The Day My Dog Saved My Life
Here’s how a series of fortunate events helped Matthew Church live to tell the tale of his heart attack.
About 11:40 pm, a few weeks before Christmas, I was standing in our living room in downtown Toronto. Just back from my semi-regular two-hour evening bike ride, I was complaining to my wife that my shoulders and elbows were aching, and that was odd because it was usually my wrists that hurt post-ride. Patricia said something like, “That’s angina until proven otherwise” and that I must arrange to see our family doctor.
Typically, I pooh-poohed her concern. She gave me a couple of ASA, instead of the usual painkiller, for its clot-busting properties. I claimed the pain was all gone but took them anyway before heading up to our third floor to watch the day’s sports recap.
With this modest bit of advice, my wife, a psychiatrist, initiated a cascading series of crucial medical interventions that over the next two hours would save my life – and ensure that I would have a life worth saving.
I have no memory of any of it.
The next thing I do remember is more than 20 hours later: I found myself lying in a cardiac intensive care unit bed, attended to by a group of very worried looking people – my wife and kids, my mother and a brother, a couple of old friends, a doctor, a resident, a nurse – with IVs and wires connecting me to some flashing, beeping monitors and machines dangling above my bed. My ribs were killing me, and my chest felt like someone had run a Roto-Rooter through it. I had no idea where I was or why. Patricia explained it to me again and again – and, she says, again and again. For the next day or more I would be in a state of flummox – unable to recall the explanation from one minute to the next. I had no short-term memory.
Next: The explanation was pretty simple
The explanation was pretty simple really: “100 per cent obstruction of the proximal LAD” had caused a heart attack, and my heart had stopped, and with it all my vital functions. The “LAD” is the left anterior descending artery, which feeds the hardworking lower left part of the cardiac muscle as it pumps blood out to the body.
When it’s blocked, cardiologists have another name for it: “the widow-maker.”
I was dead by the time I hit the wall-to-wall.
I seemed an unlikely candidate: I’m an unusually fit 56-year-old man with a taste for heart-pounding bike rides and arduous solo canoe trips. My bike is my primary mode of short- and long-haul urban transit twelve months a year. I don’t drink alcohol. I don’t smoke cigarettes (anymore). Ever since my father’s catastrophic heart attack when he was 48 (he’s now 86!), he has kept my siblings and me abreast of all the current thinking on heart health, from nutrition to folic acid and the omegas to HDL and LDL ratios and homocysteine levels. I was going to live a long time. Everybody thought so.
The story of my resurrection, as it were, begins with Zola, our good-natured and generally oblivious chocolate Labradoodle.
Soon after I took the two Aspirin and headed upstairs, Patricia heard a heavy thud. It sounded like a knapsack full of books dropping to the floor. She’s a bit of a worrier and thought about calling up to me, but I wear headphones when watching telly so she knew I wouldn’t hear her even if she did. She also knew I’d think it silly to be concerned about a random noise. She resettled herself with her book on the sofa in front of the fire in our living room.
But then Zola started barking and growling and snarling, aggressively trying to rouse her, to alert her to some urgency or danger. If only because this was so atypical, so unlike Zola’s usual languid demeanour, Patricia took notice. Zola would not be calmed, so they headed upstairs together to investigate.
Next: Anecdotal evidence that dogs can sense things we cannot
There is plenty of anecdotal evidence that dogs have the capacity to sense things we cannot: there are countless stories of them detecting everything from impending earthquakes to cancer in humans. Some experts believe that the human body emits certain odours during a heart attack or seizure, and dogs, with their vastly superior sense of smell, can register it. Was that what Zola was responding to from two floors below? We’ll never know, but she now wears a brass tag, engraved with the words, “I saved my human.”
When the two of them reached the third floor, they found me lying face down on the floor beside the leather armchair. I was immobile and turning a shade of blue. Rolling me over and checking for vital signs, Patricia found none. I was dead.
There’s something you need to know about psychiatrists: they don’t face a lot of life-and-death situations. I mean, I’m pretty sure they talk about death a lot but they seldom need to deal with it so directly. But Patricia works with the street-involved, the marginalized and vulnerable, and she works within a hospital, so she has been trained and retrained annually in basic cardiac life support. It’s just not something that she’s had occasion to use. She followed the latest CPR protocol: compressions, steady and hard; don’t be too concerned with mouth-to-mouth resuscitation. And don’t worry if you crack a few ribs. Meanwhile, she called down to our daughters, Alice and Olivia (then 23 and 17), and told them to call 911. “NOW!”
It must have been a shit storm. Olivia was stationed at the front door to meet the emergency responders. Alice stayed on the phone with the 911 operator. And Patricia performed CPR. Even as she laboured away on me, as a physician she knew the odds of my surviving were truly abysmal: more than 20,000 people suffer out-of-hospital cardiac arrests in Canada each year; fewer than 2,000 survive, roughly eight per cent. For anyone receiving CPR from a non-professional, survival rates are even worse.
And for those who do come out the other side, permanent, often debilitating damage to the heart muscle and/or the brain is pretty much guaranteed. A few lucky people emerge unscathed, but statistically they are so rare as to be anomalies, outliers. How did I dodge the bullet to my heart?
Next: It must have felt like an eternity for my wife
It was seven minutes and 43 seconds until the first fire truck arrived. That’s impressively fast to actually deliver a full complement of the latest in emergency medical care right to your door (and one of the reasons I am able to write this now). But it must have seemed an eternity to Patricia, pounding out compressions, calling my name, yelling at me to listen up, to come back.
Even with all that going on though, she had more than enough time to contemplate every possible implication, from what Christmas might be like this year to thinking of any future grandchildren not having a grandfather. Patricia is a stoic and so has been pretty tight-lipped about it all since, though one day a few months later, out of the blue, she said, “I will never forget the feeling I had when I first heard the sirens coming up the street.” Help and (some semblance of) hope were near.
Eight minutes is very close to the threshold of survivability for someone in cardiac arrest and receiving CPR. (Of course, without CPR, that threshold is zero minutes.) More than eight minutes and the mortality rate goes through the roof. Survival after that point is seldom an outcome.
When the firefighters and paramedics reached the third floor, they took over. They attached leads for the ECG. Someone suggested to Patricia, now standing to the side, that she might want to leave the room; they were going to defibrillate and it’s not pretty watching someone get shot through with 3,000 volts. Not a good final memory of your husband at the very least. She took their advice and joined the girls downstairs. (“We’re going to be okay. We’re going to be okay,” Olivia told me later is what her mother said. “Even if it’s the three of us, we are going to be okay.”)
I got a shot of epinephrine to kick-start the heart, followed by my first jolt. Nothing happened, as expected. Defibrillation seldom works. Some estimates put it as low as two per cent, but in the hands of trained paramedics, as part of a concerted effort, up to 13 per cent survive.
Either way, these are not great odds. They zapped me again. Nothing. The protocol calls for three attempts, so they waited for the system to re-charge then hit me again. Suddenly, the ECG lines started to squiggle. My heart had resumed a tenuous rhythm, irregular and jumpy. Patricia said they sounded giddy with excitement because it’s so seldom successful.
Even as the paramedics rushed to prepare me for transport, they were interpreting the ECG. What they saw was subtle but crucial: the S and T peaks on the ECG were higher than the normal, meaning I had experienced an “ST Elevation Myocardial Infarction,” or STEMI. This type has one recommended response: immediate reperfusion of the heart muscle. Pronto.
In the last 10 years, the treatment of STEMIs, the most common form of infarction, has been revolutionized.
Next: “Door-to-balloon” time
Throughout North America, massive resources have been poured into creating protocols and systems that ensure a “door-to-balloon” time of no more than 90 minutes. (“Balloon” is the old-fashioned term still used for angioplasty and the insertion of a stent in a damaged heart vessel.) Over an hour and half, and the prognosis gets ugly. The closer you live to major hospitals, therefore, the greater your chances of survival and healthy recovery. I live 3.7 kilometres from Toronto General Hospital, and it’s not even the closest one.
But TGH is home to the Peter Munk Cardiac Centre, which had recently established its own leading-edge catheterization lab specifically for treating STEMIs (identification and triage training for paramedics, an in-hospital immediate-response team and rapid on-call interventional cardiologists). Even before the ambulance pulled away from the curb, TGH was informed a STEMI was on the way. Patricia and the girls were put in the back of a police cruiser, and our two vehicles roared off, lights blazing and sirens blaring. Everyone on our street must have heard or seen it.
Just a few minutes later, I was met in TGH emerg and immediately wheeled through to the STEMI lab on the second floor. That’s when Dr. Chris Overgaard and his team took over. A founder of the TGH STEMI lab,
Overgaard is an interventional cardiologist. Boyish still in his 40s, he projects a calmness and competence typical of those who regularly confront life and death. Not long after arrival, they had a clear picture of the fingernail-sized piece of plaque lodged in my artery and were preparing for catheterization. A catheter was inserted in a vein in my right wrist and was pushed upstream into my heart and through it to the LAD to the point of blockage. Vacuum pressure latched on to the plaque, and it was retracted. Then another catheter was inserted and pushed to the same point. On it was a stent that was expanded to bolster the damaged artery. This small mesh tube infused with drugs to prevent rejection is now a permanent part of my heart.
I awoke hours later not remembering anything. Patricia tried to explain but, they tell me, I couldn’t hold on to the explanation of what had happened. Every five minutes or so, I would ask again why I was in a hospital bed and why my chest hurt so much. And every time I would be stunned and horrified and, apparently, embarrassed. It got so repetitive it was almost funny the girls say, like a comedy act. For the medicos though, including Patricia, this was a very bad sign. They know that nearly 30 per cent of the few people who survive any type of sudden and total cardiac arrest suffer brain damage, often permanently losing the capacity for short-term memory. That would be devastating. Time would tell. Or rather, over the next weeks and months, numerous CT scans, ECGs, echocardiograms would tell.
Next: I was devastated
It was nearly 24 hours before I could hang on to the facts. I was devastated. All that effort to stay healthy, and all I had managed was seven years beyond my father’s early cardiac troubles! It pissed me off, though gradually it began to dawn on me that I wasn’t unlucky: just the opposite. Starting with those two Aspirin (Overgaard smiled and patted Patricia on the back when he heard about that very first intervention), I had received precisely the care I needed to still be alive and well.
Six months later, I still have no memory of any of it. And what’s even more weird, I have none of the expected outcomes – I have no obvious cardiovascular disease, no heart failure, and I am back exercising and riding my bike. It is almost like it never happened. Some days, I could swear none of it did happen. Or that it was a crazy nightmare that had a happy ending. Of course, those who were there, who witnessed the whole awful scene, would never ever say such a thing. I feel terrible that I put them through it. Though I do like to point out that technically I wasn’t there.
There are a few questions I hear very often. Why did it happen to someone so fit, so conscientious about heart health? I asked that of every doctor I encountered and to a person they say there’s no way to say why, really.
Heredity, of course, is the main predictor; it was almost inevitable that someone in my family would be hit. And there is some evidence that habitual and extreme exertion over extended periods of time can damage the heart (quite common among endurance cyclists and marathoners). As to why I recovered so completely, Overgaard said simply, “The stars were aligned.” My GP, a thoughtful man and caring doctor named Rae Lake, called it “miraculous.” I think in some ways it was heredity again: I had learned so much from my father and his experiences that, physically and even emotionally, I was prepared for survival.
Another very common question of course is: what did I see when I was dead? Did I have a near-death experience? Did I see heaven? No, and I am glad I didn’t: I am a lifelong nonbeliever and a sceptic regarding the supernatural. Discovering there’s an afterlife would have been more than I could bear. That might’ve killed me.
Next: “How has it changed you?”
The other question I have heard often (and still ask myself) is “How has this changed you?” I don’t have an answer for that yet though I know it has. Everything feels very different. I feel a kind of immediacy now. Not urgency exactly but an awareness of the importance of everything: no matter how small or trivial it seems, it warrants my full attention. And how nothing is too terrible, no matter how big. I don’t know how much of that is attributable to my crise de coeur and how much to the fact I began practising mindfulness-based stress reduction within two weeks of my death and rebirth.
Patricia gave me Jon Kabat-Zinn’s book, Full-Catastrophe Living, which details a meditation-based practice which he originally designed in the 1990s for cardiac patients from all walks of life. It is fascinating to see how mindfulness has, in the past 20 years, become a scientifically proven therapy for a wide range of disorders. It is brilliant, I think, and has been transformative for me. I recommend it to anyone who will listen – though I try hard to not be a tiresome zealot.
How will I live now? I can’t say for sure yet but I don’t think it will be about bucket lists or red-letter days. I am taking Spanish lessons and have taken up chess (as I always said I would). Piano is next, I think. And I expect I’ll get to South America sooner rather than later. Oh, and I will appreciate Zola more. But mostly I will work on writing every day in red letters.
Next: Learn CPR
Learn CPR: It may save a life
If you find someone experiencing cardiac arrest, you must act quickly. With each passing minute, the probability of survival declines by seven to 10 per cent. Correct use of an automated external defibrillator along with CPR can increase the individual’s chance of survival by up to 75 per cent. With November being CPR month, now’s the time to learn. Find training courses in your community by visiting the Heart and Stroke Foundation (www.heartandstroke.com).
Within a week of my being released from hospital, I read Full-Catastrophe Living, Jon Kabat-Zinn’s seminal work introducing the world to Mindfulness-Based Stress Reduction (MBSR). It is brilliant. Kabat-Zinn rooted his work in meditation techniques and healthful ways of thinking and behaving that have evolved over centuries. And the health benefits have been scientifically verified and tested.
Recently, I have been hired as director of business development for the Centre for Mindfulness Studies in Toronto, which offers programming for the general public as well as intensive facilitation training and accreditation to physicians, psychologists, occupational therapists and other health-care providers. Visit www.mind fulnessstudies.com.
A version of this article appeared in our October 2015 issue with the headline, “Death Takes a Holiday.”