“Any time you have any kind of submersion injury, you worry about a prolonged period without oxygen,” she said. “But he came out breathing, with spontaneous circulation, which leads you to believe that he had been breathing the whole time.”
Despite that good sign, the most troubling question remained: What kind of damage does all that sand do to the lungs of a 6-year-old?
After the rescue, Nathan was first taken to Franciscan St. Anthony hospital in nearby Michigan City, Ind., before being airlifted to Comer Children's that evening. The physicians and staff, including Nadia Khan, MD, and Tracy Koogler, MD, stabilized him and put him on a ventilator.
Jason Reeder, RN, BSN, a nurse in Comer Children's pediatric ICU, said he wasn’t sure what to expect in those early hours.
“As caregivers in an ICU environment, we see the worst of the worst. We're the University of Chicago, and the sickest of the sick come to us, so we get a little bit jaded sometimes,” he said. “We hope for the best, and I want every one of my patients to progress and get better, but when you see a situation like that, there's definitely a concern about what the outcome really will be.”
Wolfson took over Nathan’s care the following Monday. She and her colleagues researched the medical literature seeking reports that could help guide Nathan’s care, but there were very few reported cases of prolonged burial in sand. What reports there were provided some useful information, but a big part of the puzzle, Wolfson said, was that Nathan’s case appears to be unprecedented in this area.
“We all believe at the University of Chicago that we see some very unique things, and Nathan was definitely one of those patients.”
“We just don't know what sand from the Indiana Dunes is going to do to your lungs,” Wolfson said. “You don't have a way to predict because this has never happened to anybody at the Indiana Dunes before. The composition of the sand from that specific area will impact how your body reacts to it, what type of inflammation it causes or how it will heal.”
Nathan underwent two procedures using a bronchoscope, a long tube-like instrument that can flush saline into the lungs and, in this case, suction sand out. It’s also equipped with a fiber optic camera so doctors can see into the airways and assess the extent of the injuries.
After the second bronchoscope procedure, Nathan’s airways appeared to be clear, but that didn’t mean his lungs were entirely free of sand. The bronchoscope can’t reach into the smallest passages, or the alveoli, tiny sacs deep in the lungs where the actual oxygen exchange takes place. Doctors couldn’t be sure there weren’t a few grains of sand left that could still cause inflammation, so they kept him on a ventilator, monitoring how much oxygen he required how well he was responding to treatment.
Nathan responded more quickly than anyone expected. On Wednesday, July 17, Wolfson removed Nathan’s breathing tube and took him off the ventilator. The next day, he ate his first solid food (popsicles), and the day after got out of bed for the first time since the accident. On Tuesday, July 23, he was released to La Rabida Children’s Hospital in Chicago for a few days of inpatient therapy before going home.
“He did better than anyone expected. I was thrilled.”
Wolfson said the fact that Nathan hadn’t suffered neurological damage was key because he was able to manage his own airway after being taken off the ventilator.
“The physical damage to the lungs was the wild card that no one knew,” she said. “But he was awake and would cough and do all of those things, so it was reasonable to try to get the breathing tube out. But no one could have predicted that on day one.”
Reeder said he credits Nathan’s family, especially his father and his mother, Faith, and their community for helping him through the ordeal.
“Sometimes through the nature of providing direct care, you really connect with a certain family or a certain patient. So I was really hoping for the best all the while,” he said. “He did better than anyone expected. I was thrilled.”
Wolfson, Reeder and the others involved in Nathan’s care have called this “case report material,” which would allow their experience to serve as a guide to others. A similar incident could happen again, and the doctors involved will need a reference, just as Wolfson and her colleagues relied on what they could glean from the case reports they found.
“We all believe at the University of Chicago that we see some very unique things, and Nathan was definitely one of those patients,” Wolfson said. “We have a responsibility to the medical community to share our experience so that other people can learn from it.”