Adapted with permission from Duke Magazine, November-December 2012
Kendall Bradley checked her phone and gave herself 35 minutes to fall apart. Shed left Nick in the MRA machine, his eyes full of pain and fear, and was finally alone. Or, at least, as alone as one could be in the hospital triage room. Somewhere in Ho Chi Minh there had been an accident, and victims were being rushed in in shocking states of disfigurement. The chaos did nothing to quiet Bradleys sense that her friends situation was spinning wildly beyond her control.
Her phone buzzed. Maybe its good news, she thought. Henry Friedman, her mentor at Duke, had been working connections to get them out of Vietnam, and had been consulting with Duke doctors.
Kendall, he said, you need to understand how serious this is. ... There is a 70 percent chance that Nick wont survive.
Friedman continued, passing along a colleagues instructions about medications Nick should receive. Bradley mumbled something and hung up. Nick Tsipis was 22, a varsity athlete. People like that dont just die. Except sometimes they do. Bradley, who would start medical school in six weeks, knew that much.
The lesson that Tuesday in June 2011 was positive energy, and Nick Tsipis was beaming smiles, slapping hands, whipping the kids into a kinetic frenzy. He felt great. The camp was in its final days, and after three weeks in the Vietnamese jungle, he was ready to be done. Bounding to the front of the classroom, he shouted, Todays going to be a great day!
And then, a flash of excruciating pain. His knees buckled and his stomach heaved.
Not wanting the kids to see him get sick, Tsipis stumbled to the back of the room, collapsing on a bench. He rolled over and threw up violently. Just give me a second, he mumbled. But by the end of class, he looked no better, and the other teachers fetched the camp director, who ran off to find Bradley.
Bradley had known Tsipis since they had arrived at Duke in August 2007 as soccer recruits. Both were interested in medicine, and they shared a connection to Henry Friedman, a Duke neuro-oncology professor. Friedman encouraged them to join CAPE, a mentoring program he directs that gives participants a taste of medical practice. Through it, Tsipis and Bradley took internships at Dukes Preston Robert Tisch Brain Tumor Center, where Friedman is deputy director. They became fast friends.
Vietnam had been Tsipis idea. As freshmen, he and Bradley had gone there to help set up a series ofyouth campsBoth vowed theyd return one summer to coach. The demands of soccer and pre-med, however, always trumped their plans.
Then, a few weeks before their graduation, Tsipis called Bradley. Lets finish what we started, he told her.
Bradley agreed. Both were entering Duke medical school in the fall, and theyd probably never have a free summer again. But privately, she worried how shed handle three weeks in a country whose culture and language were unfamiliar to her.
Those doubts persisted at Thuan Hung School. One day, a girl asked if she could leave early. Rain was coming, she explained, and she had to ride her bicycle for two hours to reach home. What if she fell and broke an ankle? Bradley worried. The camp had no doctor on staff, and as pre-med students, she and Tsipis often were called on to look at bumps and scrapes. But what if something really bad happened?
When Bradley walked in to see Tsipis sprawled out on the bench, barely responsive, she had no idea that her worst fears already were playing out deep inside her friends brain.
Its normally an hour-and-a-half drive from Thuan Hung School to the nearest hospital in Can Tho, the largest city in the Mekong Delta. After seeing Tsipis, the schools bus driver made it in 45 minutes. Tsipis couldnt walk or open his eyes. He was about as sick as Ive ever seen someone, Bradley says. As the driver weaved maniacally through traffic, she grabbed Tsipis cellphone to find his parents number, but the phone was dead. So she grabbed hers and called her mom.
Kathryn Andolsek recalls her daughter sounding characteristically calm but concerned about how to handle her friends deteriorating health. Andolsek, Dukes associate director of graduate medical education and a family-medicine physician, talked with her about the cultural and language differences she was likely to encounter and promised to contact some colleagues who knew Vietnamese health care. The conversation was strategic. I just wanted to be prepared for whatever I was going to face in Can Tho, says Bradley. Its not like I thought Nick was going to die.
It seemed far more likely that Tsipis was having a bad reaction to something he ate. For two days, Bradley stayed by Tsipis bed, spoon-feeding him sips of water every 10 minutes and shooing flies away. At one point, Bradley noticed that Tsipis pupils were uneven. Then, she detected a slight shuffle in his step. In CAPE, Friedman had taught them how to do a neurological exam, and she knew these could be signs of brain dysfunction. But Tsipis was stronger and beginning to eat rice. The doctor was ready to send him back to the camp. He was 22, Bradley says, So I just thought, youre overreacting. Hes going to be fine.
At 8:45 on Thursday evening in Durham, Kathryn Andolseks cellphone rang. Tsipis was not fine.
It was Friday morning in Vietnam. Tsipis had been discharged from the hospital 14 hours earlier. In the night, his head throbbed, as if his skull were in the clamps of a vise. At 6 a.m., his roommate went to find Bradley. They needed to get back to a hospital.
Through her moms contacts with the Duke Global Health Institute, Bradley had gotten in touch with David Dennis, an internal-medicine doctor who had directed a project on infectious diseases in Vietnam for the Duke-NUS Graduate Medical School in Singapore. Dennis told her the only hospitals equipped to diagnose neurological symptoms were in Ho Chi Minh.The taxi trip was a five-hour boxing match with bumpy dirt roads. As Tsipis flopped around the back seat, the pain worsened, and he began to slip from consciousness. Bradley, a Catholic, began saying Hail Marys. She didnt know what else to do.
It had been four hours since theyd arrived at SOS International, a clinic catering to foreign citizens.
You appear to have had a stroke in your right cerebellum, the doctor said.Tsipis was floored. Terrifying words crept into his head: paralysis, brain damage, loss of function. He called his parents. It was early morning in Winston-Salem, where they lived, but theyd been awake, nervously awaiting an update. He told them there was no reason to worry. Then he hung up and bawled, not so much for his own condition, but for having had to lie to them. There was plenty of reason to worry.
Bradley, meanwhile, was on the phone with Henry Friedman, who had looped in neurosurgeon Allan Friedman, codirector of the CAPE program. The Friedmans (who are not related) wanted to see Tsipis MRI scans, but the clinic had no way to digitize the films. So Bradley took a picture with her phone and e-mailed it. When she looked at the film, she was aghast: A huge swath of Tsipis cranium glowed stark white, an indication of swelling around the brain. If it got worse, he would need immediate surgery to relieve the pressure on his brain.
You have to get the hell out of there, Henry Friedman told her.
There was just one problem: They didnt have their passports.
Allan Friedman had been in the operating room at Duke Hospital when Bradley called. Someone put her on speaker phone, and he took in the details of Tsipis case in the middle of surgery. The Friedmans agreed Tsipis needed to get out of Vietnam and to somewhere with more-advanced medical technology. Another stroke, or a ruptured artery, would almost certainly have been fatal.
But their passports were locked in an office five hours away theyd had to forfeit them to clear up an error with their travel dates. The U.S. consulate in Ho Chi Minh and the embassy in Hanoi had been no help, so Henry Friedman offered to make a few calls.
He started with Paul Vick, associate vice president for government relations for Duke Medicine. Vicks contacts in Washington told him passports on such short notice couldnt be done without high-level intervention. Who do you need? Friedman asked. Name it, and Ill get them. Friedman turned to former U.S. Sen. Tom Daschle, whom hed known for several years. Daschle called the Secretary of States office.
At 4:30 on Saturday morning, they had been issued new passports. A consulate official delivered them to the SOS clinic. The documents looked fake badly pixilated photos sheathed in cheap plastic but the official beamed as he presented them. The first ones Ive ever made, he said.Six hours later, armed soldiers marched Bradley and Tsipis to a small plane. Within 15 minutes, it was bound for Bangkok, where the Friedmans had arranged for Tsipis to be cared for by Sith Sathornsumetee, a Duke-trained neurologist. Tsipis closed his eyes, one last time praying that he would open them again.
It was not over when they reached Thailand. Sathornsumetee put Tsipis on blood thinners to stabilize him for the flight home, but he kept pushing back his release. Tuesday became Thursday, which turned into Saturday and then Monday. Tsipis parents were stuck in a frustrating limbo, unsure of whether to fly off to meet him or await his arrival. Their sons final harrowing episode a sudden return of his headache, accompanied by a tingling sensation came as his parents prayed in Duke Chapel for his safe return.
But there was safety in Thailand. They were sheltered in a modern, Western-style hospital, no longer exposed to the raw edge of a foreign health system. Bradley began to contemplate the string of events that delivered them from the depths of the Mekong Delta. In retrospect, much of it seemed pure luck being in the right place at the right time, talking to the right people. We had a lot of luck and a lot of help, Bradley says.There was the Friedmans with their knowledge and connections; Kathryn Andolsek with her steadying advice; the Vietnamese doctors. There was Chris Woods, a Duke physician with expertise in infectious diseases and global health, helping Andolsek locate contacts in Vietnam. There was Bradleys father, Don, a chief medical officer with an insurance company, waking a colleague in the middle of the night to get Tsipis insurance certification for a procedure. When it was over, Bradley made a thank-you list of those who helped along the way. She counted 57 names.After 10 days in Bangkok, they were finally cleared to return home. They flew first class, accompanied by a critical-care nurse. When they arrived at Duke Hospital, Tsipis was swept up in a whirlwind of grateful family. Less than a month later, he would walk his mother down the aisle at his sisters wedding. To date he has no lingering symptoms of his stroke.
As she watched her friend disappear into the embrace of his parents, Bradley turned to her own. Lets go home now, she said. Her mother drove. They parkedand walked into the kitchen. Bradley checked her phone. In the past two weeks, she had made more than $4,000 of calls and text messages. Her phone had chosen this moment to die. Shed exceeded her maximum charge and been cut off. Doesnt matter, she thought. Im done. And she headed off to the beach.