'The Miracle on Fort Washington Avenue'
The day Andrea Hessekiel called 911 for her husband was supposed to be the last day of their Florida vacation. She and David had spent a lovely few days relaxing with friends. They planned to pack up that morning, head to the airport and return to their busy life in Westchester, NY. But first, David decided, he’d do a bit of yoga.
Healthy and active, and only in his 50s, David was holding a simple pose when he was hit with an excruciating headache. He collapsed in pain. Andrea called 911, and an ambulance took David to the local hospital. Almost immediately, it was clear the Hessekiels were confronting an extreme emergency—bleeding in David’s brain.
Only five days later, the pair would indeed be back in New York—here at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital. Two Columbia neurosurgeons would play crucial roles in the Hessekiels’ lives: first, Dr. Sean Lavine, Professor of Neurological Surgery and Radiology, and then the Department Chair, Dr. Robert Solomon. But in the emergency room in Florida, Andrea did not know any of this.
Doctors at the Florida hospital let the Hessekiels know that a procedure called an angiogram was the next step—and it needed to happen right away. An angiogram is a minimally invasive, through-the-blood-vessels procedure that is used to diagnose and treat problems inside blood vessels. The doctors began the process. But an hour into the angiogram, there was news. As Andrea remembers, “The interventional radiologist came to me and said, ‘This is more complicated than I thought.’”
The doctor had discovered the cause of the bleeding. It turned out that David had a tangle of blood vessels in his brain—a condition known as an arteriovenous malformation, or AVM. To make matters worse, along with the AVM were five brain aneurysms—weak, ballooning sections in the walls of nearby vessels. If these walls gave out, the escaping blood could be deadly.
The doctor told Andrea he would attempt to treat the aneurysms. He expected to need several hours. While Andrea waited in a “highly agitated state,” she reached out to friends and family. One friend was a neurologist, and another happened to be the sister of Columbia neurosurgeon Dr. Guy McKhann. Both described the Columbia neurosurgery team and made Andrea wish her husband were there. But he wasn’t: The Hessekiels were 1,200 miles away.
Five tense hours passed. At last, the medical team had a report—and unfortunately, there was no progress. In fact, there was a new complication: In addition to the AVM, one of the aneurysms had begun to bleed, and the doctor had to end the procedure to avoid additional risk.
The Hessekiels had a decision to make. David urgently needed further treatment. The question was, who should undertake that treatment? The doctors at the hospital in Florida acknowledged that they did not have a wealth of experience with similar cases. Andrea recalls general agreement among the physicians there that doing a second angiogram would be enormously risky. At the same time, everyone balked at the idea of moving David in his fragile condition.
Following up on her friends’ recommendations, Andrea got in touch with Dr. Lavine at Columbia Neurosurgery. It turned out that he had performed hundreds of similar angiograms. Talking to him felt different.
“I cannot tell you the level of confidence I felt when he began describing the procedure he would perform,” she remembers. “From the minute we first spoke, I knew my husband would be okay—if I could only get him to Dr. Lavine.”
But it was not at all clear that she could, with travel still a grave concern. Anxious days followed while Columbia’s team reached out to the doctors in Florida to try to help, with Dr. McKhann acting as liaison. David’s devastating headaches continued while those around him tried to make the high-stakes determination about where he should be. Ultimately, the surgical team in Florida prepared to go back in.
David’s operation was scheduled for Saturday afternoon. But on Saturday morning, a consensus emerged among the communicating doctors, their patient and his family: This was the wrong direction to go. It was time to reverse course.
“Sometimes, you just have to take a leap of faith and get on that plane,” Dr. Lavine told Andrea—and in the end, that’s what she did. David would go to Columbia.
With David’s head wrapped in medication-infused bandages for pain, the Hessekiels boarded a flight for New York. The trip felt long—and it was painful and frightening—but they landed. Grateful to have dodged a potential in-air crisis, they headed to Columbia’s emergency room.
David doesn’t remember much of his ordeal, but he does recall being admitted to the hospital in New York. The emergency department was ready for the Hessekiels’ arrival, and the resident who welcomed them was able to escort David straight to the neurological intensive care unit. She was “wonderful,” Andrea says. It was “as smooth as it could possibly be,” adds David. “We were so appreciative of that.”
In the Columbia Department of Neurosurgery, Andrea found herself and her family surrounded by supportive voices. She describes their arrival:
“Everyone was saying, ‘We know what you went through in Florida, and we’re going to take care of you.’ That alone was calming and encouraging. They told us, ‘You’ve come to the right place.’”
Andrea went home to gather her family while David spent the night in the ICU. The next morning, at 7 a.m., they were once again preparing for surgery. The chief resident explained the surgeons’ plans. Andrea recalls feeling that, this time, there were not going to be any surprises.
She was grateful David was finally at Columbia, in the care of a neurosurgeon so experienced and skilled. But of course she was still on edge as the surgical team wheeled David toward the operating room. Andrea says it meant a great deal to her that Dr. Lavine was kind and reassuring. She remembers that he “promised that if the surgery took longer than expected, we shouldn’t worry. It just meant they were doing a thorough job.”
The surgery began. Andrea sat with her children, her brothers and her sister-in-law.
We waited five-and-a-half hours. And then Dr. Lavine came out and said, “This was a more complicated procedure than I expected, but we were able to embolize [block off] all the aneurysms, and he’s going to be fine.” I threw my arms around this guy and started crying, as did everyone in my family. Everybody was crying.
Dr. Lavine had been able to create a safe path for blood flow. Blood would no longer enter David’s aneurysms, no longer press against walls that might break. With tremendous relief, David put the aneurysms behind him and embarked on his recovery.
First came nine days in the ICU. “Being in the ICU is very scary,” he says, “but the amount of attention I received was fantastic.” Soon, David could walk up and down the hallways. Because he was experiencing a bit of instability, his wife teased him a little, calling him her Frankenstein.
Over the next few weeks at home, physical therapy brought back David’s balance. As he recuperated, he had to sleep, he says, more than he had ever thought possible. David hoped to heal sufficiently for one more operation—if all went well, Dr. Solomon would address the AVM a month later.
Then it was time to meet Dr. Solomon. The Hessekiels knew he had vast experience in AVM surgery, but they didn’t know what sort of manner to expect. As it turned out, “he was kind,” says David. “We didn’t feel rushed. He spent a great deal of time with us explaining what needed to be done. We had a fabulous meeting with him.”
The Hessekiels learned they had options. Because of the particular kind of AVM David had, Dr. Solomon was optimistic about outcomes from either of two different methods for eliminating the AVM. One, a noninvasive approach called Gamma Knife, would allow the surgical team to target the AVM without making an incision. Radiation aimed at the problem area could act over time as a kind of “knife,” eventually shutting down the AVM.
The other approach, a more traditional surgery, would include a craniotomy—opening David’s skull to access the AVM and extract the tangled vessels. This way, the surgical team would have a greater degree of certainty that they were getting rid of the AVM. But the risk of complications was also higher. Dr. Solomon left the choice to the Hessekiels.
David and Andrea were both reassured by Dr. Solomon’s calm, his confidence, his status in his field and his level of experience. They chose the surgical option. “We were less scared by the time we left his office,” David said.
Dr. Solomon encouraged David to be active in the ensuing weeks, and David felt a bit better just knowing he was supposed to be out and about. His job was to get as strong as he could. A month later, he was ready. He went back to Columbia.
This time, the surgery unfolded exactly according to plan, and in the end, David was cured. “As long as I live, I will be grateful and in awe of how easily it went,” says Andrea. David was in the hospital for just 36 hours.
Now David is out of the woods—except when he chooses to play in them. He and Andrea have recently been enjoying the great outdoors, even whitewater kayaking.
David says his experience with his aneurysms, his AVM and the Columbia Department of Neurosurgery have added to his appreciation of life. And he especially appreciates that the surgery was completely successful.
Andrea says this period of time will always be with her, and she wants others to know the importance of finding the right physicians when it matters most. “The neurosurgery team saved my husband’s life,” she says, “and we are forever grateful. Every day I give thanks for the miracle on Fort Washington Avenue. I now truly understand what it means to receive outstanding medical care.”