Brittany Malone - Death Diagnosis: Acute respiratory failure, diffuse pulmonary hemorrhage. Diffuse venous thromboembolism with deep venous thrombosis, severe anoxic brain damage
It was 12:30 a.m. on December 1, 2012 when my wife and I were awoken by 2simultaneous phone calls. The first call came from our youngest daughter Morgan to my wife’s cell phone which she keeps at her bedside every night. The 2nd call came to me from our eldestdaughter Ashley to my cell phone. When my wife’s phone rang, she stepped out of our bedroom to take the call and I immediately could tell that something terrible had occurred. Ashley told me that she was calling from the hospital and that Brittany has been taken by ambulance to the emergency room after she her head rolled back suddenly and she stopped breathing at Morgan’s house.
We immediately threw some clothes on and left for Chico which is normally a 3 hour drive. I called the hospital and they said that they would have the head nurse in charge of theNeuro ICU call back as soon as she was able to give us an overview of Brittany’ssituation.
I called Ashley and she explained that the 3 of them had gone out for the evening as planned even though Brittany was not feeling 100%. While they were out, Brittany was feeling “anxious” and said that she felt like her heart was racing, but she wasn’t sure if she wanted to go homeor not because we suspect she didn’t want to disappoint Morgan by leaving early. Brittanythen commented that the music was too loud so they decided they better go back toMorgan’s house so Brittany could relax. When they arrived back at Morgan’s’ house, Brittany sat onthe couch while she drank a glass of water and ate a snack in hopes that she would relax and begin to feel better. Ashley and Morgan were sitting on either side of Brittany in an effort to helpher feel at ease. A few minutes later Brittany’s head went back and she started gurgling and stopped breathing.
Ashley called 911 immediately and began to administer CPR to Brittany. The paramedics were dispatched and got there within minutes. When they arrived, Brittany was still not breathing so they continued CPR and used paddles to deliver electric shock a number of times with noluck. They inserted a breathing tube and then transferred Brittany to Enloe Medical Centerwhere she wasrevived.
Ashley said that the nurse told her this was very serious and that we needed to get there ASAP. I assured her we would be up there as fast as my car would go. After hanging up with Ashley, we drove in silence for the next few minutes until my phone rang again. My heart sank asI realized that Brittany had been without oxygen for more than a few minutes, and while Ididn’t know how long the brain could go without oxygen, I had a real bad feeling about this. Igave Dana a summary of the conversation that I had with Ashley and we drove in silence for the next few minutes until my phone rang again.
It was the head nurse from the Neuro Trauma Unit and she explained that Brittany had arrived at the hospital after suffering sudden cardiac arrest as well as respiratory failurewith pulmonary hemorrhaging and was now in a coma in critical condition. She said that it wasnot clear how long Brittany had gone without oxygen before they were finally able to resuscitate her. The nurse made it very clear to us that this was very serious and that we needed to getto the hospital as soon as possible. For the next 2 hours we raced to the hospital incomplete silence.
When we arrived at the hospital, the Neuro ICU was full of Doctors and Nurses actively tryingto save Brittany’s life. My poor daughters, Ashley and Morgan were completely traumatizedby what they had just experience with their sister. Then we met with a team of doctors thatwere struggling to understand why a perfectly healthy 23 year old woman could arrive at the hospital in her condition. They ask a series of questions like, does she smoke, do drugs, take prescription drugs, vitamins, herbs etc…our answers were "no" just like her sisters had told them. About a couple hours later Dana remembered that she was on birth control, called NuvaRing. It's seems like it’s a class all to itself…birth control…but it's really a prescription drug. None of us thought anything of it at the time as Ashley and Morgan were also using the NuvaRing contraceptivedevice.
Toxicology reports came back immediately and were all negative. Over 40 blood testswere initiated to determine if Brittany had an autoimmune blood condition such as vasculitis orlupus that might be causing the pulmonary hemorrhaging. A number of these tests would take up toa week to come back, so a process called plasmapheresis was started in order to filterBrittany’s blood of any autoimmune cells that may have caused Brittany to hemorrhage. This process is similar to dialysis.
As part of the preparation for the plasmapheresis process, a doctor attempted to insert aline into a deep vein in Brittany’s right leg, but he was unable to get it to feed into the vein due toa massive blood clot that was discovered. This was the first indication that the blood clot maybe the root of a series of cascading events that lead to Brittany’s condition. The doctors immediately removed the NuvaRing as they said it was likely related to the extensive DVT in her right leg.
Once the blood clot was detected, the doctors suspected that a condition called Disseminated Intravascular Coagulation (DIC) had taken place. DIC is a condition that presents itself whenthe consumption and subsequent exhaustion of clotting proteins (soldiers in our blood that fightoff clots) causes bleeding in other areas of the body. With Brittany, the clotting proteins were "used up" fighting off the DVT in her leg which likely left the rest of the body depleted ofthe necessary clotting factors required to stop the bleeding in her lungs. In some cases like Brittany’s, the doctors explained that bleeding simply starts on its own without any injurydue to how “thin” the bloodbecomes.
The doctors suspect the DIC event triggered the cascading effects which in turn lead to anacute onset “Diffuse Alveolar Hemorrhage” (DAH) causing blood to collect within the alveoli in her lungs. We were told that Brittany’s blood likely became so thin that it caused the bloodcells surrounding her lungs to actually leak into her lungs and flood the alveoli. The alveoli arepart of the lungs that are responsible for the exchange of oxygen in our lungs. These alveoliinflate and deflate with inhalation and exhalation. If enough alveoli are affected, gas exchange is disrupted and the brain is stared of oxygen.
Here is a summary of the cascading events that we understand lead to Brittany’s death. 1.DVT - Alargebloodclotdevelopedinadeepveininherlegwhichwebelievewascaused by the NuvaRing.
2..DIC - Disseminated Intravascular Coagulation. This condition occurs whenthe consumption and subsequent exhaustion of clotting proteins (soldiers in our blood that fightoff clots) induces severe bleeding in other areas of the body. With Brittany, the clotting proteins (clot breaking solders in the blood) were "used up" fighting off the DVT in her leg which likely left the rest of the body depleted of the necessary clotting factors required to stop the bleeding in her lungs.
3.DAH - Diffuse Alveolar Hemorrhage. Blood began to weep into her lungs and intothe clusters of alveoli which look like individual grapes in a bunch. The individual alveoli aretightly wrapped in blood vessels, and it is here that oxygen exchange occurs. When the bloodleaked into the alveoli, her lungs began to fill up with blood instead of exchanging oxygen.Normally the oxygen rich blood returning to her heart via the pulmonary veins is pumped backinto systemic circulation. Unfortunately, the amount of oxygen flow diminished rapidly,effectively starving Brittany’s heart and brain from oxygen. This correlates with the “anxious” feelings that Brittany was describing to her sisters and her boyfriend. Her brain was not receiving enough oxygen, so it signaled her heart to beat faster and faster until she reachedhypoxemic respiratory failure, had a heart attack, and lost consciousness.
4. This is when Brittany’s life began to quickly slip away. Unfortunately, the braincannot survive more that 3 to 5 minutes without oxygen before brain damage begins. A scanof Brittany’s brain was done right after she arrived at the hospital and the initial results didnot indicate any sign of brain damage, but the neurologist warned us that the results ofhypoxia (lack of oxygen to the brain) don’t typically show up within the first 24 hours.
Over the next 2 days, the neurologist conducted a series of extensive neurological evaluations on Brittany to determine the extent of brain damage that had occurred. I watched each of these tests hoping for a sign of life, but instead, I felt like I watched her die over and overagain. These tests were extremely painful to watch as the reality sank in that Brittany’s brainwas seriously damaged. No parent should ever have to witness these tests, but I could not give up hope, so I watched until I my heart could take no more. Eventually I could no longerwitness these tests. I will live with these horrific memories the rest of my life.
The doctor was preparing us for the worst case scenario which turned out to be true.Brittany had irreversible brain damage, and a final CT scan indicated brain death. He ordered asecond opinion and the results were consistent with the first. We arranged for a 3rd opinion andheld out hope as we were desperate to save her life. Our entire family was with us and we allprayed for a miracle, but unfortunately, our prayers were not answered. Our beautiful, healthy,sweet, responsible, funny and loving Brittany was gone forever…and there wasn't anything I coulddo for her or for my other precious daughters.
DEATH DIAGNOSIS: Acute respiratory failure, diffuse pulmonary hemorrhage. Diffuse venous thromboembolism with deep venous thrombosis, severe anoxic brain damage. We believe the blood clot (DVT) which was caused by the NuvaRing is the true cause of death. Without the clot, none of the events that followed would have occurred.
All of the tests that were conducted to determine if Brittany had some sort of an autoimmune blood condition came back negative, so this solidified our theory that the NuvaRing likely caused Brittany’s death.
True to form, Brittany continued her life journey of compassion all the way to the end.Five people around the nation were blessed with Brittany's greatest gift of all…her vital organs.Her lungs are now breathing fresh air in North Carolina; her heart is beating strong in Texas and her kidneys, liver and pancreas where early Christmas presents to patients throughout theBay Area.
Brittany was on the NuvaRing for 2 1/2 years and had just inserted a new ring the day before she stopped breathing. Brittany and all of us who loved her are now robbed of what could have been.
We have formed a group of parents and health care providers to help educate women on the serious and real side effectsof the NuvaRing birth control device as well as other combination hormonal contraceptives and help share the complete picture of safety that is required in order to make an informed decision based on a combination of safety, efficacy and convenience. Not a week goes by without being contacted by a young woman or a parent whose lives have been seriously impacted by a death or near death due to what they believe was a side effect of the NuvaRing.
How many young women have to die in order for something to be done? What kind of birth control is your Daughteron?