Heart and Skill: How a Surgeon Saved Two Lives with a Single Operation

In July 2024, Daniel Barrow, MD, a neurosurgeon at Emory Healthcare, received a heartfelt letter from Mary Katherine (Katie). Katie is the daughter of a patient he’d treated at Emory 35 years earlier. In the letter, Katie thanked him for saving her mother’s life—and her own.

“My mother was seven months pregnant and woke up to a ruptured cerebral aneurysm. When she finally got to Emory, you took one look at the angiogram and took her into surgery. That's when the magic happened. You performed miraculously. You kept us both alive,” writes Katie.

Here’s their story.

On a bright May morning in 1989, Marshall Krakeel, an emergency room nurse, lay down after her night shift. At 41, she was seven months pregnant with her third child. Her oldest had just gone to kindergarten, and her two-year-old was still sleeping, which was a good time for Marshall to take a nap.

She hadn’t been asleep long when she awakened to the sound of her son playing nearby. Marshall bolted upright. She felt a sharp crack in her neck and then a wave of intense pain that rose up and around her head. Had she broken her neck?

Marshall got up, and before calling for help, she made the bed. “Mother always said, make it up in case the ambulance has to come,” she explains.

By then, Marshall had lost the use of her left arm and leg. She phoned the emergency department at South Fulton Hospital, where she worked. They told her to call an ambulance. Then she dialed her husband, the local fire chief, who rushed home to help.

A Life-Threatening Discovery

At a clinic near their home in Fayetteville, Georgia, an X-ray confirmed Marshall’s neck wasn’t broken. However, an angiogram (an imaging test that shows blood flow in arteries or veins) uncovered something more serious. An aneurysm in her brain had ruptured and was actively bleeding. This was a life-threatening condition requiring immediate care to prevent further damage or even death.

Brain aneurysms occur when an artery in the brain develops a weak spot that balloons and fills with blood. Although an aneurysm can happen anywhere in the brain, most form at the base of the skull. A ruptured aneurysm can cause stroke, brain damage, coma and even death.

Until then, Marshall hadn’t experienced any warning signs of something serious. Although she had gestational diabetes, hers had been a normal pregnancy. Her two prior pregnancies had been normal, as well.

Marshall checked into South Fulton Hospital, where she received medication to prevent seizures as the staff determined how best to treat her. “The neurologist who came in told me I needed to go right to Dr. Barrow at Emory,” Marshall recalls.

At the time, Dr. Barrow was the region's only specialist in aneurysm surgery. He had completed his residency and an internship at Emory Healthcare and was then hired specifically for his expertise in complex neurosurgical cases.

The hospital arranged for Marshall to transfer to Emory under Dr. Barrow’s care. The following day, an ambulance took her to Atlanta, a 30-minute drive.

Two Lives at Stake

Dr. Barrow recalls being very concerned when Marshall arrived at Emory. “The stakes were high,” he says. “She had survived a hemorrhage, but once an aneurysm has bled, there is a very high risk that it will bleed again in the near future.”

“She also was seven months pregnant, and so we had two lives at risk.” Dr. Barrow knew that complications during surgery, such as lowered blood pressure, can impact the baby because they depend entirely on the mother’s blood flow.

Racing against time, the neurosurgery team jumped into action.

“Nurses, neurosurgeons, assistants and anesthesiologists filled the operating room. In addition, there was a bassinet, a neonatologist and an obstetrician standing by if Marshall had a complication during surgery, and it looked like she wasn’t going to survive. We would have tried to save the baby,” he remembers.

Dr. Barrow performed a craniotomy, carefully creating an opening in Marshall’s scalp and temporarily removing a section of her skull. Dr. Barrow precisely navigated to the aneurysm using an operating microscope and secured it with clips. The clips permanently blocked blood flow to prevent another rupture. Afterward, he closed the incision with meticulous care.

A Remarkable Recovery

The surgery was a remarkable success.

“Everything went great,” says Dr. Barrow, now the chair of neurosurgery at Emory. “We were able to maintain normal blood pressure and repair her aneurysm.”

Aneurysms in pregnant women are not common, he says, and they can happen for unknown reasons.

Over the years, he’s operated on only a handful of pregnant women who've had ruptured aneurysms. “It’s an unusual event,” he says.

In the weeks that followed the surgery, Marshall made a full recovery without any lingering effects from the aneurysm and surgery. She regained full movement of her limbs without needing physical therapy and was able to return to work.

The only visible reminder of her ordeal was the half of her head they had to shave. Marshall remembers wearing a wig to work while her hair grew out.

“Marshall did extraordinarily well after surgery. Things could not have gone more smoothly,” says Dr. Barrow.

Two weeks after surgery, he explains, a patient is still in danger of complications. For example, arteries can spasm and narrow, limiting blood flow to the brain, which can cause stroke or other issues. During pregnancy, a reduction in blood flow can be life-threatening to unborn children.

Remarkably, just two months after the harrowing experience, Marshall gave birth to a healthy baby girl, Katie.

Advances in Treatment

Today, Emory Healthcare sees one of the largest volumes of brain aneurysm cases in the U.S. Our neurosurgeons pioneer new treatments and surgical procedures that improve patients' outcomes. Endovascular methods have become increasingly popular for treating brain aneurysms due to their minimally invasive approach.

This method involves threading a flexible tube, known as a catheter, into either the femoral artery in the groin or, less commonly, through the radial artery or wrist. The catheter is guided up through the neck to reach the aneurysm in the brain. Once there, devices like platinum coils or stents, called flow diverters, are placed to block blood flow into the aneurysm while preserving circulation through the artery.

Since there is no large incision in the skull with this approach, recovery is typically faster and easier for patients. This can reduce the risk of complications related to prolonged bed rest and shorten the time needed for rehabilitation.

“Surgery is still an option because some aneurysms cannot be treated by an endovascular method. For young people, in particular, surgery is still a better option. But over time, we've developed more endovascular devices and options that make surgical clipping of aneurysms less common,” says Dr. Barrow.

Expressing Gratitude Over the Years

Katie’s letter was the first time she reached out to Dr. Barrow. “Thirty-five was a big birthday, a big milestone. I thought it was probably the best time,” she says. "But I can’t remember a time when I didn’t know the story of Dr. Barrow.”

The mother and daughter recognize Dr. Barrow during each holiday, birthday or significant life moment they share together.

Over the past 35 years, Marshall has written to Dr. Barrow many times. “He always writes a handwritten letter back,” she says. “He’s wonderful, the best surgeon and a down-to-earth and friendly person who will do anything to help people.”

Visit emoryhealthcare.org/emory-clinic/neurosurgery to learn more about brain health at Emory Healthcare.

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