The call came into the Emergency Department at Mayo Clinic in Florida: Cardiac arrest, arriving in five minutes.
It was a hard diagnosis at a hard time. Florida was at the peak of the COVID surge. The hospital was overwhelmingly busy with the highest volume and acuity the department had ever seen. Morale was low among staff, one of the many casualties of the pandemic. This patient's arrival would bring yet another loss, they feared. Cardiac arrests don't usually have happy endings. The survival rate is just over 10%.
A team quickly gathered in a room to prepare. Nurses and doctors. A respiratory therapist and paramedic. All ready to work together to care for the critically ill patient about to arrive.
When he was rushed into the Emergency Department, the patient looked better than the team had expected. His skin was pink, not the grey they were used to seeing after a cardiac arrest. Because paramedics had been with the man when he had collapsed, they’d been able to begin CPR immediately and keep his blood flowing. That was good. Witnessed arrest patients who receive immediate CPR have a better chance of surviving.
The patient lay in the center of a circle of care, a tangle of tubes and lines going into and out of his body. A LUCAS device delivered automated chest compressions. A tube inserted into his trachea helped him breathe. And a new resident, just two months on the job, had her hand on the man's femoral artery, monitoring his pulse. "Anna, you're going to learn a lot today," the attending physician had told her when the call came in.
The physician was right. Anna watched the choreography around her, each staff member expertly playing their part in a dance that might save a life.
"Anna, what could be the underlying cause of this cardiac arrest?" the attending physician asked. Anna went through the list of possibilities she'd learned in med school. An electrolyte abnormality? A heart attack? A blood clot? Finding the right answer was key to finding the right treatment. The team discussed the options.
Another doctor working in the emergency department called the patient's wife, who was on her way to the hospital. He asked about the patient's health history. He'd recently complained of pain in his legs, she said.
That pain could be a symptom of a blood clot, the team knew. And a blood clot in a leg could move to the lungs and cause cardiac arrest. So in addition to standard Advanced Cardiac Life Support, the team decided to treat the patient with tenecteplase, a clot-busting drug.
The medication was ordered and administered. So were tests, blood work and ultrasounds. And still, the LUCAS device pressed on, delivering compressions that kept the man's blood flowing.
Thirty minutes passed. An hour. The team's efforts continued so long that the battery on the LUCAS device died. A new device was strapped to the man's chest and compressions continued.
The man's wife arrived and grasped her husband's hand. They'd shared so much together already. But not nearly enough. She looked like she was sending her husband a message. "It's not time," perhaps. "We have more life to live. This can't be the end."
The new physician watched, her heart opening and then breaking. She imagined the patient's family, his life outside the hospital. A life he needed to get back to.
The new physician watched, her heart opening and then breaking. She imagined the patient's family, his life outside the hospital. A life he needed to get back to. Please, Anna prayed silently, please let all of this work.
Every few minutes, the LUCAS device was turned off. The busy room would quiet, and Anna would strain to feel the man's pulse. Would it still be there without the mechanical compressions?
For 90 minutes, the answer was no. But then, her hand sweaty and cramping, Anna felt a flutter. She looked across at the nurse who was monitoring the man's pulse on the other side of his body. Their eyes met. He'd felt it, too. Yes!
The room was silent. It was also electric. Anna and her colleagues knew they had been part of something almost impossible. They'd witnessed a miracle, more than one believed.
A CT scan confirmed the diagnosis of pulmonary embolism, indicating that the team's theory was correct: a blood clot had caused the cardiac arrest. They'd saved the patient's life, but Anna knew how vulnerable he still was. Would he survive?
When Anna arrived for her next shift, she learned the answer. He'd made it, the attending physician said. She'd gone to his room for a visit. "I told him 'I had to come see you. You're a miracle,'" she told Anna. "Well," the patient had responded, "I guess I’ll have to do something good with my life since I got a second chance."
Anna went to see the miracle herself. The man was sitting in a chair, bathed in sunlight. A nurse introduced them. "This is one of the doctors who saved your life."
Suddenly, the enormity of what she'd been a part of hit Anna. This is what I do. This is what we do. What a great honor.
And what a gift.
"Sometimes we save patients," the attending says. "And sometimes, they save us, too."
Editor's note: The patient featured in this story did not want to be identified but gave permission to share his story anonymously.
The staff featured in this story are Anna Demian, M.B.B.S., a first-year resident in family medicine, and Leslie Simon, D.O., chair of the Emergency Department.
“I’ve never done CPR that long and had a good outcome,” Dr. Simon says. “This patient’s survival is a testament to what a great team we have. We could not have been busier and yet everyone gave 100% to care for this patient. The rest of our staff absorbed the workload to make sure everyone in the department got the care they deserve. This case was an amazing thing to be a part of. It was a reminder that what we do matters.”
For Dr. Demian, it was a reminder of the value of each individual life. “Every patient has infinite value and we as health care providers get to care for them in that light,” she says. “The whole health team gave this patient their all because they recognize the value of each human life.”