Vol. 6 Issue 1 Page 16
Personal Experience, Renewed Life
A firsthand look at cardiac arrest
Smart nurses make it a point to learn something new whenever possible, whether through continuing education or on-the-job experience. Laura Rodriquez, RN, agrees practical experience has helped boost her skills and abilities in the emergency department at Parkland Hospital, Dallas. However, she never expected to learn from the patient’s view as she did in a shocking experience in August 2006. Rodriquez survived sudden cardiac death thanks to fast action and competent decision-making by nurses, doctors, hospital personnel and her family members.
Most people have heard of heart attacks or stroke and the statistics that go along with those traumatic events, but not much about sudden death resulting from an abrupt loss of heart function (cardiac arrest).
The American Heart Association reports nearly 325,000 people annually die from coronary heart disease without making it to a hospital or ED, and most of those deaths stem from sudden cardiac arrest in patients never diagnosed with heart disease or prior symptoms.
This cardiac arrest occurs minutes after symptoms appear, with brain and permanent death following 4-6 minutes later. Patients must receive CPR and defibrillation immediately to survive. Fortunately, Rodriquez was in the right place at this very wrong time.
Nurse Saves Nurse
Although she awoke feeling dizzy and dehydrated that morning, Rodriquez had no prior warning signs of what was to come. Intending to get out for a little fresh air, she took her daughter Jayla (then 5 years old) to school.
She still felt weak and disoriented after dropping Jayla off at her classroom. Rodriquez went to the school nurse, Vicki Taft, RN, to have her blood pressure checked. Suddenly, the seemingly healthy 34-year-old nurse collapsed and Taft used her CPR certification for the first time.
Rodriquez’s blood pressure was in the normal range, but her heart rate fluctuated wildly from 40 to 180, her body was tense and contracted, her skin turned from grey to blue and purple, and she lost consciousness. Taft kept Rodriquez alive with CPR until paramedics arrived 10 minutes later, defibrillating the patient.
Soon after, Rodriquez arrived at a local medical center where the staff did blood tests, ECGs, echocardiograms and more. She had three more ventricular tachycardia (v-tac) episodes. No cause was evident. Rodriquez floated in and out of consciousness as her medical team looked for answers and her husband prayed. The only certainty: her heart function was only at 5 percent.
Doctors asked hard questions to find the cause, but clues were elusive. Eventually, they blamed a virus for damaging her heart. Some speculated it was coxsackievirus, but blood tests could never confirm the exact cause of the viral cardiomyopathy, which affects people of any age who are otherwise healthy with no risk factors for heart disease, according to her doctor, Jacob Chemmalakuzhy, MD, at Baylor Medical Center at Irving, Irving, TX.
“Everyone has this virus in their body, but not in the bloodstream. Mine somehow got into the bloodstream and attacked the heart, leaving my left ventricle paralyzed,” Rodriquez said. “Someone who is not in the medical field might be able to accept this explanation more readily. It didn’t make sense to me. I wanted to know how and why.”
Her biggest fear was the prospect of needing 100 percent assistance, as some doctors warned early on. She did not want to burden her family.
“I don’t like to use the term ‘second chance,’ because that’s too simple,” she explained. “I spent years working so hard to make life better for my family and build a future for my child, but suddenly it all turned around. I had to fight for myself. Now, I tell my patients, ‘Without your health, you can’t be happy. To keep your family happy, take care of yourself.'”
The first step of the transforming experience for Rodriquez and her family was learning to ask specific questions of as many sources as possible. This helped them understand her unexpected cardiac condition and choose their options with care.
The only option to keep her alive was aggressive cardiac therapy. Her ejection fraction (heart strength) was just 15-20 percent versus the normal range of 65-100 percent. Heart transplant was one suggestion.
With Rodriquez in and out of consciousness, her husband turned to her co-workers at Baylor Medical Center at Irving for advice; she worked in the ED here at the time of her cardiac arrest. One supervisor even stayed on the phone line, listening to Rodriquez go into v-tac as her husband dropped the receiver in a panic. Rodriquez’s Baylor family helped get her transferred to their facility, known for its state-of-the-art cardiology department, cross-trained staff and highly regarded cardiac cath lab. An added bonus was the reassuring sight of friendly, familiar faces.
During the ambulance ride to Baylor, Rodriquez looked up to see surprise on the face of an EMT she’d given “a piece of her mind” in the ED just days earlier. He kept her alert during the ride, saying her name, asking repeatedly, “Is that really you? Do you remember me?”
Now stable enough to transfer, the team at Baylor assessed her condition and recommended implantable cardioverter defibrillator (ICD) rather than a transplant. The permanent ICD continuously assists the heart with multiple functions using electric shocks and a pacemaker. The “combination” system calls for lifelong monitoring, but after the 3-hour surgery to place the ICD, Rodriquez said breathing and talking felt easier. She felt like smiling for the first time.
She spent 6 weeks in the hospital, then 3 months at home during treatment and rehab. The devoted nurse found it difficult to be on the receiving end of caregiving. She took “baby steps” to build up her strength and endurance, reducing her shortness of breath. She was able to return to work in the ED after only 3 months, with her heart function stabilized at 35 percent. Since then, she’s taken a position at Parkland where she started her career in the U.S. Doctors have been impressed with her physical recovery, as well as her positive mental outlook.
“If I don’t do things the way I want, no one else will do it for me. It’s up to me,” she said.
One challenge has been convincing family and friends to relax. Her family still avoids giving her any bad news, for example, and co-workers caution her, “Don’t overdo it.”
“I have to remind them stress or activity had nothing to do with my problem. I don’t want them to resent me. I shouldn’t have to explain my heart problem, but I do if it helps them understand. It gets easier to talk about over time,” Rodriquez said.
For example, she has to ask others to take patients into certain areas of the hospital where electronic equipment might affect her ICD. For the most part, however, she does every task she did before on her night shift in the ED, with the addition of a few curious questions.
“The No. 1 question now is ‘when your heart stopped, did you see a bright light? The Holy Mary? Your grandfather?’ I guess I was so busy trying to breathe and survive, I didn’t have time to see anything. All I know is I woke up feeling as if I’d run a marathon,” she said.
“I had a unique opportunity to survive something major. Not everyone has that. I thought I had problems before, during my 34 years of life, but nothing motivated me to change things like this opportunity,” Rodriquez explained. “Because of what happened, I feel this drive to keep going to improve and do things better than before in all facets of my life.”
That includes being more vocal about her feelings with loved ones, as well as delivering more thoughtful, informed care to patients.
Speak Up With Authority
“Before all this, I have to admit I was all business when advising patients. I would say, ‘follow up on the treatment or else.’ Now I have more patience, take more time, go into more detail, and talk to them about how important it is to take meds and follow up with their doctors,” she noted.
“I explain more, but I also see the need to be straightforward and get the point across. There’s a balance there. Sometimes, you can be more persuasive when you lay it on the line for the patient and his family.”
She recalled a recent patient with chest pain in the ED. She noted his symptoms, explained his ECG to him, and asked all the right questions about medical background and drug use that might affect his heart. Lab tests showed the presence of possible unprescribed drugs in his system that he did not report.
When he came back from labs and other tests, she continued her professional, upbeat conversation but interjected a casual comment she was a little mad at him and jealous of his strong ECG.
The patient’s curiosity finally got the better of him and he asked why she was mad. She pointed to his heart monitor and told him about her near-death experience, subsequent lifelong heart damage and use of an implanted defibrillator/pacemaker. All that for someone who avoided drugs and tobacco. Yet, here was a strong young man risking his healthy heart by taking harmful drugs. The patient realized the serious message behind his nurse’s story and thanked her.
The biggest reward from nursing for Rodriquez is seeing patients come back to the hospital for follow-ups, doing much better after the initial contact with her in the ED. She enjoys seeing progress as they learn to take better care of themselves.
“Since my illness, I see changes in the way I can talk about ICDs and other devices, read ECGs and evaluate cardiac patients. Other nurses say I ask too many questions, especially if patients come in with a cardiac problem,” she admits. “But I see the need to put it all on the chart and fully understand the situation. I hope it helps the doctor make a more accurate diagnosis. Most of all, I am not afraid to speak up and say what I think.”
Through ongoing regular follow-ups with her doctors, Rodriquez maintains that same “can-do” attitude. Her new cardiac monitor at home sends data to her doctors during the night, looking for any unusual rhythms. Statistically, most heart attacks occur very late at night or very early in the morning as the patient sleeps.
“I much prefer having a wake-up phone call if something is odd, rather than not waking up at all,” she said. “I am not supposed to be here, so whatever I have to do to maintain my health is welcome. Even the scar on my chest is a blessing because God kept me here for a reason. That’s my visible reminder to do the best I can every day.”
Lola Howle is regional editor at ADVANCE.