that she hadn’t been home alone at the time. The artery had burst and there was still a blister aneurysm to contend with. Think of a garden hose filling a water balloon. Now think of that water balloon having filled from a weak point along the garden hose and now swelling with continuous, pulsing pressure from the heart just upstream of the internal carotid artery. That’s more or less what was happening behind Hannah’s left eye.
Hannah overheard a doctor say, “It’s life or death.” The nurse in her thought, “Oh, that poor patient. I hope he’s OK.” Then she realized the patient was she. Chris kept vigil at the hospital as family and friends took care of Raegan. Hannah was at times lucid and conversant. Then her eyes rolled back into her head and a seizure commenced. She spent five days in the hospital’s neuro ICU before doctors there recognized that they couldn’t risk treating her. They called the UCHealth Stroke and Brain Aneurysm Center on the Anschutz Medical Campus and described the case of a young nurse they felt could have huge complications.
University of Colorado School of Medicine neurosurgeon Dr. Christopher Roark took the lead when she arrived. He sent Hannah for a new set of scans and saw that indeed this was a high-risk case. In addition, Hannah’s middle cerebral artery – another important blood supply to the brain – depended entirely on the internal carotid artery (in many people, there’s a circle of arteries that acts as a sort of backup). Roark well knew that operating on a blister aneurysm was fraught. It has a consistency of tissue paper. Fortunately, there was another option – one that, as Roark put it, has “revolutionized the treatment of some aneurysms.”
In 2011, the U.S. Food and Drug Administration approved a Medtronic product called the Pipeline Flex embolization device. It’s made of a fine woven mesh of cobalt chromium and platinum tungsten and can be delivered via catheter through a small incision near the groin. In Hannah’s case, the catheter would snake up through the aorta and into the internal carotid artery, where Roark would position it and expand the mesh tube. That would stabilize the damaged artery and, by channeling blood flow through the artery’s natural path, take most of the pressure off the blister aneurysm. The artery could then heal naturally.
The procedure is minimally invasive, and the complication rate is low when there hasn’t already been brain bleeding. Hannah didn’t have that luxury. Roark figured the risk of a clot or bleed as a result of the procedure to be in the 20% to 25% range. Assuming she made it out of the operating room alive, Hannah could end up paralyzed on the right side and unable to talk or even understand speech.
Prior to the surgery, Roark sat down with Hannah and Chris. He simplified the math somewhat. Among those with ruptured brain aneurisms, 10% to 15% die before getting to the hospital. One complication or another kills 40% to 55% within six months. Of the survivors, two-thirds have some degree of deficit, some mild, some severe, and the remaining one-third (33%) end up completely normal afterward.
“Let’s go with the last 33%,” Hannah said.
Chris brought Raegan to the hospital so Hannah could say goodbye. It was no easier with Chris.
“I want to raise our daughter with you,” she told him. “I don’t want to leave you as a single dad.”
The procedure took but a few minutes, and no sooner was it over than it was clear to Roark that the last 33% it would be.
There had been damage done by the initial bleed, though. Hannah spent 26 days in UCHealth University of Colorado Hospital (UCH) Neuro ICU. Between the weakness from atrophy and the damage from the stroke, she could hardly walk. She did physical and speech therapy for months afterward. The family moved in with her parents Mark and Musetta Dean in Parker for help not only with Raegan, but also with Hannah.
Hannah and Chris had, for obvious reasons, set aside the idea of having more children. But in June 2020, a new set of scans showed Hannah’s internal carotid artery to have entirely healed. Roark took her off one of two antiplatelet drugs he had prescribed to prevent clotting. With that, he told the couple they had his blessing to get pregnant again. They wasted no time.
Hannah received prenatal care through the UCHealth Maternal Fetal Medicine Clinic – Anschutz Medical Campus, where doctors coordinate high-risk pregnancy care with primary-care and specialist physicians such as Roark. Given Hannah’s clean bill of health, his interactions were minimal, Roark said.
Cooper was born in early March this year at 37 weeks – a rise in Hannah’s blood pressure had led the obstetrics team to induce delivery at that point. He weighed just over seven pounds. One might think that, given the young family’s outsized share of health scares, fate would smile upon them this time around.
But Cooper was no sooner born at UCH than it was clear that he was having a hard time breathing.
The care team ruled out a heart issue such Raegan’s. This problem looked to be with the lungs themselves. Dr. Tom Parker, a CU School of Medicine and UCHealth neonatal and perinatal specialist, considered several possibilities.
One was too little surfactant – the material that holds the lungs open and allows babies to breathe with ease. Surfactant deficiency is much more common with preterm babies, but does occasionally happen with seven pounders such as Cooper, Parker says. Another possibility was that the lungs had retained some amniotic fluid or, during birth, that Cooper had aspirated fluid. Or perhaps Cooper had a lung infection.
The path forward was consistent across those possibilities: Cooper would spend some time in the neonatal intensive care unit with a CPAP machine not so different from those used by adults with sleep apnea. The machine would push air enriched with supplemental oxygen into Cooper’s lungs and help him breathe while his body developed and healed. Should an infection manifest, antibiotics would be administered.
Hannah admits to being “high-strung” in the NICU.
“One of the docs said, ‘Don’t worry – he’s the least-sick child here,’” Hannah recalled. “And I was like, ‘Listen, if you knew what we’ve been through in the last three years, you’d understand.’”
Parker had been meaning to sit down with Hannah and Chris but hadn’t managed to connect. At one point, he spotted Hannah walking out of the NICU and ran down the hall to catch her. They sat down in Cooper’s NICU room. They talked for a few minutes, and Parker conveyed this message, as he recalled: “Even though Cooper was in the NICU, and this wasn’t going as we would have predicted or as she would have wanted, this was going to be OK.”
Family of four
And it did turn out OK. While the cause of Cooper’s lung problem remained unclear, Cooper’s lungs strengthened. Hannah and Chris got him back home just before two feet of snow buried metropolitan Denver the weekend of March 12. Cooper stayed on supplemental oxygen and basked in a bili light for a few days. Three months later, he was as healthy as his big sister and his mom.
Hannah and Chris Holt (not to mention Raegan and Cooper) have been through a lot. They’re well aware that striking advances across many fields of medical science have made their family of four possible. They’re grateful for the care they’ve received and the personal qualities of those delivering it.
“It was literally every single doctor, nurse, therapist – even the people who bring the meals – they were just so professional and so caring at the same time,” Hannah said.
Chris’s initial impression upon arriving at UCH’s formidable campus in Aurora was one of slight worry. Would Hannah just get lost in such a massive place?
“Then you realize there are so many resources. Other hospitals look like neighborhood clinics,” he said. “If it had been anywhere else, it would have been a totally different outcome.”
Hannah’s take was simpler yet.
“Go to UCHealth,” she said. “I promise you, they’ll figure it out.”