Medicine and Miracles

Medicine and miracles don't often mix. I think most doctors would tell patients we don't believe in miracles. How many times have I been in the critical care unit, holding the hands of a family member at the bedside of a dying patient? All their organs are failing; it is only a matter of time. I break the news as best I can, indicating that to the best of my medical knowledge, the patient will not survive. The family acknowledges what I am saying, but then tells me that they believe in miracles. They want to keep going in hopes that a miracle will happen. Every time I've had one of these situations, we wait hours, days, even weeks, and no miracle happens.

Yet sometimes, rarely, we find ourselves wondering whether we are experiencing a miracle. During my week in the intensive care unit, I admitted a patient who had a witnessed cardiac arrest. She came into the hospital with nausea, chest pain, and diaphoresis. While the emergency department was putting her on the monitor, she said she wasn't feeling so great, and on the EKG, they saw her flip from sinus rhythm into ventricular fibrillation. She lost consciousness, and the emergency department started chest compressions and defibrillated her heart. No matter what they did, however, they could not get her heart to stay in a perfusing rhythm. She got multiple rounds of epinephrine, lidocaine, amiodarone, atropine. She ended up being shocked over twenty times. She had compressions for over an hour. When I arrived, the floor was littered with empty syringes, open code trays, discarded equipment. But just as we were about to call it, that is, to say that there was nothing we could do to salvage this cardiac arrest, she regained a pulse and a normal rhythm. I quickly rushed her up to the intensive care unit, unsure of what the outcome would be.

We were most worried about injury to the brain. Without the heart pumping appropriately during cardiac arrest, the brain is entirely reliant on the quality of chest compressions. Many survivors of cardiac arrest have residual neurologic symptoms. Some never wake up. The best intervention immediately after resuscitating the patient is to cool him down because lowering the temperature reduces how much oxygen and energy the brain needs. It gives injured brain time to heal. We quickly began the cooling protocol anticipating that there would be significant neurologic impairment.

Imagine our surprise when she awoke, still intubated, and signaled that she wanted a pen and paper. As she wrote, we realized her brain was completely normal. In medical terms, she was neurologically intact, but what that meant was that she wrote to us about her symptoms, acknowledged us when we explained what happened, communicated with her family, and consented to her procedures. We quickly rushed her off to the cath lab and stented her heart; a heart attack had set everything off. Although her heart, kidneys, liver, and lungs suffered significant injuries during her cardiac arrest, within a few days, I managed to extubate her, stabilize her blood pressure, and transfer her out of the intensive care unit.

I have never seen someone recover like this after an hour of coding. It was truly unbelievable. All the physicians and nurses taking care of her were amazed. There is no doubt that good compressions saved this patient's life. Although it is true that witnessed cardiac arrests and ventricular fibrillation are both good prognostic factors to surviving cardiac arrest, this was still a miracle. I have never seen someone dead for an hour come back to life.