The Save

Kendall Bradley ’11 checked her phone and gave herself thirty-five minutes to fall apart. She’d left Nick in the gaping mouth of an MRA machine, his eyes full of pain and fear, and was finally alone. Or, at least, as alone as one could be in the ghastly circus of the hospital triage room, which teemed with people in various states of agony. Somewhere on the streets of Ho Chi Minh there had been an accident, and victims were being carried in in shocking states of disfigurement. Nearby a teenager in his underwear writhed on a stretcher, a large bandage on his head turning scarlet with blood. The chaos did nothing to quiet Bradley’s sense that her friend’s situation was spinning wildly beyond her control.

Her phone buzzed. Henry. Maybe it’s good news, she thought. Henry Friedman HS ’83, her mentor at Duke for the past four years, had been working connections to get them out of Vietnam, but he was calling for a different reason. He’d been consulting with Duke doctors. “Kendall,” he said, his voice solemn from 9,000 miles away, “you need to understand how serious this is.”

Bradley tried to sound calm, assuring Friedman that she had it all under control. That was important, she knew—everyone needed to believe she could handle this, that Nick could count on her.

“No, you don’t understand,” Friedman pressed. “There is a 70 percent chance that Nick won’t survive.”

Friedman continued on, passing along instructions from one of his Duke colleagues about medications Nick should receive. Bradley mumbled something and hung up, her mind racing past her attention. Nick Tsipis ’11 was twenty-two years old, a varsity athlete. People like that don’t just die. Except sometimes they do. Bradley, who would start medical school in six weeks, knew that much.

Slumping deeply into her seat, she undammed a flood of tears. Go ahead, she told herself. Be upset and then get over it, because that’s not going to help anyone.

He was hamming it up, as usual. The lesson that Tuesday morning in June 2011 was positive energy, and Nick Tsipis was all over the room, beaming smiles, slapping hands, whipping the kids into a kinetic frenzy. He wasn’t faking it; he felt great. The camp was in its final days, and after three humid weeks in the remote Vietnamese jungle, he was ready to be done. Bounding to the front of the classroom, he shouted, “Today’s going to be a great day!” And then, a flash of excruciating pain. The room spun like a roulette wheel. His knees buckled and he felt himself tipping. His stomach heaved.

Not wanting the kids to see him get sick, Tsipis stumbled to the back of the room—weaving, teetering, crashing into desks—before collapsing on a bench near the back. He rolled over and threw up violently into a cardboard box. “Just give me a second,” he mumbled to the other teachers. But by the end of class, he looked no better, and so they fetched the camp director, who ran off to find Bradley.

Bradley had known Tsipis since her first day at Duke. They had arrived together in August 2007 as soccer recruits—he a goalie from an elite private high school near Cleveland, she a Durham native and the daughter of a Duke professor. They both were interested in medicine, and they shared a connection to Henry Friedman, Duke’s James B. Powell Jr. Professor of neuro-oncology, who is a longtime friend of Tsipis’ uncle and the father of one of Bradley’s classmates. Friedman encouraged them to join the Collegiate Athlete Pre-Medical Experience (CAPE), a mentoring program he directs (funded exclusively by private donors) that gives participants a taste of medical practice. Through CAPE, Tsipis and Bradley took internships at Duke’s Preston Robert Tisch Brain Tumor Center, where Friedman is deputy director. Their common experiences brewed a tight, platonic friendship.

Vietnam had been Tsipis’ idea— “my fault,” he would later say. As freshmen, he and Bradley had taken a spring break trip there to help set up Coach for College, a series of youth camps started by former Duke tennis player and Rhodes Scholar Parker Goyer ’07. Goyer wanted to enlist college athletes to inspire Asian teens to dream big, and Tsipis and Bradley vowed they’d return one summer to coach. The demands of soccer and premed, however, always trumped their plans.

Then, a few weeks before their graduation, Tsipis called Bradley. “I signed up,” he told her. “And you have to come with me. Let’s finish what we started.”

It was hasty and impulsive, but Bradley agreed. Both she and Tsipis were entering Duke medical school in the fall, and they’d probably never have a free summer again. But privately, she worried whether spending three weeks in the wilds of a country whose culture and language were unfamiliar to her might be too far outside her comfort zone.

Those doubts continued to tug at her throughout her time at Thuan Hung School. One day, a girl asked if she could leave early. Rain was coming, she explained, and she had to ride her bicycle for two hours to reach home. What if she fell and broke an ankle? Bradley worried. Other kids hiked an hour through the jungle to come to the school every day. The camp had no doctor on staff, and as premed students, she and Tsipis often were called on to look at bumps and scrapes. But what if something really bad happened?

When Bradley walked in to see Tsipis sprawled out on the bench, pale, drenched in sweat, and barely responsive, she had no idea that her worst fears already were playing out somewhere deep inside her friend’s brain.

It’s normally an hour-and-ahalf drive from Thuan Hung School to the nearest hospital in Can Tho, the largest city in the Mekong Delta. After seeing Tsipis, the school’s bus driver made it in forty-five minutes. Bradley was terrified. Tsipis couldn’t walk or open his eyes. She had seen plenty of sick people working at the Duke brain-tumor center, but he was “about as sick as I’ve ever seen someone,” she says. As the driver weaved maniacally through traffic, she grabbed Tsipis’ cell phone to find his parents’ phone number, but the phone was dead. So she grabbed hers and called her mom.

Kathryn Andolsek HS ’79 recalls her daughter sounding characteristically calm—not rattled, but concerned about how to handle her friend’s deteriorating health. Andolsek, Duke’s associate director of graduate medical education and a family-medicine physician, talked with her about the cultural and language differences she was likely to encounter at the Can Tho hospital and promised to contact some of her Duke colleagues who knew Vietnamese health care. The conversation was strategic, uncolored by emotion. “I just wanted to be prepared for whatever I was going to face in Can Tho,” says Bradley. “It’s not like I thought Nick was going to die.”

"You have to get the hell out of there"

No one did—it seemed far more likely that Tsipis was having a bad reaction to something he ate, his American stomach rebelling against some bit of Vietnamese cuisine. At Can Tho, a doctor who spoke some English explained Tsipis was likely dehydrated, and he ordered an IV. And it seemed to help. Tsipis was still vomiting frequently, but he was more alert and engaged. He and Bradley argued with nurses to open up the IV drip to feed more fluid into his bloodstream. The nurses declined, worried, incorrectly, about overwhelming his system with fluids and causing heart failure. It might have been a legitimate concern for an elderly patient, but Tsipis was young and in peak physical condition. So whenever the nurses left the room, he opened the IV drip up anyway.

For two days, Bradley stayed by Tsipis’ bed, spoon-feeding him sips of water every ten minutes and shooing flies away. Bugs buzzed everywhere and kept her from sleeping. But it was better than the hallway, where rats ran the corridor.

At one point, Bradley noticed that Tsipis’ pupils were uneven. Then, when for the first time in two days he had to go to the bathroom, she detected a slight shuffle in his step. In CAPE, Henry Friedman had taught them how to do a neurological exam, and she knew uneven pupils and an interrupted gait could be signs of brain dysfunction. But there hardly seemed cause for alarm: Tsipis was stronger and beginning to eat rice. The doctor was ready to send him back to the camp. “Working at the braintumor center, the first time you get a headache, you’re like, ‘Oh, my God, it’s glioblastoma. I have six months,’ ” Bradley says. “He was twenty-two. So I just thought, you’re overreacting. He’s going to be fine.”

At 8:45 on Thursday evening in Durham, Kathryn Andolsek’s cell phone rang. Tsipis was not fine. It was Friday morning in Vietnam. Tsipis had been discharged from the hospital in Can Tho fourteen hours earlier and headed straight to his room to sleep. In the night, his head throbbed, as if his skull were in the clamps of a vise. At 6 a.m., his roommate, a linebacker at the University of Virginia, went to find Bradley. Intercranial pressure set off all kinds of alarms; they needed to get back to a hospital.

Through her mom’s contacts with the Duke Global Health Institute, Bradley had gotten in touch with David Dennis, an internal- medicine doctor who had directed a project on infectious diseases in Vietnam for the Duke-NUS Graduate Medical School in Singapore. Dennis told her the only hospitals equipped to diagnose neurological symptoms were in Ho Chi Minh, five hours away by car. “Go to Ho Chi Minh,” Andolsek advised her daughter. “If nothing’s wrong, you’ll have a nice dinner and celebrate.” The Vietnamese coaches argued with Bradley, urging her to go back to Can Tho. But Bradley was adamant. They were going to Ho Chi Minh.

The taxi ride was a five-hour boxing match with bumpy dirt roads. As Tsipis flopped around the back seat, the pain in his head worsened, and he began to slip from consciousness. The color drained from his face. Bradley, a Catholic, began saying Hail Marys. She didn’t know what else to do. “There’s a look to people. They say that in the hospital—sometimes there’s just a look,” she reflects now, then pauses, not finishing the thought.

“I’m afraid I have somewhat bad news,” the doctor said.

It had been four hours since they’d arrived at SOS International, a clinic catering to foreign citizens. To their relief, Tsipis and Bradley found their doctor friendly and fluent in English. But it was a small slice of comfort in a delicatessen of the bizarre. They had been taken in an ambulance across town for an MRI, which doctors had downplayed as merely a precaution. The clinic was in the basement of a parking garage, and dozens of waiting patients lined up alongside parked motorcycles. When his test was done, Tsipis’ scans came rattling off a printer in the middle of the waiting room, the films of his brain flopping out for anyone to see.

Back at SOS, they’d sat in a clinic room waiting for the doctor to explain the results. She’d popped in three times, her questions growing increasingly alarming: “Any family history of blood clots? No? Okay, we’re still looking.” And then: “Has anyone in your family had a stroke?”

Still, Tsipis and Bradley were unfazed. He’d gotten fluids and food and was rebounding. Before the doctor returned, Tsipis had been urging Bradley to take him out of the clinic. He was due to fly home on Monday. They’d get a hotel, rest up in air-conditioned luxury.

Then the doctor delivered her news: “You appear to have had a stroke in your right cerebellum.”

Tsipis was floored. He knew little about strokes, and what he did know said they don’t happen to twenty-two-year-olds. Terrifying words crept into his head: paralysis, brain damage, loss of function. He shunted them away, questions for another time. “I didn’t really want to take time to think about the meaning of it,” he says. “I was just thinking, ‘What do we have to do? What’s the next step?’ ” He called his parents. It was early morning in Winston-Salem, where they lived, but they’d been awake, nervously awaiting an update. He told them there was no reason to worry. Then he hung up and bawled, not so much for his own condition, but for having had to lie to them. There was plenty of reason to worry.

Bradley, meanwhile, was on the phone with Henry Friedman, who had looped in neurosurgeon Allan Friedman HS ’75, the Guy L. Odom Professor of neurosurgery who codirects the CAPE program. The Friedmans (who are not related) wanted to see the MRI scans, but the clinic had no way to digitize the films. So Bradley took a picture with her phone and e-mailed it. When she looked at the film, she was aghast: A huge swath of Tsipis’ cranium glowed stark white, an indication of swelling around the brain.

If it got worse, he would need immediate surgery to relieve the pressure on his brain. “You have to get the hell out of there,” Henry Friedman told her. Gladly, she thought.

There was just one problem: They didn’t have their passports.

Allan Friedman had been in the operating room at Duke Hospital when Bradley called. Someone put her on speaker phone, and he took in the details of Tsipis’ case in the middle of surgery. The Friedmans agreed Tsipis needed to get out of Vietnam and to somewhere with more-advanced medical technology. “If everything about Nick’s situation was perfectly static, he could have been any place,” says Allan. “But it wasn’t a static situation. There was a risk of increased swelling, and there was a risk of a second stroke. If he needed surgery to reduce the swelling, [the doctors in Vietnam] would not have been able to handle it.” Another stroke, or a ruptured artery, would almost certainly have been fatal.

They also agreed Bradley needed to know what could happen, to steel herself for the possibility that Tsipis might die. “She’s going to feel responsible,” Henry told her mother. “We need to protect her.”

Meanwhile, in Vietnam, Bradley’s to-do list was burgeoning. She had taken charge of increasingly significant portions of Tsipis’ life, reviewing his medications, negotiating with his insurance carriers, and even temporarily assuming his medical power of attorney. There were clearances to get, tests to approve, and a growing cast of doctors a continent away to keep apprised. Her cell phone rang like a stock trader’s.

Tsipis couldn’t have picked a better caretaker. Everyone regarded Bradley as relentless, a woman of sheer will and gumption. She had been captain of the soccer team, a near-flawless student. Everything she took on she did with focused intensity. She was a doer, a fixer of problems. And if her tendency toward introversion sometimes masked her compassion, medicine drew it out. She loved the science, but more than that, she loved the idea of helping people, of solving what was wrong.

The nurses' fantastically wrong reasoning "saved my life."

By Friday evening, however, Bradley’s formidable resolve was waning. Doctors had ordered an MRA, a more-detailed scan of the blood vessels in the brain, to ensure Tsipis was safe to be evacuated, and on yet another ambulance ride he slid into a half-lucid miasma of pain. At the sight of the horror scene in the triage room, he pleaded with Bradley, “Don’t let them touch me.” When Henry Friedman called to tell her Tsipis might die, it was finally too much. She came undone. Soon after, her phone buzzed again. She answered to hear her mother, repeating almost verbatim what Henry had just told her. And then Bradley did something she had never done before, and never since: She hung up on her mother.

It was the inertia of the situation that frayed her. She couldn’t do anything. Their passports were locked in an office five hours away—they’d had to forfeit them to clear up an error with their travel dates. What should have been an administrative hiccup was now threatening to derail their plans. The U.S. consulate in Ho Chi Minh and the embassy in Hanoi had been no help, and so Henry Friedman offered to make a few calls.

He started with Paul Vick ’66, associate vice president for government relations for Duke Medicine. Vick’s contacts in Washington told him that passports on such short notice couldn’t be done without high-level intervention. “Who do you need?” Friedman asked. “Name it, and I’ll get them.” Friedman turned to former U.S. Sen. Tom Daschle, whom he’d known for several years. Daschle called the Secretary of State’s office.

At 4:30 on Saturday morning, Bradley got a call from the consulate office: They had been issued new passports. A consulate official delivered them to the SOS clinic. The documents looked fake— badly pixilated photos sheathed in cheap plastic—but the official beamed as he presented them. “The first ones I’ve ever made,” he explained.

“You seem to know a lot of people in the government,” the official added, asking Tsipis and Bradley to put in a good word with their friends in Washington for an ambassador who was awaiting Senate confirmation.

Six hours later, armed soldiers marched Bradley and Tsipis to a small plane on a tarmac. Within fifteen minutes, it was airborne, bound for Bangkok, where the Friedmans had arranged for Tsipis to be cared for by Sith Sathornsumetee HS ’07, a neurologist who had trained at Duke. Neither Tsipis nor Bradley had slept the night before. Tsipis closed his eyes, one last time praying that he would open them again. Bradley just watched the clouds, feeling, for the first time in days, light as the air around her.

It was not over when they reached Thailand. Sathornsumetee put Tsipis on blood thinners to stabilize him for the flight home, but he kept pushing back his release. Tuesday became Thursday, which turned into Saturday and then Monday. Tsipis’ parents were stuck in a frustrating limbo, unsure of whether to fly off to meet him or await his arrival. Their son’s final harrowing episode—a sudden return of his headache, accompanied by a tingling sensation—came as they prayed in Duke Chapel for his safe return.

But there was safety in Thailand. They were sheltered in a modern, Western-style hospital, no longer exposed to the raw edge of a foreign health system. With nothing to do but watch Titanic on Thai television, Bradley felt unburdened. She began to contemplate the string of events that delivered them from the depths of the Mekong Delta. In retrospect, much of it seemed pure luck, being in the right place at the right time, talking to the right people—“ blessed coincidences,” as Tsipis would later describe.

But what is luck? Shakespeare wrote that “Fortune brings in some boats that are not steered.” Tsipis had many hands on the wheel: the Friedmans with their knowledge and connections; Kathryn Andolsek with her steadying advice; the Vietnamese doctors; the miraculous nerve of their drivers. There was Chris Woods M.D. ’94, a Duke physician with expertise in infectious diseases and global health, calling on the road home from a funeral to help Andolsek locate contacts in Vietnam. There was Bradley’s father, Don (M.H.S. ’02), a chief medical officer with an insurance company, waking a colleague in the middle of the night to get Tsipis insurance certification for a procedure. When it was over, Bradley made a thankyou list of all the people who helped along the way. She counted fifty-seven names. They were not adrift by any means. “

It was just so amazing to see how much people care about people who are not members of their family,” says Bradley. “Even though we were literally on the other side of the world, they were there for us. They were going to be supporting us every single step of the way. We had a lot of luck and a lot of help.”

True, not all luck is made. Remember the mistake in Can Tho, when nurses refused to open Tsipis’ IV drip for fear his heart would fail? They were wrong— but so was Tsipis. He thought he was dehydrated; he had no idea a blood vessel in his brain was blocked. Coursing his blood with fluids would have put pressure on the blockage and likely caused the vessel to rupture. Which would have been fatal. The nurses’ fantastically wrong reasoning “saved my life,” Tsipis says. “By opening the IV, I was essentially trying to kill myself.”

But for most of their adventure, luck came to Bradley and Tsipis not as a gift, but as the fruit of intention. “Sure, they got lucky,” reflects Henry Friedman. “But they got lucky because Kendall put them in position to have that luck. She was fantastic. She did exactly what she was trained to do.”

After ten days in Bangkok, they were finally cleared to return home. They flew first-class, accompanied by a critical-care nurse. When they arrived at Duke Hospital, Tsipis was swept up in a whirlwind of grateful family. Less than a month later, he would walk his mother down the aisle at his sister’s wedding. To date he has no lingering symptoms of his stroke.

As she watched her friend disappear into the embrace of his parents, Bradley turned to her own. “Let’s go home now,” she said. Her mother drove. They parked the car and walked into the kitchen. Bradley checked her phone. In the past two weeks, she had made more than $4,000 of calls and text messages. Her phone had chosen this moment to die. She’d exceeded her maximum charge and been cut off. Doesn’t matter, she thought. I’m done. And she headed off to the beach.