for Philly Chef Brad Spence
What was supposed to be a dream vacation turned into a nightmare for 27-year-old Morgan Smith.
It wasn’t exactly a dream vacation for Morgan Smith – more of a nightmare, actually.
Last June, the day before Morgan, then 27, was due to leave for Switzerland with her mother, she started feeling a “weird sensation of hypersensitivity” in her hands. That night, she was kept awake by severe pain in her right shoulder. The next day, her leg began tingling. Thinking she was well enough to get on a plane, she spent most of the overnight flight standing — because sitting was so painful.
During the next three days, Morgan’s sight-seeing was disrupted by increasingly intense nerve pain and breathing difficulty. When the doctors at an emergency room in Berne couldn’t offer a diagnosis and wanted to perform a lumbar puncture and MRI, Morgan opted instead to fly home. Her father, who met her and her mother at Philadelphia International Airport, immediately took her to the ER at Thomas Jefferson University Hospital.
PEG in the ICU
Choosing Jefferson for accurate diagnosis and treatment was an easy decision for Morgan, who’d recently marked her two-year anniversary as a Pathologist Assistant in Thomas Jefferson University’s Department of Pathology, Anatomy and Cell Biology laboratories. “I love working here and I trust Jefferson,” she explains.
Within hours of her June 11 arrival, Jefferson doctors diagnosed Morgan with Guillain-Barre Syndrome (GBS) and admitted her in Jefferson’s Medical ICU to get her stabilized. On June 24, she had to be intubated by a Rapid Response Team for acute respiratory failure due to GBS and was transferred to Jefferson’s Neuro Intensive Care Unit. On July 10, she underwent a tracheotomy and placement of a percutaneous endoscopic gastrostomy (PEG) tube for her nutrition, hydration and pain medications, including gabapentin and tramadol.
On July 22, Morgan was transferred to Jefferson’s Acute Rehabilitation Unit. Under the supervising care of the unit’s Medical Director, Dr. Kristofer J. Feeko, Morgan underwent another five weeks of care – this time, in the form of daily physical therapy, occupational therapy and speech-language pathology.
“At first, my physical therapist, Alex Moriconi[, PT, DPT, NCS], had to coax me to get out of bed,” recalls Morgan. “All of my muscles felt like they’d wasted away because I hadn’t been using them. I wasn’t strong enough to lift my arms and legs to get into a wheelchair. During my first few days in rehab, I also had a terrible time with fluid in my lungs that I was frequently coughing up. Fortunately, Dr. Feeko checked on me and adjusted my medications each day, and my nausea and symptoms soon went away.”
It took four weeks before Morgan was able to get out of bed and into a wheelchair entirely by herself, but her confidence, like her muscles, steadily grew stronger. When wheeled down to the unit’s gym, Alex helped Morgan regain the ability to stand and sit by herself, raise her arms and shoulders – basic functions we take for granted. Gradually, she was able to walk with the horizontal bars, and then a walker.
“The most pivotal moment in Morgan’s physical therapy rehabilitation was her first uncoordinated steps in the horizontal bars with the assistance of two people,” says Alex. “It was a culmination of about two weeks of training by our therapy team, and made her realize that walking out of our rehab unit was a real possibility. From there, she quickly progressed from perfecting her walking pattern with our over ground body weight supporting system to eventually walking our Facility dog, Newie, without an assistive device. Her grit, continual formation of new goals and our comprehensive team made her progress so quick.”
“Each day, I was able to move a little further, it felt a little easier, and I was able to do something I hadn’t done the day before,” says Morgan about her physical therapy. “That totally helped me psychologically.”
Morgan also worked with occupational therapist Sara Frye. Advanced Clinician II, OTR/L ATP, Jefferson Acute Rehab Unit, Thomas Jefferson University Hospital.
“Sara was amazing,” says Morgan. “We worked a lot on my arms – especially my right arm, which I could barely lift when we started. We started every day with arm stretches, because they felt really tight. Soon, I felt strong and confident enough to lift my arms above my head so I could put my hair in a ponytail. She also took me through various motor skills so that I could regain the ability to pick up little items and put them in small spots, and she helped me to write words again so I could communicate more clearly.”
“When I first met Morgan, she was so weak she was unable to do anything for herself,” recalls Sara. “We knew Morgan loved her dogs and her job at Jefferson, so we incorporated these things into our therapy. We were able to use her work instruments to complete a paper cutting project. This was meaningful because it allowed Morgan to work on her fine motor skills while gaining confidence that she would be able to do her job again.”
Eat, Drink and Feel Normal
Early on, Morgan wasn’t able to eat at all, and after having been intubated for a few weeks, had great difficulty eating, drinking and swallowing. Her speech-language pathology exercises, administered by Mari Doran, strengthened her vocal cords and tongue.
“I also had several nurses during my stay at Jefferson, and they were all very attentive and encouraging,” adds Morgan. “Every nurse, such as Donna Curtain, was so excited and happy to hear about each milestone I was making and it was really encouraging. I felt like they were always on my side, rooting for me!”
All in all, Morgan spent 10 weeks as an inpatient at Jefferson – five in intensive care and five in acute rehabilitation.
A week before her discharge in late August, accompanied by therapists Alex and Sara, went on a short outing to Center City ice cream parlor Scoop DeVille for a treat.
“I don’t know which I enjoyed more – the ice cream or being outside for the first time in two-and-a-half months,” says Morgan.
Adds Sara, “Morgan was surprised when I suggested leaving her wheelchair behind, but she was able to walk down the block with her walker and gain confidence she was ready to go home.
“Working with Morgan was a pleasure because of her adventurous spirit and determination. I can’t wait to see what else she will accomplish in the future!”
Morgan spent a few weeks resting and exercising at her parents’ home in Delaware. Just a couple of days after being discharged, she attended a close friend’s wedding. “I wasn’t able to dance, but it was so good to see everybody. I’m not as strong as I used to be yet, but now, I feel almost normal in terms of my ability to move.