Call it a medical miracle.

Or a skilled surgeon. Teamwork at its best. A family looking after its own. A community giving when it’s needed most.

The remarkable saga of the successful repair of three ruptured abdominal aortic aneurysms is all of these. The procedure, known as the infamous triple A surgery that has upwards of a 90-percent mortality rate during or after surgery, was performed three times at Providence Kodiak Island Medical Center during the past five years.

Today, the faces at Providence behind the successful surgeries are proud. Together they stretched the resources of their relatively small facility and, while beating the odds, achieved feats that lead to three more people realizing their lives were destined to endure.

Two of the three triple A surgery patients — Gloria Cabbab and Phyllis Watkins — their family members and a few medical personnel at Providence sat down with the Kodiak Daily Mirror for interviews about the events.

‘The general surgeon’s worst nightmare’

The aorta is the main artery of the body that, if hemorrhaging to the point that doctors define as a rupture during an aortic aneurysm, can be immediately fatal — even within a matter of minutes. Patients who do make it to a hospital generally complain of severe pain in the abdomen or back. Some can eventually go into shock, depending on how long the aneurysm has been ruptured and how rapidly it is bleeding.

If the patient’s blood pressure drops, becoming hypotensive (low blood pressure) at any point during a triple “A” surgery, the mortality rate is roughly 90 percent, said general surgeon Dr. Greg Norkus of Providence. Even after successful surgeries, complications from the initial hemorrhaging can still lead to death.

Norkus was the leader of the large medical personnel team that successfully completed the three triple “A” surgeries. Even with his background in vascular surgery, he said each instance of this kind is serious, a kind of worst-case scenario even in the emergency room.

“A ruptured aneurism is kind of a joke. It’s like the worst thing that can happen,” Norkus said. “If you want to kid around and get somebody’s attention, you make a joke and say there’s a ruptured aneurism in the emergency room. It’s the general surgeon’s worst nightmare.”

Each case he’s seen is memorable.

“From the surgeon’s standpoint, when you’re talking to these people, in your mind you’re thinking, ‘Well, chances are the patient I’m talking to right now … (will) be dead,’” Norkus said. “These patients have the look of death in their eyes. I think they sense it, too. You don’t forget that.”

He said it’s unusual for a small community like Kodiak to do three triple “A” surgeries, successful or not. In most areas, those types of patients might be evacuated to larger, more comprehensive medical facilities. Kodiak’s location, however, makes that kind of transport difficult, with a roughly four-hour minimum lag time from hospital bed to bed — Kodiak to Anchorage. Many patients would not likely survive such a delay in care.

“The uniqueness of our environment, being isolated and such a long distance and time away from another major medical center, puts us in a situation where we would have to deal with problems that most hospitals of this size would never have to deal with,” Norkus said.

‘We needed them and they stepped up and did it’

Norkus credited from among the host of favorable outcomes as to why Cabbab, Watkins and the third patient are alive today to a quick diagnosis in all three cases. Furthermore, there was an “extraordinary effort by the hospital and medical personnel to do the type of surgery that can fix these aneurisms. It’s not the type of thing that would be typically be done in a hospital of this size,” he said.

The staff anesthetists, including Dr. Bill Twohy, who was involved in the surgeries on Cabbab and Watkins, also did their jobs well, keeping the patients stable during surgery and afterward when they were sent to Anchorage for further treatment.

“The receiving physicians (in Anchorage) were just amazed at how stable they were,” said Norkus.

The triple A surgery involves a small medical operating army: around 25 medical personnel. Besides surgeons, several more nurses are needed in the operating room. A few replacements then help fill in vacant spots outside the operating room. The respiratory techs are maxed out. The lab personnel work hard as well for the increased processing demands.

Then there are the blood donors.

These were the life-saving Kodiakans who Providence has pre-screened and are on-call for blood donations at the hospital. For the triple A surgeries, a process that uses more than the normal amount stored at Providence, the donors’ blood went straight from them to the operating room to the patient.

They were called — and they came immediately.

“People just dropped what they were doing and came. It was awesome,” said Providence operating room registered nurse Virginia McCarty. She was involved in the surgeries of Cabbab and Watkins.

“The community didn’t have any problem coming in and giving blood,” McCarty said. “We needed them and they stepped up and did it. They didn’t say how come, why, no, I can’t do it now — they just did it. I think that’s how this whole town is.”

Twohy said from among his extensive experience at many hospitals, “Very few clinicals I’ve ever encountered involved so many people working together, as well as people outside the hospital working to save someone’s life. It really speaks volumes for the community … I’ve never seen people donate blood the day of the surgery for an emergency case like this. It’s a very, very giving community.”

McCarty and others were also very complimentary of Norkus’ surgical work.

“He’s so calm ... he just sort of tells us what we’re going to do, how it’s going to go, this is what (he needs), and we do it,” McCarty said. “And it works really well, and he stays calm the whole time. Therefore, I think the whole team, then, works really well because he’s confident in what’s doing. We’re confident in what he’s doing. It’s chaotic, but it’s calm at the same time.”

Norkus generously credited and thanked his staff for their efforts and said the successes help build staffwide confidence-boosting momentum for later on.

“Aside from the fact that we took care of an individual patient, it helps prepare you for the next bad thing that might happen,” Norkus said.

When asked about the idea of a higher-up medical miracle, he said he was open to it.

“The right people were there at the right time (and) made the right decisions,” he said. “Does that happen by chance or coincidence? Or are there higher powers at work? I believe there are.”

‘It’s a miracle. We’re done’

Sonny Basuel said when the EMTs came to pick up Cabbab and take her to the hospital that fateful day in July 2008, they called her “Auntie.”

Basuel, one of Cabbab’s six children, works at Providence in maintenance and facilities support. He was alongside his mother’s emergency at the hospital with two of his brothers. The three of them sat through the agonizing time in the waiting room while the surgery was in process. He said they were initially told Cabbab needed to be evacuated to another facility, only to be re-told that evacuation wasn’t feasible and the staff would perform the emergency surgery.

However, Basuel said he knew of Norkus’ success with two previous abdominal aortic aneurysms, so he felt slightly relieved.

“I was more relaxed than my two brothers … but still worried not knowing the outcome.”

Basuel did not know, though, the high fatality rate of the situation. Furthermore, the memory of losing his aunt and uncle to brain aneurysms was still fresh.

“Dr. Norkus said just pray, and we’ll hope for the best,” Basuel said.

The three brothers waited for about three hours. The support came in.

“Once somebody heard, the word spread around,” he said. “People, family members, friends in general came in to see us.”

They received two updates during the surgery. They were told everything was going OK. But the third time was the charm.

They came to the brothers sooner than expected and said, “It’s a miracle. We’re done.”

Cabbab was then taken to Anchorage for more treatment, where she had some more close calls like stopped breathing. Cabbab said she was told she “died” twice but was revived a third time.

“I just saw myself praying and needing to live,” she said. “For the last time, make me live and let me be able to see my grandchildren and my children.”

Cabbab’s recovery has been long, but today she is back in Kodiak at Providence and doing well with physical therapy. She wears Buddhist prayer beads and has pictures of her family — including some of her 13 grandchildren — near her bed.

She can move her hands and talk, but nerve damage remains in her right foot. Still, she has been able to, on her own, recently brush her teeth and use the restroom.

“That’s the mindset we wanted her to have … my mom, she has a strong mind,” Basuel said. He added that he was very happy in her recovery.

“The first time I saw her in a wheelchair, actually moving around herself, that shocked me. I never imagined her being in that position. I thought she’d be stuck in a wheelchair without being able to move herself. Now she’s to the point where she can get in and out of bed, almost by herself with a walker.”

Cabbab chimed in: “I told myself I’d be running around the corner in the hallway.”

‘But there was still a chance’

Kathy Watkins, daughter-in-law of Phyllis Watkins, knew the odds were against Phyllis’ survival — only about 10 percent. It was a number she hung on to that paid off.

“But there was still a chance,” Kathy said.

Like Cabbab, Phyllis also was sent to Anchorage after the first successful surgery, which happened just before Christmas in 2006. Understandably, the whole ordeal made for an upsetting holiday. Learning about the various stages of Phyllis’ condition was an emotional rollercoaster for the family, especially with the recent memory of another family member in New York who died from an aneurysm.

“Grandma was gone. We weren’t sure if Grandma was going to make it,” Kathy said. “We had already lost (our uncle) … we had a gloomy Christmas.”

While Kathy and the family waited during the surgery, they said they became shocked at the sight of the blood donors.

“There were people lining up, going one after another, one after another,” Kathy said. “We were just overwhelmed. Later on, I told (Phyllis) she was related to half the town.”

Kathy said the family received a lot of support.

“There was a prayer chain going around … this community, I tell you, when people need something or there’s a tragedy or anything like that in this town, it’s like they just all come together.”

When she later found out, Phyllis said she, too, was shocked at the blood donations.

“I couldn’t get over that — and everybody I talked to said they were praying for me, and they don’t know me … but they were praying for me,” Phyllis said. “It was just amazing.”

Phyllis today is at her home, undergoing physical therapy but still endures numbness in her feet. She said she feels lucky to be alive, and mentioned at least one reason to stick around — her granddaughter, Amy.

“I told Amy when she was a little girl that I was going to hang around for her wedding. That’s what I’m gonna do,” Phyllis said.

Kathy summed up her and her family’s feelings for the work done at Providence: “You can’t thank somebody enough. You can’t thank anybody (enough) for a life.”

Mirror writer Bradley Zint can be reached via e-mail at bzint@kodiakdailymirror.com.