Patient Saved by Series of Steps After Cardiac Arrest
NOVEMBER 19, 2024
Larry Wetzel remembers feeling fine on the morning of March 13, 2023. He and his wife Susan had left their Hingham home and were driving to a funeral service in Milton. Several months earlier, Larry had retired from his longtime insurance career, and he and Susan, a nurse in the Greater Boston area, were enjoying spending time with their three children and six grandchildren. “I was keeping busy and was in good health,” says Larry. “I had been managing high cholesterol for many years but I had never had any cardiac problems or concerns. I didn’t even have a cardiologist.”
Which is why the events that followed that morning were all the more shocking. As Larry exited Rte. 128 and was merging onto busy Randolph Avenue, he slumped over the steering wheel. “There was absolutely no warning,” remembers Susan. “All of a sudden he was unconscious. His lips were slightly blue and his hands felt cold. I was terrified. I knew if he wasn’t gone, he was very close.”
Susan’s immediate fear was that Larry had suffered a stroke. But Larry had suffered cardiac arrest.
“Cardiac arrest occurs when the heart malfunctions and stops beating unexpectedly,” explains Eli Gelfand, MD, BIDMC Section Chief of General Cardiology. Often triggered by an irregular heartbeat known as ventricular fibrillation, cardiac arrest disrupts the heart’s ability to pump blood to the brain, lungs, and other organs. Death or brain damage can occur within minutes if a patient doesn’t receive immediate treatment.
Through a series of steps that the American Heart Association refers to as the Chain of Survival, together with emergency care at Beth Israel Deaconess Hospital-Milton and intensive coronary care at Beth Israel Deaconess Medical Center (BIDMC), Larry received the critical treatments – at the critical times – needed to restore his heart function and ensure his recovery.
“It’s truly amazing that today I’m healthy and fully back to my routines,” says Larry.
The Right Place at the Right Time
On that morning in March, Lt. Charles Caputo of the Milton Police Department was traveling on Randolph Avenue. Seeing that the Wetzels’ car was stopped on the double yellow line in the middle of the road, he turned his police cruiser around and went back to see what was wrong. “I initially thought it was an accident, but as I got closer, I could see that the driver was in trouble,” Caputo remembers. The lieutenant’s instinctive next steps would prove critical.
“Larry was completely unresponsive,” says Caputo. After calling his station to alert them to the medical emergency and request a defibrillator, Caputo pulled Larry from the car and immediately began to administer cardiopulmonary resuscitation (CPR). “Talk about being in the right place at the right time,” says Caputo. “I just kept pounding away on Larry’s chest. Pounding and pounding.” Although Larry remained unconscious, by immediately performing CPR, Caputo was able to keep blood flowing to Larry’s body and brain until further help was available.
Within minutes, additional police and emergency medical technicians arrived at the scene with an automated external defibrillator (AED). Defibrillation delivers an electrical shock to the heart to restore normal heart rhythm. For Larry, it took a took a few tries. “I remember them shocking him three times before someone yelled, ‘We have a pulse,’” says Susan. “It felt like an eternity, but it was just minutes.”
A Rapid Response
Emergency medical technicians (EMTs) stabilized Larry for the ambulance trip to BID Hospital-Milton, just a few short miles away. “It was extremely fortunate that there was an emergency room so close,” says Larry. “I had never traveled in an ambulance before then, but by the end of the day, I would be in two.”
Within minutes, the emergency medicine team at BID-Milton took over the urgent next steps in Larry’s care. “We still didn’t know if he was going to make it, and I think I was still in shock,” Susan recalls. “The Milton doctors and staff let me stay at Larry’s side the whole time, they called my daughter for me, and a social worker stayed with my young granddaughter who was with my daughter when she arrived.” Of critical importance, the decision was quickly made to transfer Larry to BIDMC in Boston, where he could receive a higher level of care. “I was still very scared but I knew Larry would be in good hands,” says Susan.
After being transported by ambulance to BIDMC, Larry would spend the next four days in the Coronary Care Unit (CCU), one of BIDMC’s seven intensive care units that treat patients with life-threatening illness and injuries. Larry was hooked up to a ventilator to help him breathe and was placed in a medically induced coma to lower the chances of permanent damage to his vital organs, especially his brain. Susan and her three children were with him at the hospital.
As a nurse, Susan was aware of the tremendous challenges that Larry was facing, and as Larry’s healthcare proxy she was responsible for making his medical decisions. Right away, Susan requested pastoral visits. “Larry was so gravely ill and pastoral care was very important to me and my family,” she says. The family also received support from BIDMC social workers. “Everyone was excellent,” says Susan.
That day Dr. Gelfand was the attending physician on the CCU unit. “Dr. Gelfand carefully explained everything that was happening to Larry,” she says. “When he learned that Larry didn’t have a cardiologist, he asked if our family wanted him to oversee Larry’s care,” Susan remembers. “At that point, everything was so overwhelming. We gratefully accepted.”
Getting Better and Better
By Friday, four days after Larry was stricken, the CCU staff began gradually weaning him from his medically induced coma and removing the ventilator and other machines that had helped to keep him alive. Within a relatively short time he was breathing on his own and was able to clearly answer questions designed to assess his mental status. “He just got better and better,” says Susan.
A series of tests had revealed that there was a blockage in the left anterior descending artery of Larry’s heart. “This artery is sometimes called the ‘widow maker’ because it often proves fatal when it is blocked,” explains Gelfand. By preventing the flow of oxygen, the blockage can lead to ventricular fibrillation, the dangerous heart rhythm that caused Larry’s cardiac arrest. Dr. Gelfand recommended that Larry undergo cardiac bypass surgery and a team led by Chief of Cardiothoracic Surgery Kamal Khabbaz, MD, successfully performed the operation.
“They later told me that three of my heart’s four arteries were completely blocked, and the fourth was partially blocked,” says Larry. “I honestly had no suspicion that I was as ill as I was.”
By March 28, Larry was ready to go home. In the ensuing weeks and months, his recovery would continue, as staff from the Norwell Visiting Nurse Association coordinated Larry’s care with the BIDMC cardiac surgery staff. Today, under the care of Dr. Gelfand, Larry watches his diet, is careful to take his medications, and weighs himself every day. “The scale may cause me the most distress,” he laughs. “I am very thankful for the level of care that I received. As Dr. Gelfand later told me, it’s a very small percentage of patients who get to tell their stories following a cardiac arrest.”
Lt. Caputo echoes that message. “I honestly didn’t know how this would turn out,” he says. “In the 28 years that I’ve been a police officer, I’ve performed countless CPRs. Only three patients have fully recovered. It was so fantastic to learn that Larry is doing well.”
Adds Susan, “It’s extraordinary that everyone came together to save Larry’s life. Beginning with the CPR performed by Lt. Caputo, to the emergency care at BID-Milton and the smooth transition to the CCU at BIDMC, everything came together beautifully. As a nurse, I’ve always known that BIDMC provides exceptional patient care. I just never imagined that I would personally experience this in such a dramatic way.”