By Dr. K. Javeed Nayeem, MD
In my last four articles in this series on Sudden Cardiac Death (SCD), I have told you almost everything about why such deaths occur and what you can do to prevent them and also how you should react to save the lives of the victims, if you do happen to encounter one such situation. I also told you about why it is so difficult to rescue people who run into this problem and the distressingly high mortality of more than ninety percent that it carries, if not promptly treated within the very short time it takes to kill the person.
Understandably, this grave problem makes us feel both bad and sad. Yes, I have seen a very close friend of mine dying this way quite recently. He was hale and healthy in his mid-forties and had gone to a supermarket with his family. After they finished their shopping, as he walked to his car and was about to unlock it, he suddenly collapsed on the pavement and became unresponsive.
His panic-stricken wife called me up on my mobile phone, surprisingly at a time when I was passing right in front of his house in my car and told me about what had happened. I advised her to rush him to the nearby super-speciality hospital and told her that I would be reaching there immediately.
But even as I had gone only half way, the duty doctor at the hospital called me up to say that my friend had been brought dead and was not responding to any of the resuscitation attempts they were making to revive him. And, that was the tragic and most untimely end of his life!
But while most victims can end this way, there are also some instances where as a practicing doctor I have myself seen people beating the steep odds and surviving sudden cardiac arrests.
One afternoon, more than thirty-five years ago, while I was on duty as a Post-Graduate medical student at the Mysore Medical College, an autorickshaw driver brought a passenger who had collapsed on the seat of his vehicle as he was driving him around the city. The man who hailed from the town of T. Narasipur had been visiting the houses of his various friends and relatives to distribute the invitation cards of his daughter’s forthcoming wedding.
The driver was so concerned and quick that he did not even wait for the staff of the emergency room to fetch a stretcher trolley and take the patient inside. Instead, he himself carried the victim in his arms and laid him on the examination table.
My friends and I examined the patient and found that he was pulseless and completely unresponsive. In those days, cardiac defibrillators that can jolt a stopped heart electrically and restart it, had not yet made their way to our city and so we quickly started a manual cardiac massage followed by artificial respiration to revive the patient.
Thankfully, our efforts bore fruit and much to our relief and joy the man opened his eyes and started looking around in dazed confusion. The wedding invitations in his handbag gave us the detailed information about his identity which helped the Police to send a wireless message to their counterparts in T. Narasipur, thus quickly fetching his relatives to the hospital.
The follow up treatment ensured that he was discharged in a stable condition, in just a few days. He went home healthy and happy but not before inviting all of us in the unit for his daughter’s wedding and making us promise that we would attend it without fail.
And, attend it we did, not just to make him and his family happy but also to celebrate our maiden victory in bringing back to life from the brink of death, our very first patient of Sudden Cardiac Death, even as we were still mastering the art of saving lives!
But the most dramatic incident that I know of where perfect timing, perfect coordination, the presence of the right people at the right time and place, with the requisite drugs and plain good luck, saved a fellow doctor’s life, is the one I am now going to narrate. Although the dramatis personae in this real-life drama are many, the main protagonist is my close friend, Dr. S.N. Rajeshwar, a practicing Radiologist and the son of late Dr. S. Narayana Setty, the former Superintendent of the P.K.T.B. Hospital in the city.
One Sunday afternoon, Raju, as he is known to all those who know him closely, decided to go to a hotel here in the city for lunch. For company he pulled along two of his friends who were both ENT surgeons. As they were having their lunch, Raju suddenly lost consciousness and slumped limply in his chair. Since both his companions were doctors, they quickly assessed his condition and determined that he had had a sudden cardiac arrest. So, they promptly started the resuscitation drill of giving him a cardiac massage and artificial respiration. But to their dismay they found that he was not responding to their efforts and were thus beginning to feel desperate.
Seeing this turn of events, a group of medical Post-Graduates who were also having lunch at a nearby table joined them. Thankfully one of them was an anaesthetist and more thankfully he had his emergency kit in his car which he rushed and fetched. He quickly opened an ampule of adrenaline, a very potent life-saving drug and administered an intra-cardiac injection that delivered it straight into Raju’s heart. This did the trick and his heart started beating, albeit irregularly!
Meanwhile, the ambulance which had been summoned, arrived on the scene and the patient was shifted to the hospital to which he himself was attached, where he was put on the necessary medical support and stabilised. He remained in a semi-comatose state for nearly a week and seemed to have lost his memory which he thankfully regained gradually. Tests revealed that he had an inherent problem with his heart rhythm and therefore two weeks later, he underwent the implantation of a special kind of pacemaker called an Implantable Cardioverter- Defibrillator (ICD).
Thankfully this marvel of modern medical technology, sitting inside his chest and keeping a silent, round-the-clock vigil, is now ensuring that his once truant but now chastised heart, is behaving like a good and obedient schoolboy!
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