“The stars were aligned that day” - making the difference between life and death

"The stars were aligned that day" - making the difference between life and death

Geff MacDonald doesn't remember most of what happened to him on the afternoon of June 27 of this year. But his six cracked ribs, sore head, cuts and bruises, and repaired heart are vivid reminders of his brush with death that day.

Geff, 64, was on his way to Cape Cod Hospital for medical attention for some symptoms he was having, including an achy left arm and soreness in his jaw. His wife, Suzanne, who was babysitting their grandson, had urged him to call 911, but he said he felt well enough to drive himself.

Talking with him every five minutes as he drove, Suzanne became concerned when he suddenly stopped answering. Unbeknownst to her, Geff had gone into cardiac arrest one exit from the hospital, and his car had careened off the highway.

Suzanne would later describe what happened next as "divine intervention." Cape Cod Hospital emergency nurse Hamish Wilkinson, RN, BSN, MPH, simply called it "lucky." And Cape Cod Hospital (CCH) emergency physician Meredith Horton, MD, said it probably made the difference between a tragic and a successful outcome.

In the Right Place

If a person's heart was going to stop while driving on Route 6, they couldn't have asked for a better person to be traveling shortly behind. Wilkinson was driving home after picking up a Jeep in Plymouth when he saw a car off the highway down an embankment, leaning as if almost about to tip over. People were clustered around the car, and several were screaming for help. He pulled over and ran back to the scene to find Geff unresponsive in the driver's seat, his head resting against the window.

"I could tell he was in cardiac arrest," Wilkinson said later.

Knowing that time was of the essence in order to save Geff's life, he "went into ER mode," smashing the passenger-side window and crawling into the car to begin CPR. The airbags on Geff's car had not deployed, but it was still tricky to perform CPR between Geff and the steering wheel, so Wilkinson and another man, who happened to be an off-Cape operating room nurse, pulled Geff out and laid him on the ground.

"When you do CPR, you're trying to make the heart compress so it circulates the blood," said Wilkinson. "If somebody doesn't have CPR, it's a matter of minutes before all of this cell death happens. The heart tissue dies; the brain tissue dies."

Bystanders had already called 911 and Wilkinson continued the CPR but he was unable to get Geff's pulse to return. Knowing that the CPR was vital to keep Geff's brain and other organs oxygenated, he continued.

Eventually, he and the off-Cape nurse took turns working - Wilkinson doing CPR and the other nurse doing ventilations, or rescue breaths, which push air into the lungs. Wilkinson repeatedly pleaded with Geff to "stay with me, stay with me," as Geff's cell phone rang over and over in the car; his frantic wife trying to reach him.

When emergency crews from West Barnstable Fire and Barnstable Fire arrived, they quickly loaded Geff into an ambulance and dashed off to the hospital. Wilkinson called the CCH Emergency Department and told charge nurse Brian Hendrixon, RN, to "rally the troops" and prepare for Geff's arrival. He then walked back to his car and drove home, covered in blood, sweat and glass, and exhausted. He had worked in the ER until 3 a.m. that morning and had had little sleep before his son woke him to go pick up the car, he said.

"That doesn't always happen in emergency departments"

Meanwhile, Suzanne MacDonald was desperately trying to find out where her husband was. She called the hospital and was told by the Emergency Department operator that no one by his name had checked in.

"That's when I knew," she said.

Her son and daughter-in-law, who had been traveling off-Cape to a memorial service, checked the Facebook page, "Cape Cod Incidents," and saw the accident near the Route 6 commuter lot. They quickly turned around and headed back, calling a friend who could take their 2-year-old son so Suzanne could get to the hospital.

When the ambulance carrying Geff arrived at the ED, Hendrixon made the connection that it was the man Suzanne had called about earlier and called her to tell her Geff was at the hospital and to drive carefully. When she walked in, she was ushered into the unit Family Room and kept apprised of everything that was happening.

Suzanne said she has worked for hospitals in the health information services field for 32 years, much of it at academic healthcare systems in Connecticut, where she and Geff lived up until moving to South Sandwich seven months ago. For Hendrixon to have called her and to have had the personal, compassionate attention throughout Geff's time in the ED "was amazing," she said. "That doesn't always happen in emergency departments."

At the Hospital

Paramedics in the ambulance had been able to get a pulse on Geff on their way from the scene, but he was still unconscious when he arrived at the hospital, said emergency physician Meredith Horton, MD, who handled Geff's case that day. While the situation was dire, she was encouraged by what she found.

"We got a pre-arrival notification (from the ambulance crew) and we knew he had immediate CPR and that EMS had shocked him multiple times. So, when he got here, he was not awake, but he already had signs that were promising," she said. "We saw things that we don't always see in cardiac arrest patients, like he was moving his arms, and his pupils were reacting. That was very reassuring."

However, based on his EKG and other tests, Dr. Horton suspected Geff was still having an ongoing cardiac event. The heart rhythm he had been in when he arrived was called "ventricular fibrillation," which is usually caused by a heart attack or ischemic event, she said.

"That was the highest thing on my differential. I was worried he had had a cardiac event that caused him to arrest," she said.

A Possible STEMI

Dr. Horton and the medical team knew that Wilkinson had started resuscitation efforts within minutes of the accident, but they did not have a clear history of what had happened prior to that. They sent Geff for a full-body CT scan, which, aside from six fractured ribs and a cracked sternum - likely from the CPR itself, showed he had nothing major wrong with the rest of his body.

"We had to make sure that the reason he arrested wasn't from a traumatic injury," she said.

Dr. Horton then concentrated her focus on Geff's heart. There were some changes on his EKG test that she was concerned about, including the fact that his heart rhythm had changed to something called 'ventricular tachycardia.' She also saw signs of a condition called ST-elevation myocardial infarction, or STEMI, which occurs when a coronary artery is completely blocked. The initial EKG was inconclusive, but Dr. Horton pressed on.

"There were signs that he had a STEMI in the back of his heart, so we had the nurses flip him over - while he was sedated and intubated - to do an EKG on the back of his chest. And that confirmed it was a STEMI," she said.

Geff was then taken to the Cardiac Catheterization Lab at the hospital and was found to have a fully blocked artery that had caused his heart attack and subsequent cardiac arrest. There were no other blockages in his heart. A stent was placed in the artery, removing the blockage and taking Geff out of danger.

"I am confident (Geff) will walk out of this hospital neurologically and physically intact," Dr. Horton told Suzanne that day.

Having done her medical training in many hospital units in addition to emergency rooms, including intensive care and cardiac intensive care units, she was encouraged by Geff's signs.

"I've seen what it looks like when patients come in and end up walking out of the hospital, and there were good signs of that here," she said.

Geff spent three days recovering in the Cardiac Intensive Care Unit at CCH, before returning home, sore and tired, but safe and sound. He has since returned to work part time to his job selling revenue cycle software to hospitals, including CCH.

Not a Classic Candidate

By most measures, Geff was not a classic candidate for a heart attack. He had been to his primary care provider for an annual check-up last fall, and his blood pressure, cholesterol numbers and other tests were within normal range. He takes no medications and is active physically. The only risk factor he has is a family history of cardiac disease, he said.

When he looks back on it, he now knows he had been having signs of a heart attack for several days.

"I had been doing work around the house, and I was a little sore muscular-wise for a couple days," he said. "My left arm was aching a little, but I didn't pay any attention."

He decided to go to the hospital when his arm became quite sore and he started having pain in his jaw. "I knew something was going on," he said. He recalls talking to Suzanne on the way, and the last thing he remembers is putting his cell phone in the car cup holder.

"It's almost like it didn't happen," he said.

Geff totaled his 3-month-old Audi Q7 in the accident that day, in addition to suffering a cut leg, and a head bruise that is still numb. His cracked ribs and sternum are "super sore," he said. But, he says he gladly accepts that because the CPR saved his life.

Thankful for the Care

For Suzanne, the worry and fear from Geff's cardiac arrest and car accident have not yet left her.

"I'm so traumatized by it that I wake up every morning in an absolute panic because of the whole thing from start to finish," she said. June 27, which is her son's birthday, is now the date of her happiest memory and her worst, she said.

The bright spot, she said, was the care her husband received that day.

"There is a hero that day - Hamish, and a heroine - Dr. Horton," she said. "I feel like it was divine intervention that Hamish happened along and did what he did."

Wilkinson agrees "the stars were aligned" that day. But says he didn't do anything that anyone else wouldn't have done.

Suzanne said Wilkinson visited Geff while he was in the cardiac ICU and told him "Sorry for your broken ribs - and your sweet Audi."

Speaking several weeks after the event, Dr. Horton said Geff's case is not a typical outcome from a cardiac arrest.

"We almost never see early signs of neurological function in people who come in (in cardiac arrest). He also had very little down time (due to Wilkinson's immediate CPR), as well."

Geff and Suzanne recently returned to the CCH Emergency Department to deliver cupcakes and cards to the key players responsible for saving his life that day. Dr. Horton, who was kept apprised of Geff's progress that weekend, was not on duty that day, but said she was touched by the MacDonalds' card.

"This is the first gift I've ever gotten (in the ED)," she joked.

As tragic and traumatic as the day was, it was the people involved in rescuing and caring for Geff that "made it so much better," said Suzanne.

"I hope they are recognized for their amazing expertise, their professionalism, their compassion. If it had to happen, I'm glad that the people that were there, were there."