SPOKANE — When Eugene Roberts heard while lying in the emergency room that he had blood clots in the main pulmonary artery to his lungs, he began to prepare to die.
“I need to tell my family I am probably not coming out of the hospital, and they need to prepare for my demise and that I’m not going to make it,” Roberts told the emergency doctor last fall.
The physician seemed perplexed and replied: “What are you talking about?”
Roberts had been a paramedic for 25 years before he began to drive buses at the Spokane Transit Authority in 2018, and he had tried to resuscitate or keep alive many patients previously with similar diagnoses.
But he knew that often, the outcomes were not good.
What he didn’t know is that technology has improved since then, and clinicians and radiologists have started using new tools and technologies to treat and remove blood clots more intesively in the last five years.
Ten years ago, Roberts might not have survived. But in 2021, his odds were much better.
Roberts had no history of clotting, but in September 2021, he did get COVID-19, which he said is the sickest he’s ever been in his life.
After nearly two weeks of experiencing symptoms, he went in to see his physician, who diagnosed him with COVID pneumonia and prescribed antibiotics and steroids.
But Roberts still struggled to breathe. And one night he awoke to a sharp pain running straight through his chest. He felt like a sword had pierced his chest , and his difficulty breathing had gotten worse.
It took Roberts nearly two hours to come to terms with the fact that he was experiencing something he’d only treated before in medical emergencies for others. He had a pulmonary embolism, when blood clots block arteries in your lungs, and he needed to get to the hospital.
But he could barely move. Calling an ambulance was the last thing he wanted to do, but when he tried to stand up, he nearly collapsed. Eventually, Roberts called 9-1-1 and paramedics rushed him to the hospital in an ambulance.
Lying in the emergency room, Roberts hoped that his clotting was mild, but the doctor came in to deliver the bad news. He had a sub-massive saddle pulmonary embolism, blocking the main pulmonary artery connected to both of his lungs.
This was a wild diagnosis for Roberts to comprehend. He had no family or personal medical history of blood clotting, and while his physicians cannot be 100% certain, they suspect that his bout with COVID-19 led to his blood clotting.
Dr. Jordan Castle, an interventional radiologist at Inland Imaging, has been performing blood clot retrieval procedures for about two years with a new technology.
Castle performs pulmonary artery thrombectomies at Providence Sacred Heart Medical Center with a new technology, called the FlowTriever System. The procedure starts with the team inserting a catheter through the groin vein and up into the arteries, then attaching a syringe on the outside to suck out some of the big clots.
“We can clear that highway for the blood to travel where it normally does,” Castle said.
Previously, serious clots like what Roberts had were treated predominantly by blood thinners, or with a similar catheter that would target blood thinners at the clotted areas. Survival rates are not always promising for patients with clots that were similarly severe to Roberts’.
Many patients don’t know they have a pulmonary embolism until it’s too late. About 25% experience sudden death as their first symptom of the condition, according to the Centers for Disease Control and Prevention.
For those who notice symptoms in time like Roberts, time is of the essence to get treatment. Sub-massive pulmonary embolisms have a mortality rate of about 5 to 25%. For people with even larger clots, the mortality rate increases.
Administering blood thinners is still a part of treating patients with clots like Roberts, Castle said. But the procedure he performs is in addition to those medications in order to relieve pressure on the heart.
The FlowTriever System, like other tools to treat blood clots, is in clinical trials to evaluate their effectiveness in treating patients with clotting that threatens their lung or heart function. Roberts consented to the new treatment and technology and was enrolled in the clinical trial before he got the procedure.
Castle said an advantage to removing some of the clots is that it decreases the amount of stress a patient’s body endures during treatment. Typically, patients will not need to be treated in the intensive care unit afterwards and will experience relief quickly.
The clinical trials will show whether patients improve in both the long and short-term after the procedure .
“We don’t have that data yet, and that’s something the medical field is working on,” Castle said. “We’ve been part of one trial, and we’re about to be a part of another trial where we’ll be following some of these patients.”
Castle and his team took many clots out of Roberts’ vessels, including one section that was 12 to 18 inches long. Roberts didn’t feel better initially. He had immense pain still, but slowly he began to realize his breathing was improving .
After getting pain medication that enabled him to rest overnight, Roberts said he woke up feeling significantly better. Nurses were able to take him off of high-flow oxygen, and he was up and walking around the hospital for several days before he was discharged.
Initially, Roberts was sent home with oxygen, but he didn’t need it for longer than a day or two.
As a part of his enrollment in the clinical trial, Roberts sees a pulmonologist and takes a blood thinner daily to keep his clotting in check. Now that he’s had a pulmonary embolism, Roberts is at higher risk for developing them again.
COVID-19 has been tied to clotting in the blood for some patients, and some researchers believe this might be due to the inflammatory nature of the virus’ impact on the body. COVID-19 is more than just a respiratory virus. It has the potential to impact other organs, a person’s sense of taste or smell and even memory.
During the pandemic, Castle said that anecdotally he’s seen more patients with blood clotting. He estimates that he’s done about one to two procedures for pulmonary embolisms per week at the hospital. COVID definitely increases your risk of clotting, Castle said.
Roberts, who was not vaccinated against COVID-19, tested positive for COVID-19 at the height of the delta variant wave in fall 2021, which hit Eastern Washington and North Idaho particularly hard.
Long COVID research is underway, as patients have vocalized the myriad symptoms that lingered or started anew after they fought off their initial COVID-19 symptoms.
For Roberts, he still doesn’t quite have his right sense of smell back all these months later. Coffee finally tastes right again but smells off. A scent can get stuck in his nose for hours at a time.
Sometimes that smell is exhaust after a day of driving routes for the Spokane Transportation Authority, where he returned to work in January after having to use some Washington family and medical leave funds when he could not immediately get his commercial driver’s license back due to his pulmonary embolism. The license lapsed while he was ill.
And If taking a pill a day to keep his clotting under control is what it takes to stay alive, he’s grateful. Roberts says every doctor and specialist he sees now tells him how lucky he is to have survived.
That reality is not lost on him.
“I realize how lucky I am to be on this side of the grass,” he said.