At the Crossroads

At the Crossroads offers a change of pace from our usual clinical fare. Here we can read about the life endeavors of our patients. It may help us remember that this patient in front of us on the cath table is not #5 for the day in this room with Dr. Whatever, but rather a fellow human being with an interesting story or two to share. As Michelle states at the end of her story, the cath lab is definitely not your 9-to-5 job that leaves you empty and without compassion. Regardless of the time of day, it has got to give you a great feeling of worth. If not, then you need to have patients like this one. Bruce W. Coyne RCIS, LRT, RT My name is Michelle Nelson, and I am the manager of the cardiac cath and EP labs at Mercy Medical Center in Canton, Ohio. I would like to share my most touching patient story with everyone. On March 6, 2001, a 55-year-old man named Rodney had been shoveling snow from his sidewalk after work. When he finished, he went inside and played Nintendo. His wife walked to the kitchen to make tea, and when she returned, she found Rodney unresponsive on the floor. She had never taken a CPR class before, but she called 911 and the dispatcher instructed her on what she needed to do as EMS responded to the scene. When the ambulance arrived less than three minutes after the call was made, Rodney was found to be in full cardio-pulmonary arrest. He was showing VF on the monitor, and he did not respond to ACLS medications and defibrillation. He was intubated by the squad and transported to our ED while resuscitation efforts continued. After following ACLS protocol in the ED for 30 minutes, the staff and physicians were still unable to revive Rodney. As a last thought before discontinuing efforts, the ED clinical manager suggested calling the medical director of the cath lab to see if there was anything he might be able to do for this young man. Because Rodney had no signs of life, he could not be admitted to the hospital. He never had spontaneous respirations or a cardiac rhythm. Our cath lab medical director decided to take him to our portable cath lab in our ED, place him on peripheral CPS (cardio-pulmonary support), and attempt to perform a cath and PCI. We put Rodney on bypass, performed the cath and found that he had a totally occluded LAD and RCA. There were many critics (including other cardiologists) who questioned what we were trying to do. They thought that even if we managed to save his life, there would be too much neurological damage from hypoxia related to the prolonged down time for Rodney to have a reasonable recovery. After much effort on everyone’s part, we managed to open both vessels. I have never worked so hard to save someone’s life as I did that day. We weren’t sure what the final outcome was going to be, but we couldn’t and wouldn’t give up. After restoring coronary circulation, we were finally able to defibrillate him and restore a sinus rhythm. His vital signs stabilized and he was transferred to the operating room to remove the peripheral CPS catheters. He was then admitted to the CCU, where he remained in a coma with no reflex responses for 48 hours. Rodney gradually woke up, but his neurological and cognitive responses were slow. His memory was poor and he was debilitated from the prolonged bed rest. His initial EF was 20% and within one week improved to 40%. When he was stable from a cardiac status, Rodney was admitted to our rehabilitation unit for intensive therapy (April 19, 2001). At that point, he still had a tracheotomy and PEG tube. The neurologist, Rodney’s wife and the rehab staff worked with him for many weeks. Eighty-one days after his AMI with an out-of-hospital unwitnessed sudden cardiac arrest, Rodney walked out of the hospital under his own power to resume his life with full recovery of his neurological, cognitive and physical functioning. This is a man who many physicians would have pronounced dead shortly after his arrival to the ED. Because of the quick thinking of an ED nurse and the skill of the paramedics, ED physicians and staff, and the perseverance and talents of the cardiologist, cath lab staff, perfusionists, and respiratory therapists, not to mention the rehab physicians and staff involved in his care, Rodney was able to return to his family fully recovered. Three months after Rodney’s initial event, we had a cath lab tech position posted for our department. One of the applicants was Rodney’s niece, who had been working in our radiology department. She was so inspired by what we had done for her uncle that she wanted to join our team so she could make a difference. This is the same story that was featured at a local gala. That night we were officially presented with our accreditation status. (We were the first fully accredited chest pain center in the nation!) Our state senator, who was also there that night, was so impressed with our accomplishments that the state of Ohio presented Mercy with a $1,000,000 grant to build a fixed cardiac cath lab in our emergency department. Rodney wasn’t our first patient to experience and survive a cardiac arrest in the setting of AMI with CPS and PCI in our ED, and I’m sure he won’t be the last. But Rodney left a mark on my life. When my pager goes off at 2:00 am, he is the inspiration for me to respond without regret and make a difference in another person’s life. Life in the cath lab is far from easy, but it’s the most rewarding career I could ever imagine.

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