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House Calls

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A close call

How my sister, along with small-town care, saved my life after a heart attack

By Peter Metcalfe

I had no symptoms—no warning signs. As I began a run with my sister, Kim, on the early afternoon of Feb. 24, 2021, I remember feeling as healthy as I ever had. I'm 69, and Kim is two years my senior. We were training for another Klondike Road Relay. But as I was to learn, asymptomatic heart failures are not uncommon.

When you hear of someone "dropping dead of a heart attack," that is usually a sudden cardiac arrest, like I experienced nine minutes into our jog up the Brotherhood Bridge Trail.

My last memory of this is of standing next to Kim's car preparing for our four-mile jog along the Mendenhall River.

A scary experience

Kim did CPR on me before the first responders arrived. Immediately after that, she called my wife, Sandy, to tell her that I just had a heart attack while we were on a trail run. Sandy was soon on her way, but after arriving at the wrong parking lot, she headed directly to the Emergency Department (ED).

ED nurse Regena Deck, MSN, RN, recalls, "Your wife came in looking upset, as anyone would be. I'm sure she was playing out every scenario in her head."

Within moments, Sandy was able to focus, thanks to Sarah Zaglifa, the on-call social worker, who allowed her to be present in the moment, to just be there.

"The medical team was amazing," Sandy says. "I never doubted you were in the best of care."

Ready for anything

Regena heard the call come in about a cardiac arrest in the field with a bystander (Kim) providing cardiopulmonary resuscitation.

"We started to prep for that, but then we didn't hear anything for a while," Regena says. "Then we were hearing multiple calls for assistance to get you off the trail and that CPR was still in progress. Without knowing exactly what was happening in the field, it seemed highly unlikely that we were going to get a viable patient."

Hannah Marko, RN, the case manager on duty, agrees. "It takes really good quality CPR to save a life in those circumstances."

Hannah says that even with doubt increasing, the ED continued to fully mobilize the team and alert others to be on standby—radiologists, respiratory therapists and surgeons.

A sense of dread fell over the ED with the long pause between radio calls. Then a call came in from the ambulance. "Not only were you alive, but they were getting good vitals and signs you were going to do well," Regena says. "It was pretty remarkable."

Quick, lifesaving care

Everyone involved in my immediate care praised my sister for providing nonstop, high-quality CPR for nearly 14 minutes, which would exhaust a person half her age. All the while, Kim was expertly coached over the phone by the police dispatcher.

I'm told I came into the ED in obvious pain, and I was combative due to my confusion. But I was alive and\ kicking. The team knew immediately that I was hypoxic—my cognitive functions were impaired by a lack of oxygen during the more than 25 minutes of CPR provided by my sister and the first responders.

My appearance might have really upset my wife were it not for Sarah

"Making sure the loved one is with someone who attends to basic needs—water, blanket—that is best practice," Hannah says. "Most important is communication, so the loved one can focus on the patient."

At the most intense moment for Sandy, the attending physician, Jodie Totten, MD, introduced herself and asked permission to administer a clot-busting drug. "When someone has a large heart attack like you had," Dr. Totten tells me, "almost always there is a blockage to a main artery, and our mission is to unblock."

The drug is not without its risks, but Sandy is as level-headed as anyone I could hope to be with. She was able to focus, carefully consider and then sign the permission form.

The small-town treatment

Regena then turned my head to the side so I could look Sandy in the eye. "Peter, this is your wife, Sandy," she said.

"You were confused," Sandy recalls, "I sat there and held your hand. Soon you began conversing, and although you would return to the same questions again and again, you were getting more cognitive."]

"Once we got some pain meds on board, you were holding court just a little bit," Regena says with a laugh. "You were in a trauma room divided by a curtain. When things had calmed down and we were talking with you and Sandy, a gentleman in the other bed called over to you through the curtain, said his name, and yelled, 'Peter, Peter, it's me! I don't want to get in your business, but I know things are going to be OK; we are praying for you.' I thought, ha! That's small-town life right there."

Regena certainly has it right from my perspective: Juneau is a small, wonderful town. I had met two of the first responders when they were children, and Dr. Totten is a friend Kim and I met in 2019 when she joined our Klondike Road Relay team.

Moving forward

The goal of the ED team, Dr. Totten says, was to get me stable enough for transport. Soon after my transfer to Anchorage, I received two stents by angioplasty, a noninvasive procedure.

Angioplasty requires a specialized team, as does heart bypass surgery, and heart transplant surgery requires an even more specialized team. Such services can only be credentialed with a regular flow of customers. For this reason, small communities like Juneau have limited specialist medical care.

But we have an advantage: Our medical providers are also specialists, skilled in preparing us for transport and readily sending us to the best possible services.

Incredibly effective care

The moral of my story: Follow your doctor's recommendations. Several years ago, I had been prescribed a cholesterol-lowering drug—a statin, to help reduce plaque buildup—and one to lower my blood pressure. But I subscribed to that all-too-common antipharmaceutical attitude—I didn't think I needed to take pills. The type of heart attack I had, commonly known as a "widow-maker," was likely caused by plaque buildup.

I intended to keep well ahead of the Grim Reaper by frequent exercise. Instead, I was recklessly rushing toward that mortal appointment. Thankfully that appointment was interrupted by my sister's heroic CPR, my wife's support and the incredibly effective care I received from Juneau's first responders and the Bartlett ED staff. Thanks to all who saved me, and to the daily medications I take, I'm here to write about it.

Editor's note: Peter Metcalfe began writing articles for House Calls in 1989. For several years in the 1990s he wrote and produced the newsletter, and again from 2003 to 2012.

No time to spare

"It just hit me. I had to do this."—Kim Metcalfe

Nothing was out of the ordinary when running-buddy siblings Kim, 71, and Peter Metcalfe, 69, pulled up at the Brotherhood Bridge trail parking area for their biweekly run along the Mendenhall River, the glacier with the same name on the horizon. On precipitation-free Feb. 24, 2021, the trail was covered with a smooth layer of snow and ice.

"My brother took off like a shot, as usual," recalls Kim. Going on about a mile in at the foot of a small rise in the pavement, she spotted Peter.

"As I was coming up, I saw him lying on the ground. I thought maybe he slipped. He was lying on his back. His eyes were closed. Just looking at him, I knew that he was out. I knew something was very wrong."

"Call 911" and "start CPR" flashed into her brain—what she remembered from a CPR course she'd taken years ago as business agent for a state employees union. "I called 911," Kim says.

Alex Vicario, a young woman with two years on the job at the airport fire station, walked her through how to do CPR and the correct timing. "She told me where to place my hands. I did have my hands in the right place, between the nipples with one hand on top of the other. She told me to press down two inches to the rhythm of 1, 2, 3, 4."

Kim kept counting to the beat of the dispatcher's voice.

"It was surreal, Kim says. "No one else was around. His face was a purple color. He was exhaling, making these noises. That was disconcerting. Doctors later described it as a death rattle. It's not breathing, but it's keeping the blood pumping."

Fourteen minutes later, Kim, exhausted, was still administering CPR, now with her forearm, when paramedics from Capital City Fire and Rescue arrived.

Peter was revived after a few shocks to his heart with a portable defibrillator. Kim later learned that survival rates are low, 2% to 11%, when CPR is administered outside of a hospital.

"It felt like a miracle," she says.

Knowledge is power

Learn to spot symptoms of a heart attack

You could have one or more of these:

Head: dizziness; light-headedness

Shoulders or arms: pain or discomfort in one or both

Neck or jaw: pain or discomfort

Chest: pain or discomfort

Back: pain or discomfort

Lungs: shortness of breath

Stomach: pain or discomfort; nausea; vomiting

Body: breaking out in a cold sweat; fatigue or weakness

Call 911 if you’re having symptoms of a heart attack.

Categories: Heart health

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