After three inconclusive visits to the Health Center, senior Javier Espinosa went to the hospital, where he was told he needed a liver transplant immediately. (Lindsey Perkins)
Javier Espinosa, a senior at SMU, recently came within two hours of dying. Doctors at Methodist Hospital in Dallas saved his life with an emergency liver transplant.
While Espinosa initially went to SMU’s Memorial Health Center to be treated and diagnosed for his cold-like symptoms, he said the health center is not equipped with proper resources to diagnose and treat severe cases.
“The health center can’t recognize and [doesn’t] really know how to handle hard-core cases like mine,” Espinosa said.
Espinosa said he expected the health center to offer advice and guidance when they were unable to diagnose his symptoms. However, staff at the health center said very little and did not suggest going to a hospital.
“I expected the health center to be more responsible,” he said. “It was obvious my test results were off the chart and they weren’t like ‘Go and see a doctor in this hospital,’ and they should have.”
The health center had no comment regarding Espinosa’s case and referred questions to SMU’s Assistant Director of News & Communications, Robert Bobo.
Bobo said that Espinosa’s case cannot be talked about unless he signs a contract releasing the school from HIPAA or FERPA. HIPAA is the Health Insurance Portability and Accountability Act and according to the online U.S. Department of Health and Human Services it’s the “national standards to protect the privacy or personal health information.” FERPA is the Family Educational Rights and Privacy Act.
However, Bobo did say that he believes the center and SMU do a great job staying involved with students who are sick.
“SMU tries to do everything possible to help its students when they’re sick and in helping them to try and get better,” he said. “I would say the health center does a fantastic job staying involved and seeing how students are and how their recovery is going.”
While the health center may keep in contact and inquire on the status of ill SMU patients, Espinosa believes there was nothing “fantastic” in the way the health center handled his case.
Espinosa’s symptoms started one Friday morning in February. The cinema-television and advertising major attended classes, but said he felt a cold coming on. Initially Espinosa shrugged off the symptoms, took some cold medicine and took it easy for the rest of the day.
“By Saturday I was still feeling pretty bad,” he said. “Then I started vomiting up everything I ate.”
That night Espinosa spoke with his mother, who lives in San Antonio. She said she was coming to Dallas on Monday to look after him. Meanwhile, Maribel Espinosa told her son to see a doctor at SMU’s Memorial Health Center immediately.
“I went to the health center Monday morning with a sore throat, fever and vomiting.” he said.
First Espinosa saw Dr. Peter Davis, who suggested taking X-rays and blood tests after noticing something might be in Espinosa’s lungs. Test results did not reveal anything serious, but Davis told Espinosa it was possible he had pneumonia. Espinosa received medicine from the health center to treat pneumonia, but because he could not keep anything down, he vomited up the medication.
That night Mrs. Espinosa arrived in Dallas and decided something was wrong with her son’s stomach. The next morning, on Espinosa’s 22nd birthday, mother and son went to the health center again.
“The second doctor I saw was a lot more critical than the first doctor, which was good, and the first thing he said was that I needed to be hydrated,” Espinosa said.
It was then, Espinosa said, that his second doctor, Dr. Cesar Torres, and his mother noticed he started turning yellow.
Espinosa took a few tests issued that day by the health center, but for HIPAA and FERPA reasons, the type of tests performed cannot be revealed. The two tests Espinosa did release, however, were the results of his mononucleosis test that showed he had tested positive and a test that indicated his bilirubin level was off the chart.
Blood test for total bilirubin, according to biochem.northwestern.edu, measure both unconjugated and conjugated bilirubin, and are performed to evaluate jaundice, anemia, various liver diseases (including hepatitis) and impaired bile excretion.
Espinosa said SMU does not have adequate machinery to determine exact levels of high bilirubin and as a result, Espinosa said the test results either had to be sent to a hospital or Espinosa could go directly to a hospital. At the time of his clinic visit, Espinosa decided to have his results sent to a hospital through SMU.
“I didn’t want to go to the emergency room so I stayed with the health center and got the tests done there,” Espinosa said.
Hooked up to an IV in the health center for the next few hours for dehydration, Espinosa said the nurses sang happy birthday and gave him Gatorade as a birthday present.
A few hours later Espinosa was feeling better. He no longer had a yellow tint to his complexion. He left the center and then tried eating, but again he found he was unable to keep food down. He decided to return to the health center the next day.
The next morning Espinosa and his mother went to the health center where Dr. Laura Zeballos, Espinosa’s third doctor, informed him his bilirubin level was extremely high. Mrs. Espinosa then phoned a friend of hers, a doctor in San Antonio, informing him on her son’s situation. Mrs. Espinosa’s friend then suggested going to the hospital as the test results were so high.
For HIPAA and FERPA reasons, Dr. Zeballos’ recommendation for Espinosa is not known.
“My mom’s friend was like, ‘these are dangerous numbers.’ I think regular bilirubin levels are around two or three and my numbers were around 35 so obviously something was wrong,” Espinosa said.
By the next afternoon Espinosa had checked into Methodist Hospital.
“When I walked in I thought I was going to have to get another IV but one of the first things the doctor said to me was that I had to think about a transplant or serious surgery,” he said.
Espinosa then had an ultra sound performed and says he memory of the events from then on is vague.
“I just remember telling my dad that if I needed a transplant, do it,” Espinosa said.
For the next few days friends and family visited Espinosa. Melissa Alvarez, a senior and close friend of Espinosa, went to visit him and said the whole experience was very moving.
“I went to visit Javi and the whole thing was really scary,” she said.
When Espinosa regained consciousness a couple of days later, doctors told him he had received a liver transplant. Espinosa was fortunate to receive a donor liver so quickly, he said, because he had a healthy medical record.
“There is a grading system for transplants based on how sick you are, your age, health and whether or not you have health care insurance,” Dr. Davis said.
Espinosa’s parents rejected the first liver that came in but approved the second as his blood had started to thin. The surgery took two and a half hours and was performed by Dr. Alejandro Mejia.
For the next few days Espinosa said staff at the hospital had to extract blood from him every three hours and he was hooked up to three IVs.
“I was given morphine,” Espinosa said. “At first the pain wasn’t that bad, but after a couple of weeks its gets kind of painful.”
Doctors then told Espinosa that after extracting his liver, they found it was 90 percent dead. The doctors said that if he had not received a transplant he would have died within two hours.
“That’s why the doctors are doing a case study about me – because there’s no case like it,” Espinosa said.
An interview with Dr. Mejia was not possible but Dr. Davis offered his opinion as to why Espinosa’s case turned into a study. Dr. Davis believes Espinosa’s case rapidly progressed and went from point A to point B in a brief period of time, which he says is unusual. The fact that Espinosa even developed liver failure due to his original symptoms, he said is odd.
“This case is newsworthy because it’s so rare,” Dr Davis said. “What he had to progress to where he ended up was phenomenal.”
Dr. Davis said he went through Espinosa’s case with physicians in the health center to show them how unique his case was.
“Javier’s case will probably be submitted to a medical journal for physicians to review,” he said.
Dr. Davis also took this time to explain the capabilities of the health center. He said the health center has a lab and X-ray area where blood tests can usually be done. The health center, he said, also has an observation office for people to receive IV fluids while doctors determine whether they need to go to the hospital.
“We’re also one of the few centers that are accredited and only about ten percent of universities that are credited,” he said.
Being accredited means the health center does everything they can to provide quality health care.
Espinosa is now in the recovery process and said the most frustrating part was not being able to walk for a couple of days as he had previously been very active.
“Literally, the day before I got sick I was going to play racquetball with a friend, and they day before that I went swimming,” Espinosa said.
Espinosa is now diabetic and must take 12 medications daily in addition to insulin. However, doctors say being diabetic is temporary.
“I’ve been pretty good with the medication so far and haven’t had a bad reaction so it looks good,” he said.
Espinosa is now back at SMU and said his professors were all very understanding of his situation. Alvarez called the Dean of Student Life, Dean Sisco, to see what could be done for Espinosa.
“The dean told me she would contact all of his professors and do the work so Javi wouldn’t be dropped from his classes,” Alvarez said.
SMU is refunding the classes Espinosa decided to withdraw from due to exhaustion. Initially Espinosa thought he could handle his work load but soon decided he wanted to stay in just two classes.
Espinosa said that while health center called him everyday when he was in the hospital, he said the combination of having three different doctors and the lack of appropriate resources to diagnose fatal cases complicated his experience there.
“If the center can’t afford specific tests and machines then maybe it is not the best place to go,” he said.
But Espinosa and Alvarez also said the center should have been more immediate to send Espinosa to the hospital and should not have overlooked him so soon in the beginning.
“I think the center does help you when you have a cold or something hurts but at the same time I think they overlook simple cases that could be potentially serious,” Alvarez said.
Senior Monica Mehra, another friend of Espinosa’s said the way the center handled his case shocked her and has raised serious questions in her mind.
“Javier’s case has made me more skeptical of going to the health center with any sickness I might have,” she said. “If SMU isn’t equipped to help out students who are severely sick, I’m not going to recommend anyone going there.”
Espinosa also added that the center should be better about referring students to hospitals and should be more helpful to students that are international or don’t have transportation.
In response to this, Dr. Davis said the center handles cases in the same way any doctor’s office would and that each doctor determines what treatment is best and appropriate based on a patients history, set of vital signs and a patient exam.
He also said that if there is an emergency at the health center an ambulance is called to take a patient to the hospital and in urgent cases the health center will allow friends and family to take patients to the hospital. However, SMU does not have a service, he said, to take students to the hospital mostly due to medical liability issues.
For now Espinosa said he is feeling better but the most frustrating part about the whole process is not knowing how he’s going to feel on a day-to-day basis. He also said the whole experience has given him a new perspective on life.
“Before getting sick I wanted to make a film before I was 28 and now I don’t think about things like that at all. At SMU people get so caught up in caring about stupid things like how people dress or what’s going on socially,” he said.
“The reality is that as people at SMU worry about those stupid things, people are in hospitals, dying.”
