It was a few days before Halloween when Peter Rogal caught what he thought was the flu.
As it worsened, he remembers carving pumpkins — more than 100 — for his family’s annual Halloween display. On Oct. 31, feeling awful, he went to bed as soon as the last trick-or-treater was gone.
One of his next memories is waking up early on the morning of Nov. 7, unable to breathe after a bad coughing spell.
Rogal’s wife, Tracy, drove him to the emergency room at Delta Hospital, leaving behind their yard filled with dozens of grinning Jack-o’-lanterns. He would be greeted by Christmas lights when he was finally able to return home.
Within hours, Rogal was on the brink of death — in an induced coma, hooked to a ventilator, with less than a 10 per cent chance of surviving the night.
In Delta’s ER, a nurse checked his oxygen saturation. She thought the machine was broken and tried another. As she realized the numbers were correct, all hell broke loose, said Tracy, who must fill in the gaps in her husband’s memory.
“It felt like minutes and he was in a coma and on a ventilator,” she recalled.
X-rays showed Rogal’s lungs were filled with bacteria. It would take six days before he was diagnosed with Legionnaires’ disease, a severe type of pneumonia.
Almost immediately, Rogal was transferred to Surrey Memorial Hospital, where a doctor met Tracy in the Intensive Care Unit (ICU). The doctor’s first words to her were, “I’m sorry.”
Rogal was on the highest ventilation setting possible, but his lungs weren’t getting enough oxygen.
Tracy called her parents in Palm Springs, Calif., where the couple’s two daughters — Danielle, 17, and Taylor, 14 — were vacationing, and told them to come home.
It looked like they wouldn’t make it in time to say goodbye.
LAST HOPE
Nine and a half kilometres separate Surrey Memorial from Royal Columbian Hospital in New Westminster.
RCH is the Fraser Valley’s “referral centre,” where the sickest patients in the Fraser Health region receive care. RCH is also home to the area’s only Extracorporeal Life Support (ECLS) system, which can perform the work of the lungs or heart, allowing a patient’s organs to rest and recover.
Surrey Memorial doctors told Tracy the machine was her husband’s last hope — if he could get to it.
In the past, transporting critically ill patients requiring ECLS was impossible.
RCH ICU doctors tell stories of squeezing the life-saving machines into a wheelchair-accessible taxi because they wouldn’t fit in an ambulance, hoping they’d get to Surrey, or another area hospital, in time.
That led RCH doctors to “MacGyver” a portable system to move patients to New West, explained RCH ICU Dr. Derek Gunning, adding the situation was less than ideal.
In September 2013 — two months before Rogal became sick — the hospital found a solution.
Two donors provided more than $120,000 to the Royal Columbian Hospital Foundation, allowing the ECLS team to purchase a specialized stretcher, monitors and other equipment. RCH’s mobile ECLS is the only one of its kind in B.C.
An RCH team visited Rogal’s bedside at 9 p.m. and determined the system might save him.
Possibly the sickest person in the province at that time, he was transported using the mobile ECLS and arrived at RCH at about midnight.
Still unclear about the cause of his pneumonia, Rogal had already been started on broad-spectrum antibiotics, which in B.C. include the drugs that fight Legionnaires’ disease.
The ECLS system was performing the work of his lungs, pumping blood from his body and oxygenating it.
Later, when he saw a picture of himself hooked up to the machines, Rogal would be moved to tears before joking it looked like “an adventure playground” of tubes and pipes.
He spent eight days on ECLS, and 11 in a coma. When he finally awoke, Rogal had no idea where he was.
“I thought I’d been in a car accident,” he said.
He was 40 pounds lighter and suffering from severe muscle atrophy — worse than if he’d spent a year in space, someone told him.
His doctors and family were enthusiastic about his condition. “He was alive,” said Tracy. But Rogal felt devastated.
He returned home a few weeks before Christmas.
‘I SHOULD HAVE BEEN DEAD’
Over the last few years in B.C., there have been only two or three known cases of Legionella longbeachae infection — the dirt-based form of the bacteria that causes Legionnaires’ disease.
Rogal works at the City of Richmond’s composting facility. After his diagnosis, operations were suspended, said Richmond spokesman Ted Townsend. An independent company did testing at the site, but found “little or no risk” of employees contracting an infection and operations resumed.
WorkSafe B.C. also investigated, ruling Rogal’s illness was work-related. But Townsend said the city “believe(s) the illness was not contracted at work” and is considering an appeal.
Rogal did not want to discuss the case out of respect for his employer. He remains on sick leave.
His time on death’s doorstep has had other impacts on his life, too.
So close to death, some of his organs began shutting down, including his kidneys. His toes turned black due to poor circulation, and he had terrible bedsores on his heels. He also suffered post-traumatic stress.
But while “his coordination, stamina and strength have a ways to go,” said Tracy, Rogal has made remarkable progress.
His kidneys are now working at “100 per cent.” He continues to do physiotherapy, but is no longer taking any medication.
“I should have been dead,” he said. “I have no complaints. I’m the luckiest person walking.”
On Friday, Rogal met the doctors who helped saved his life and one of the couples who funded the mobile ECLS, Ralph and Florence Winkler.
“It’s nice to meet you finally,” he said, after embracing both Dr. Gunning and Dr. Hussein Kanji.
“I’ve met you before,” quipped Gunning, referring to the days Rogal spent in a coma in the ICU.
Kanji said about eight to 10 patients require RCH’s mobile ECLS each year. Without it, “we probably wouldn’t be here today,” he said.
Rogal and his family understand the meaning of that better than anyone. With no time to waste, they’re already planning this year’s Halloween celebration.
Legionnaires’ disease
Legionnaires’ disease is caused by a water or soil-based bacteria that infects the lungs and can lead to a severe type of pneumonia.
• More than 90 per cent of Legionnaires’ cases are caused by Legionella pneumophila, while Legionella longbeachae (the bacteria Rogal contracted) is less common and is usually found in Australia and New Zealand.
• There have been only two or three known cases of Legionnaires’ caused by Legionella longbeachae in B.C. in the last few years.
• From 1999 through 2008, 34 cases of Legionnaires’ disease were reported to the B.C. Centre for Disease Control.
• Many individual cases and outbreaks have been linked to air conditioning systems in large buildings, hot tubs and decorative fountains.
• Legionnaires’ symptoms can include high fever, chills, coughing, pain in the chest and difficulty breathing.
• Legionnaire’s earned its name after an outbreak among people attending an American Legion convention in Philadelphia in 1976. Of 182 reported cases, 29 people died.
