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Monday, July 30, 2007

This is quite an experience: Emergency response with defibrillator, CPR and family

Dave's Story

This is quite an experience. The bottom line is that things are looking good. I returned home today and the next two weeks will be spent tweaking medications. Here is the best I can give you about a blow by blow on the event.

We had a family reunion and I guess I had dropped people off at the airport and then went to the Princeton Club to work out at about 3.30PM on May 28. I remember nothing of the events following that day or for the four days following that. I am told that I went to the Princeton Club for a workout; that the clerical person just happened to be looking down at the people working out and saw me drop. She called the paramedics who are based less than a block away from the club. The manager ran down stairs and found me pulse-less. He did the Automated External Defibrillator (AED) and CPR (he trained in both). The paramedics were there in less than five minutes after I dropped. If any one of these (the clerical person seeing me, calling paramedics, the manager applying the AED and CPR, the paramedics being so close) did not happen then I am still dead.

The paramedics took me to the hospital. The first my wife heard about it was when she got home from some errands. She was responding to a call from the fire department about me when two police arrived. She drove to the hospital. While one shock of the AED has started my pulse they could not get me to regain consciousness. So they asked permission to put me on a deep freeze bed that lowered my temp and put me into induced coma.

The kids, who were with their families heading home from our event, were called and messages left. All immediately headed back to Madison.

The help we got was amazing from family, friends, and colleagues. I am told that people as far away as Dartmouth, South Africa, and others all over the place got involved in advising the family, interacting with healthcare administrators, working with local clinicians; and just generally supporting the family (praying with and for us, hand holding, food, lawn mowing, telling us what to do).

I could spend the rest of this email and many others just listing the support I got from friends; this includes colleagues. But no matter how hard I tried, not all would be mentioned and that would be a terrible disservice. First because I would forget what some have done, and not know what others have done. Their acts and thoughts of kindness (and possibly most important, their prayers) got us through this and probably affected the ultimate outcome. We deeply appreciate it. Thank you so much.

I began to respond on day four. But before that the family and friends kept talking to me, encouraging me to respond, and telling me I was ready to respond and I guess I gave some signals: mostly vague utterances, small hand movements and tears. Family got me to respond long before health care providers could. I think this is an important message for all of us for future healthcare events; the involvement of family and friends is critical to recovery.

While I want to avoid thanking specific friends and colleagues. I just mention my wife and the kids. As has been the case for the last 51 years of my life, my wife was my rock. She initiated the efforts to engage many people, insist on high quality care and provided the central support in virtually all ways. As usual she was tough and constant. Now as the crisis ebbs, the effect of this crisis on her becomes very evident. She is just plain exhausted. One of my daughters was the organizer and the person with clinical background who could interact with and ask important questions. Another daughter was the Howitzer: "You (nurse) will never again talk about my father in the third person while you are in his presence. Do you understand me?!". And my son was the gentle politician who kept trying to keep the nurses happy so that they would give me good care.

I must not have felt "at home" at the hospital and wanted to be transferred to the University of Wisconsin Hospital cause when I did start communicating I kept asking "why did you bring me here? In reality they probably did just fine with the deep freeze protocol. But once I was moved to the step-down unit (from ICU) I and others wanted me to be at UW. My first real memory of this whole event was the ambulance ride to UW on day 5.

UW was amazing. Do you know that for the last three years running UW has the highest scores on cardiac quality (death rates, complications, medical errors) of any academic medical center in the USA?! The prevention, intervention and the rehab teams are so competent, well organized and positive in outlook. You know who is in charge and so does everyone else. The primary care doctors are deeply engaged in the work. Things work almost like a machine. Morale is high. Staff like each other and treat the patients with respect and commitment. And you can see what a woman's touch (the CEO is a woman) can do to one of the ugliest healthcare organizations I have ever been in. If someone had told me ten years ago that UW hospital and clinics could be a calming, pleasant place to work and be cared for, I would have suggested that the local mental health hospital could find a room for them. But she has transformed it (or at least someone has).

I don't mean to suggest this experience was a walk in the park. In fact being treated for cardiac problems is pretty demeaning. The lead nurse counseling me before my catheterization warned me a that a lot of hot-looking nurses would be playing with my crotch but to not get any ideas. She was right and I did not get any ideas.

Once we arrived at UW prospects just kept getting better. At first they were going to do a stent to open up one of my arteries, put in a pacemaker and defibrillator. Then after the catheterization the doctor in charge of my case said: all you need is to put in a stent to open things up and get your potassium levels straight!

On day four at UW I was discharged. The head of my team (who is also the head of cardiac rehab) said at most I injured about 5% of my heart and that should come back. He told me as far was my heart was concerned there were no restrictions; that I should take a week off and then get back to working out at least 5 days per week, up from three. The stent cured the problem. My wife, however, suggested he might want to see a psychiatrist and told me that I was taking the rest of June off! I married a good woman and I will do what I am told.

But the key result in all of this is that compared to what my wife and the family and friends went through, this was a walk in the park for me. I slept through virtually all of the toughest half of it. And the other half for me has been without incident; pain, etc. By contrast my family as well as other family, friends and other colleagues have (to different degrees) been through hell and back. They faced fear and uncertainty and made tough decisions that went far beyond what I faced. I wish I could have spared them of that.

It is hard for me to consider this experience to be just a melding of random events, but it might be. What is the probability that the event would occur at a setting that had an AED when I could have just as easily been out jogging? That the check-in woman would have just happened to be looking down and saw me collapse instead of attending to some detail or checking in someone. That the manager would have been there when he never comes in at that time on a holiday. That he knew how to operate the AED and do CPR. That the paramedics were just down the block not four of five minutes away. That an incredible team of people would come together just in time to prevent me from staying dead and to treat me in such a way that the event has now turned out to be one of relatively minimal consequence. What is the probability? But if there is a higher power in operation (which I choose to believe), it raises other disturbing issues such as Why me? Why Darfur? Why is the middle class reducing? Why is there no national health insurance program that would provide similar care for all? Why? I guess I will never know, at least until I permanently cross over, which I hope and pray will not be a quite some years.

Thanks again to each and everyone one of you for providing us support that "passes all understanding. "

Dave’s Advice: Family got me to respond long before health care providers could. I think this is an important message for all of us for future healthcare events; the involvement of family and friends is critical to recovery.

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