Two Portland doctors say vaping marijuana oils likely led to the death of the Oregon patient they tried to save earlier this summer in one of six deaths nationwide now attributed to e-cigarettes.
Pulmonologists Jason Wells and David Hotchkin for the first time described the patient’s five-week struggle to survive.
They said Tuesday that they wanted to speak out now to warn people against the hazards of using e-cigarettes.
“It’s important that people understand that vaping is dangerous,” Hotchkin said.
Their patient seemed to get better after a special machine drew the person’s blood, saturating it with oxygen and then pumping it back inside the body.
Until the very end, recovery seemed possible.
Just an hour before succumbing in July, the patient had managed to walk in and out the intensive care room, with staff standing by for support and nurses trailing behind pushing the blood-pumping machine.
“It’s one of those cases that will stick with you for your career,” Wells said.
The Oregon patient was one of six in the country to die after using e-cigarettes amid a frightening rash of severe lung illness. At least 450 people in 33 states have fallen ill with the mysterious disease, according to data compiled by the U.S. Centers of Disease Control and Prevention.
State and federal investigations have focused on vape oils with THC, the chemical in cannabis that gives users a high. Most victims vaped such products, officials said, though some reported only using nicotine-based e-cigarettes.
The Oregon resident who died was on the “young” side of middle age and was using marijuana for chronic pain and recreational reasons, Wells and Hotchkin said.
Health officials have released no biographical information about the patient, citing the family’s wishes. They also wouldn’t name the hospitals where the person was treated.
State health investigators said the patient bought THC oil at two legal marijuana stores in Oregon. But as of last week, they had not found the product that the victim used before falling ill. Officials haven’t named the two stores where the person shopped.
The state is now investigating another vaping-related case of a severe lung illness, bringing the total number of Oregon cases to two. The second patient survived, the Oregon Health Authority said.
The Oregon resident who died while fighting the lung disease first went to a Portland emergency room after suddenly having trouble breathing.
The person was sent home with a prescription for an anti-inflammatory drug but got worse over the next two weeks and checked back into the ER, Wells said. By that point, lifting an arm made the patient feel like people do after exercising to the limit of their physical ability.
This time, the patient stayed at the hospital. But the person’s lungs kept losing capacity. The victim’s condition got worse every day. To cut oxygen use, doctors sedated the patient into a medical coma. They put a tube hooked to a mechanical ventilator into the patient’s trachea.
Nothing worked. Within a few days of coming to the hospital, the patient’s blood tests showed kidney damage, Wells said.
Hotchkin first heard of the case when he stepped out of a business meeting one Monday morning to take a phone call. The physician on the other line said a patient’s lungs were failing and that the person would likely have to be hooked up to an artificial lung.
Hotchkin and Wells work at the The Oregon Clinic in Northeast Portland but have privileges at a hospital that has one of the state’s few extracorporeal membrane oxygenation machines, which put oxygen into a patient’s blood. The machines are reserved for the most severe cases of respiratory illness. About 80 percent of people who need one are in such dire straits, they die.
Hotchkin said he immediately agreed to take the patient — and about an hour and a half after getting the call, the person was at the second hospital.
Hotchkin and Wells eliminated all the obvious possible explanations for the person’s illness. The cause wasn’t an infection, tests showed, and it wasn’t an immune system run amok.
The pulmonologists’ main concern was keeping the patient alive, Hotchkin said. Tiny errors could have major consequences, he said, and the focus was on making sure every detail of the treatment went smoothly.
The night the patient got to the hospital, the pulmonologists hooked the Oregon resident to the artificial lung and, soon after, took the person out of a medically induced coma.
The patient was now able to talk and walk. Over the next three weeks, friends and family visited in droves, Wells said. The patient was “a very optimistic person,” smiling often, talking and remaining upbeat, Wells said.
The patient walked multiple times, physical therapists standing by in case the patient needed support and nurses pushing along the lung machine. The doctors were trying to build up the patient’s muscle strength.
But the patient couldn’t stay hooked up to the lung machine forever. A lung transplant center in California agreed to take the patient for an evaluation. That didn’t guarantee a new lung but getting to the center was the necessary first step.
It didn’t happen fast enough.
About an hour after walking out of the ICU room and back to bed on the final day, the patient suffered a brain hemorrhage and died.
At the time, Wells and his colleagues were in a meeting to figure out how to transport the patient to the California transplant center.
It had been about five weeks since the patient first sought treatment. The patient originally had gone to the ER, left the same day, spent two weeks at home, went back to the ER, was admitted to the hospital for four days and then spent three weeks at the second hospital.
Wells and Hotchkin stressed that they don’t know what caused the person’s illness. All signs point to vaping, they said, but they didn’t do a biopsy that could have led to a conclusive diagnosis. They feared taking a sample of the patient’s lungs could be fatal. They hope an expected autopsy report will answer some of their questions.
But the absence of any other explanation and the parallels between the victim’s symptoms and those of patients elsewhere lead them to suspect that THC oils are the culprit. Like many victims nationwide, the patient had no infections, vaped in the three months before falling ill, and had nausea, severe trouble breathing and abdominal pain.
And the two pulmonologists have long harbored suspicions about vaping, they said. Wells and Hotchkin were categorical on their thoughts about using e-cigarettes of any kind.
“Putting a foreign substance in any form into your lungs is not safe,” Wells said.
— Fedor Zarkhin firstname.lastname@example.org
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