Something “very unusual and unexpected” happened to alter Mary Johnny’s condition in the early morning of her sixth day at the Watson Lake hospital, her family doctor testified Wednesday at the inquest into her death.

Nurses at the hospital the night of Aug. 8, 2012, called Dr. Said Secerbegovic to inform him Johnny, who had been relatively stable and breathing easily earlier, now had an elevated pulse, low blood pressure and mottling on her legs, indicating poor circulation.

Johnny was short of breath and her oxygen saturation level dropped.

“Bang, something’s happened,” Secerbegovic said yesterday in a Whitehorse courtroom, where the circumstances of Johnny’s death are being investigated this week.

It could have been, he speculated, a blood clot, a stroke or a heart attack.

Since she was admitted to hospital on Aug. 3, the dehydrated Johnny received fluids through an IV. It’s possible that if she wasn’t taking her thyroid medication, her heart would have been weakened and unable to pump effectively, Secerbegovic said.

Johnny, 60, was medevaced to Whitehorse General Hospital on Aug. 8, and died the next day of a bowel obstruction, according to a coroner’s report.

An inquest was called into her death last November. B.C. coroner Norman Leibel is presiding over the proceedings, which began Tuesday and are scheduled to wrap up Friday.

A six-person jury has been tasked with determining the identity of the deceased and where, when, how, and by what means she died.

Wednesday’s testimony came from the physician onboard Johnny’s medevac, a paramedic who was also on the flight, a nurse who cared for Johnny in Watson Lake, a doctor who tended to her upon her arrival in Whitehorse, and a B.C. surgeon who wrote a report on her death.

Secerbegovic called for a medevac at 11 a.m. on Aug. 8. The team arrived at the Watson Lake hospital by 3:35 p.m., and had Johnny to Whitehorse by 7:15 p.m.

When questioned why he didn’t request a medevac sooner, given the sudden change in Johnny’s condition, Secerbegovic said he wasn’t sure she was going to survive.

“I wanted to see if she was even going to be stable enough to make it,” he said.

Joy Ferguson, one of the nurses caring for Johnny that night, said she was in “extremely poor” condition just after midnight.

Ferguson felt she should have been medevaced then.

“I think that generally when somebody is this sick then we’d be medevacing them,” she testified. “Generally they should be medevaced when they’re unstable.”

She knew there was a do-not-resuscitate order in place to withdraw care in the event Johnny’s heart stopped or she stopped breathing.

“I believe we would have advocated for her to be medevaced sooner had the discussion been that we were saving her,” Ferguson said.

She spoke to Secerbegovic about calling Johnny’s family to let them know about the change in her condition, but that request was “blown off,” she said.

“Now looking back, I wish I would’ve done it,” she said. “But I didn’t.”

Upon his arrival in the community, medevac physician Dr. Brad Avery said Johnny had critically low blood pressure, and her hands and feet were mottled and cold.

She had high levels of creatinine and urea in her system, which indicate kidney problems. Dehydration can cause elevated creatinine levels, Avery said.

His prognosis was “guarded,” he said – with her vital signs, there was a chance she’d die.

The medevac team was able to stabilize Johnny for flight, and her condition had improved by the time they arrived in Whitehorse, although she was still critical.

They transferred care to Dr. Huy Chau, a Whitehorse doctor who works in the hospital’s emergency room.

Chau testified Wednesday that Johnny was “very sick” upon arrival. She had renal, or kidney, failure and poor vital signs.

“She was completely shutting down,” he said, adding his prognosis was “bleak.

“I didn’t think she was going to survive.”

A CT scan of her abdomen and pelvis showed a small bowel obstruction. A chest X-ray indicated her lungs were fairly clear.

Chau said after discussion with Johnny’s family, they decided to withdraw care. She died at about 7 a.m. on Aug. 9.

Secerbegovic had noted in his doctor’s orders Johnny’s wish to not be resuscitated. She advised him of this on her third or fourth day in hospital in Watson Lake after a discussion he had with her about how to proceed if her condition worsened and she was unable to communicate with medical staff.

“No doctor, don’t do it (resuscitate), I’ll go see my friends,” he said Johnny told him.

Secerbegovic began working in Watson Lake in 1977, and was Johnny’s doctor for 35 years. He said he knew she had had a drinking problem since she was 18.

Over the years, she made dozens of visits to the hospital to detox, he said.

Johnny’s son, George Morgan, testified on Tuesday that his mother started each day with a drink, and that once or twice a year she’d go to hospital for respite.

The alcoholism took a toll on her body, which Secerbegovic said was like that of a 90-year-old.

She was frail and had had many fractures over the years. A few years ago, she was in a serious car accident and was thrown out of the vehicle, fracturing her pelvis and rib.

When she arrived at the hospital in Watson Lake in August 2012 via ambulance from Secerbegovic’s private practice, Parhelion Medical Services, she was complaining of nausea, vomiting and diarrhea.

Johnny was dehydrated, and said she last drank alcohol 10 days ago. Initially, her symptoms were thought to be related to alcohol withdrawal.

But her mother, Eva Johnny, later told a nurse she was drinking up until the morning of her admittance.

The plan, Secerbegovic said, was to rehydrate Johnny and allow her to detox. She likely needed more fluids than staff gave her, but he was concerned about overloading her small body.

Too much fluid can cause congestive heart failure, the inquest heard.

When asked why his notes from Johnny’s stay were lacking, Secerbegovic said, having worked in the community since the ’70s, he knew his patients so well it didn’t make sense to write down their entire history every time he saw them.

“The record-keeping was not up to today’s standards,” he admitted.

He also said he was the only doctor at the hospital in Watson Lake, and was on call 24 hours a day, seven days a week. He’d only had a couple hours of sleep over the past few days.

Several parties are represented by lawyers at the inquest, including the Yukon Hospital Corp., the physicians involved, Johnny’s family, and the coroner.

At an inquest, the jury’s role is not to find guilt, but rather to determine circumstances of Johnny’s death.

Jury members may also make recommendations to prevent similar deaths.

Earlier this year, an inquest was held into the death of Teresa Scheunert, also of Watson Lake, who died in the summer of 2012 after being treated at the hospital there.

The jury determined she died accidentally of mixed-drug toxicity.

The inquest into Johnny’s death continued today with further testimony from Secerbegovic. It’s also being streamed to a courtroom in Watson Lake.