Mid-Flight Crisis Leads to Emergency Surgery at Emory Healthcare

Steve, 76, knew something was wrong almost as soon as the plane lifted off. His throat tightened. Swallowing felt strange and difficult. He didn’t touch his in-flight snack, afraid he might choke. He sat quietly for two anxious hours, unsure what would happen when they landed in Atlanta. He let his wife, Becky, sleep beside him, not wanting to alarm her.

As the plane made its descent to Hartsfield–Jackson Atlanta International Airport, Becky woke up. "I was shocked to see Steve just covered in sweat," she says. "I talked to him for a minute and then asked a flight attendant to have paramedics meet us at the gate."

Steve and Becky suspected that his symptoms were related to a health crisis he had had about a year earlier. That’s when he had a tear in his esophagus, the tube that carries food from the throat to the stomach. He spent two weeks in a hospital near his hometown in western Illinois. Doctors there chose not to operate, hoping the tear (called a perforation) would heal on its own.

Unfortunately, it hadn't. After assessing Steve, the airport paramedics called an ambulance.

"Someone was definitely looking out for us that day, because we ended up at the one hospital that could help us more than any other in Atlanta," Becky says. "Emory specializes in esophageal perforations. You can call it serendipity or divine intervention or whatever you want. But I have no doubt that the paramedics' decision saved Steve's life."

Steve and his family had been on their way to Disney World. However, within a few hours of landing in Atlanta, he was in the operating room at Emory University Hospital Midtown.

"Given his symptoms and history, I suspected a significant tear in his esophagus,” says thoracic surgeon Alicia Bonanno, MD. "I used a minimally invasive endoscope in the OR to get a good look. Ideally, we can surgically repair tears like this. But Steve's esophagus was in bad shape. It would not be a simple fix."

Dr. Bonanno did what she could to stabilize Steve, including placing tubes to manage the fluids in his chest. When Steve woke from surgery, Dr. Bonanno met with him and Becky to talk about next steps.

"One of the many things I love about Dr. Bonanno is that she includes you in the decision-making," Becky says. "She was very, very honest about what she saw during the procedure and how serious the problem was. She recommended removing Steve's esophagus. I don't remember ever being that scared in my entire life."

Steve recalls thinking, "I don't know if I'm going to survive this one." Three days later, he was in surgery again.

According to the National Institutes of Health, esophageal perforations are rare, affecting about three in 100,000 people in the U.S. every year. Most tears heal on their own or can be repaired surgically.

Emory Healthcare is one of the country's most experienced centers for advanced esophageal surgery. Dr. Bonanno and her thoracic surgery colleagues do two to three repairs a month, often for people with cancer. They also do a high volume of esophagectomies (esophagus removal surgeries) compared to other centers.

"We collaborate with surgical oncologists at Winship Cancer Institute of Emory University to care for patients with very complicated problems, including caring for patients like Steve who don’t have cancer," says Dr. Bonanno. "These surgeons have extensive experience that is invaluable for esophageal reconstructions."

Dr. Bonanno and surgical oncologist Maria Russell, MD, planned and performed the surgery together. First, they removed the diseased esophagus. Then, they pulled part of his stomach up to his neck and shaped it into a tube to create a new esophagus.

Some people need a feeding tube after an esophagectomy, but Steve doesn't because the reconstruction kept his digestive process intact. The top of his new “esophagus” connects at the base of his neck, while the lower part still functions as his stomach; it’s attached to the small intestine.

The nine-hour surgery was excruciatingly stressful for Becky, her daughter, Ande, and Ande's husband, Jeff. Afterward, Dr. Bonanno tried to prepare them for what they'd see in the ICU. Steve was stable but swollen, had a feeding tube and was on a respirator to help him breathe.

"Steve and I have been married 42 years, and it was so frightening to see him that way," Becky says. "I stood beside his bed and asked him if he could hear me, and he started waving wildly. Ande said, 'Mom, he wants you to hold his hand.' So that's what I did."

Steve's main challenge after surgery was a persistent leak at the connection between his "new esophagus" and neck. To treat the leak, Dr. Bonanno performed a procedure twice a week for six weeks. Called endoluminal wound vac therapy, it involved guiding a tube through Steve's nose and down his throat. Then, she pushed a tiny sponge through the tube, using it to gently suction the connection to help it heal. Over time, it did.

Steve spent 53 days in the hospital. Becky almost never left his side, and Ande got a hotel room nearby, visiting Steve daily. "I don't remember much about my time at Emory because I was so sick and kind of out of it," Steve says. "I know my family went through a lot. It's much harder to be on that side of an illness like this."

Becky says she will never forget the kindness that Dr. Bonanno, the nurses and others showed her, Steve, Ande and Jeff. "The whole staff, including our wonderful nurses, was so welcoming and loving," she says. "They became just like family. I wrote all the doctors thank-you notes, because every single one contributed to Steve's recovery."

Steve continues to heal, but life is pretty much back to normal. "My stomach is smaller than before, but it will expand over time," he says. "Meanwhile, I have to eat smaller meals because I feel full quickly. Also, I am prone to getting heartburn. I sleep at a 30-degree angle to prevent that from happening at night. But I am getting my energy back and feeling more like myself.”

Scar tissue in Steve's esophagus caused it to narrow, which makes swallowing difficult. He returns to Emory University Hospital Midtown every month for follow-up treatment. Dr. Bonanno gently stretches the esophagus with a small balloon. Over time, the scar tissue will soften—and eventually, he’ll no longer need the stretching procedures.

"Atlanta has become a little bit like a second home for us, and we are happy to come down to see Dr. Bonanno any time," Becky says. "We just don’t have this kind of specialized care close to home.”

“Dr. Bonanno will always be our hero,” Becky adds. “She has been the most considerate, caring doctor we could ask for. There are not enough words to express how grateful we are to her and everyone who cared for us at Emory."

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