Five stories that will make you believe that, on their best days, doctors really do have superpowers.
The Widow Maker
A doctor’s heart stops in his own ER.
Enduring an early-morning meeting. Going to the gym. Folding laundry. Taking a shower. These are the little tasks that make up most of our days. We take them for granted because we think we’ll be doing them all over again tomorrow. So, Andy and Kerry Ziller, Denverites who’d been married for 22 years, could’ve been forgiven for their casual approach to a Wednesday morning in April 2012. “I remember we had spent some time online that morning trying to find a replacement for the rubber stopper on our salt shaker,” Andy says. “Really just mundane stuff…until it just came out of the blue.”
And by “it,” he means the pain.
He wasn’t short of breath. The ache was not radiating down his left arm. But located right in the center of his chest was an agonizing spasm. Kerry was upstairs folding laundry, so, thinking it was just a panic attack, Andy tried to relax. He walked around. He got a drink of water. He laid down.
Kerry isn’t sure why she stopped what she was doing mid-task—she thinks maybe she was hungry and ready to grab lunch up the street at Modmarket—but when she came downstairs she could tell immediately that something was wrong with her 54-year-old husband. He was sweaty and couldn’t get comfortable. “I told him we should just go get it checked out at the ER,” Kerry says. “But I guess I didn’t really think it would be anything because I grabbed a bottle of water, a granola bar, and the New York Times crossword puzzle to have in the waiting room.”
As the Zillers drove north on Colorado Boulevard toward the ER at Rose Medical Center, Andy, who initially said they should just go on to lunch, became less and less reluctant about seeing a doctor. The pain was getting worse. So bad, in fact, that Andy called his friend, emergency room doctor Donald Lefkowits, who was working that day. “I called Don and said, ‘I’m coming in,’ ” Andy says. “ ‘I think it’s probably just anxiety, but I’m having chest pain.’ ”
Rose Medical Center’s ER sees an average of 110 patients each day—but Andy Ziller was no average patient. Andy, or more formally, Dr. Andrew Ziller, had been an ER doc at Rose for the previous 20 years and was the president of the medical staff.
The text from Lefkowits came through to Andy’s iPhone just seconds after they had finished talking. The Zillers were still a mile or two away. It read: Bed 2 is waiting. Just walk right in.
Andy didn’t have to walk very far once Kerry turned into the small ER parking lot: It was a quiet day in the emergency department, so Lefkowits had decided to meet Andy outside. Andy got out of the car and the longtime colleagues entered the ER together. Within minutes, a tech had hooked up the electrocardiogram (EKG) to Andy, who snuck a peek at the reading as it rolled off the machine. Before Lefkowits could look at the EKG himself, Andy knew it was bad. He had recognized what doctors often call “tombstones”: EKG readings that portend a massive heart attack. Lefkowits told Andy he was calling a cardiac alert—the emergency protocol for managing a heart attack across multiple hospital departments—a fact that made Andy think to himself: You’re not telling me anything I don’t know, and, yeah, you’d better be calling a cardiac alert.
Eight minutes after Andy walked into the ER, his heart stopped.
Although he could barely believe what was happening to his friend, Lefkowits delivered a precordial thump—essentially a carefully aimed blow to the chest—to try to interrupt Andy’s ventricular fibrillation, an abnormal heart rhythm. Then they tried to shock him—but the machine didn’t fire. A tech began CPR while cardiologist Dr. Vijay Subbarao, who had responded to the cardiac alert, connected what ended up being a missing adapter. It took two shocks to convert Andy’s heart back to a normal rhythm. Seeing the alarm on Lefkowits’ face, one of his colleagues offered to intubate Andy. “I could have done it,” Lefkowits says. “I’ve done it a million times but I just kept saying, ‘No way, no way, this can’t be happening.’ ”
A coronary angiogram—a test that uses dye and special X-rays to see the heart’s arteries—administered by Subbarao showed that Andy’s heart was experiencing a worst-case scenario. Although there was only one clog in his heart, the left anterior descending artery was completely blocked at the most critical juncture. Most people know this particular occlusion as the “widow maker.”
Using the angiogram as a guide, interventional cardiologist Dr. Michael Wahl threaded a catheter through Andy’s groin and up into his heart, where he expanded a small balloon to open the blockage and then placed a stent to keep the artery open permanently. It had taken less than 45 minutes from “door to balloon,” an important time frame that quantifies how long it takes from the time a patient enters the hospital until the obstruction is opened in the cath lab and blood is flowing. The national standard is 90 minutes or less.
After the procedure, Andy’s heart was weak—only squeezing at a little more than half its typical strength—but it appeared the muscle was mostly undamaged. Once the obstruction was removed, his heart began to recover. That left only one unknown: how Andy’s brain had fared.
To make sure they saved as many brain cells as they could, Dr. Michael Schwartz, the ICU attending, conferenced with Lefkowits and Subbarao to determine if therapeutic hypothermia might be a reasonable course of action. Therapeutic hypothermia—a treatment that brings a patient’s body temperature down to about 91.4 degrees—has been shown to improve neurological outcomes after cardiac arrest. “He was out long enough after he arrested,” Lefkowits explains, “that we all thought hypothermia was warranted. But that was hard for us because it takes 24 hours of keeping a patient sedated, and we just wanted to see Andy wake up and be Andy.”
Watching her husband be “cooled” by a special jacket and be deprived of blankets and clothing was difficult for Kerry. “I just kept asking them if we could at least put a sheet on him,” she says. The answer, of course, was no—but Kerry knew there was a medical method to what seemed like madness. And that was evident Friday morning when doctors allowed Andy to wake up.
“My first conscious thought was that I was at home in bed,” Andy says, “and as I reached out to touch my wife who would normally be sleeping next to me I hit the bar of the hospital bed. And then the memory hit me: Oh yeah, I had a heart attack.”
Andy was still intubated when he first awoke so he couldn’t talk, but he motioned for a piece of paper to write on. The first word he wrote: “Stent?” The second thing he wanted to know was his ejection fraction, which is medical terminology for how well the heart is squeezing blood. And lastly, he wanted someone to call Kerry and tell her that he loved her. “Andy was very dialed in,” Schwartz says. “He was ‘all there,’ and it was very cool to see.”
Two days later, Andy walked out of the hospital through his own ER, having escaped death in the very same building in which he had been born. About six weeks later, he was back at Rose for his normal shifts. Today, the doctor has no lingering effects from the heart attack. “We take great care of everyone,” Schwartz says. “We apply the same level of care to a homeless guy, a board member, or a colleague. But Andy is loved here, and he really did ride on that wave of love.”
The Top Docs
Dr. Andrew Ziller
Dr. Vijay Subbarao
Dr. Donald J. Lefkowits
Dr. Michael D. Schwartz
Critical Care Medicine