Back from the Brink: Teamwork and Quick Action Save a Life

Larry Black looked forward to a quiet retirement – playing golf, spending time with his wife, and enjoying his large brood of children, grandchildren and new great-grandchild. But just 13 days after stepping down as Chief Magistrate for the 20^th Judicial District of Virginia, Larry was in the Inova Loudoun Hospital Emergency Room (ER), fighting for his life.

An infection had invaded his lumbar spine and had spread to his brain. Only the quick action and expertise of a collaborative team of Inova nurses, emergency physicians, intensivists, orthopedic surgeons and neurosurgeons averted a tragic outcome.

The 76-year-old from Leesburg, Virginia doesn’t remember much about this shocking turn of events.

He’d been battling debilitating back pain and was scheduled for a lumbar fusion with Ali Moshirfar, MD, an orthopedic surgeon who is fellowship trained in spine care. He is also the  Medical Director of the Inova Spine Program at Inova Loudoun Hospital, a program of the Inova Neuroscience and Spine Institute (INSI). As the pain intensified, Larry began to feel other, odder symptoms. “I was lethargic and disoriented. I felt like I was walking around drunk,” he recalls.

When the symptoms progressed to acute delirium and a high fever, his wife, Cheryl, and Larry’s daughter, Danielle, rushed him to the Inova Loudoun Hospital ER after his oldest son, Dayton, was emphatically telling him over the phone that he needed to go to the hospital.  “To this day, I have no idea how we got this 250-pound man down the stairs and into the car,” Cheryl says.

ER doctors suspected a possible infection. After hours of waiting and multiple tests run, Larry was moved to the intensive care unit (ICU) where an emergency MRI revealed a septic facet joint in his lumbar spine with epidural and subdural extension.  The infection had moved beyond his bones and joints, invaded his subdural cavity of the spine and spread to his brain.  Without emergency surgery, Larry could die.

Inova’s comprehensive care delivery model and team approach produced a quick response that likely saved Larry’s life. Inova Loudoun Hospital, ICU physician Ignacio Mendiguren, MD, a critical care specialist, made the initial diagnosis. He immediately alerted Dr. Moshirfar, who arrived at 4 a.m. to perform an emergency, three-level posterior fusion. But the subdural spine infection had to be tackled immediately too. So, Dr. Moshirfar called in his INSI colleague, neurosurgeon and Associate Chair, Neurosurgery, INSI, Nilesh Vyas, MD. He came to help immediately with the emergency, and opened the spinal membrane and evacuated the subdural space.

Larry spent the next two weeks in the ICU engaged in a life-and-death battle.  “It was literally a roller coaster ride,” Cheryl says.  “One minute he was up, the next minute he was down.” 

Sarfraz Choudhary, MD, FACP, of the Infectious Diseases Tropical Medicine and Travel Clinic worked feverishly to find the right combination of antibiotics to flush out the infection.  Family and friends rallied around in support.  Slowly he began to recover.  One month after his surgery, Larry was discharged to an acute rehabilitation facility for intensive physical, occupational and speech therapy. 

Just 10 days later, Larry was back home.  For the next month and with the help of his mother-in-law, Mary Ann, sister-in-law, Kelly, granddaughter, Taylor, and neighbor, Cheryl, drove him daily to the Inova Loudoun Hospital Outpatient Infusion Center for his antibiotics infusion.  In addition, he continues physical therapy 2-3 days per week and trips to the gym to water walk.

Recovery has been a long, hard slog and tough. With grit and perseverance, Larry has regained many of his cognitive and functional skills. He can walk, go to the gym, drive, read and eat. He hopes to return to the golf course soon. But, he continues to face an uphill battle. Doctors still don’t know yet the full impact on his brain. “Healing from this type of infectious neurological injury is a slow and extremely challenging process,” says Dr. Vyas. “It can take several years and requires a lot of hard work.”

Still, the Blacks consider themselves fortunate and know that without the rapid response of Inova’s team of experts, Larry would have died. Dr. Moshirfar agrees. “Many people had to drop everything and come together quickly to make this happen,” he says. “Larry’s positive outcome is an outstanding demonstration of how Inova’s continuum of care and the commitment of its clinicians work in tandem to save lives,” he goes on to say,  “We are happy he is doing as well as he is.”