FORUM: Cardiac Arrest

I was a Research Professor at Northwestern University Medical School in the Department of Emergency Medicine, with multiple affiliations in the Department of Medicine, and an Adjunct Professor of Academic Psychology at the University of Illinois at Chicago. One of my primary areas of expertise (including the focus of my PhD) was antecedents of heart disease.

Just turning 50, I was presumably not yet in the “danger zone” (starting at 55 years) for a cardiac arrest. I imagined I still had time to reform. I was 60 pounds over the “ideal” weight for my age and height. I chain-smoked cigarettes: my favorite brand was Red More, because they burned out when not puffed upon. I was so busy that I had no time to eat until dinner—when I went to McDonald’s across the street to pick-up two Big Macs, one plain Quarter Pounder, large fries, two apple pies, and a large Coke. I had a young child, and plenty of work assigned to me on projects which funded my salary. After that, I had endless research to conduct on theoretical statistics. I hardly slept.

One day I found five one-pound Hershey’s chocolate bars in the house. I sat in the living room recliner and ate them. They were delicious!

After finishing the last bite, I went downstairs to the car to unload a box containing ten reams of paper for my printer. I threw the box on my left shoulder (two decades younger, I was able to dead-lift 300 pounds). I started to walk up the stairs leading to the first floor of the house. Half-way up I felt a muscle pull in my chest and shoulder.

I was familiar with sprained and torn muscles. I played a lot of sports earlier in life, including baseball between third grade and my first year in graduate school. Through high school I was put in left field because I could throw runners out at second and third base directly on the fly, and I could hit the catcher from the warning track in two low, hard top-spin bounces. In college my vision began to suffer (all that reading, writing, and arithmetic) so I had to wait a second or two to judge fly balls coming my way. I was switched to a relief pitcher with a frightening fast ball (85 MPH—fast enough in those days) which rose—up and in—to a right-handed batter. To get my curve in the center of the box I had to aim at the ear of the right-hander. To lefties I threw a screwball—which is extremely tough on one’s arm. All my life I was a switch hitter, left-handed for line-drive slaps through the infield, right-handed for power and extras-base hits. I was the fastest runner on the team: twice I ran out of pickles between second and third. I also played tennis, badminton, volleyball, ran the hundred, sustenance fished (my family was poor), hand-cooked chicken at Kentucky Fried Chicken, delivered mountains of papers, mowed lawns, bowled in college, and used my feet, bike or subway train to get around (no car). I’d hurt very many body parts, very many times.

I thought I pulled a muscle again, carrying that heavy box of printer paper. I sat in a recliner, applied ice to my injury, and rested. The following day my shoulder and chest hurt more than the prior day, so I continued my rest and ice regimen.

In the evening of the third day I experienced a severity of pain that was unique in my experience. I stood in a hot shower to dull the pain. When the hot water ran out, I stayed in the shower anyway—the cold water seemed to gate the pain. I stood up the entire night, keeping the water spray exactly on my aching arm.

Then a series of events happened as fast as a bullwhip crack.

Without warning my arm felt a stabbing pain, like what I imagined a butcher knife running through the middle of my left bicep might instill. The pain in my arm moved up and over—it felt like I was punched, hard, in the middle of my chest, and it knocked out my wind. The pain went upwards into my teeth: it felt as though they were piano keys, and several flew out of my mouth against the shower wall. The pain turned upwards and hit my right eye, which I imagined was stabbed with an ice pick. Then the pain reversed course! It migrated into my stomach, felt like a gut punch, making me double over and lose my breath again. Next the pain went down my abdomen into my right knee and made be collapse—falling out of the shower.

I got dressed and my wife drove me to Northwestern Memorial Hospital faster than an ambulance. I recall silently praying the Lord’s Prayer in the car, but nothing else. We arrived at the entrance to the ER and I walked in. I saw my favorite guard at her station by the door. She smiled at me, then looked extremely concerned. I whispered that I had a heart attack. She ran into the ER and got my boss—the Department Head of Emergency Medicine (I was the senior professor in the Department). For the first time ever, his face looked alarmed and frightened when he saw me.

I was immediately put in a wheelchair and rolled to the first examination room. A blood test confirmed I had a heart attack. I was put on a rolling gurney and wheeled into a very cold room with a cardiac team standing like statues at their posts—it seemed like a dream (I learned later that I’d been given morphine). They lifted me onto the operating table. Nobody said a word. My second-to-last thought was “I’ll never catch a big fish.” My last thought before falling asleep was “I won’t be able to watch over my daughter!”

I regained my sense of space and time after serving a stint in the ICU (I have no idea how long I was unconscious). When I awoke my first thought was “I’m alive—I can watch over my daughter!” My second thought was “I’m going to catch a big fish.”

I was transferred to a standard room and slept most of the time. I was interviewed by a small army of cardiologists over several days, who wanted to hear my recall of the event. I was the most topically educated person who’d survived this experience, a Professor of Medicine, Emergency Medicine, and Behavioral Medicine (in Psychology). I was later told that my recount changed thinking regarding the mechanics underlying a cardiac attack. Every part of me which I described above was the scene of a bad sports- or work-related accident which I’d endured over my lifetime. Like lightning, the cardiac event attacked all my weakest parts—selecting the path of least resistance, wreaking havoc as it explored my body. I learned later that experts believed it appeared to be neurologically driven.

Over the next two years I recuperated. I lost 70 pounds, eating properly, hiking seven miles a day. I completed cardiac rehabilitation—which I attended three times a week for months. We had a myriad of machines to work, all the time attached to a nine-lead EKG. I found that the best workout was a rowing machine—which systematically worked every muscle from toe to scalp, twice on each stroke. I was able to maintain the Olympic cross-training regimen of 19 strokes per minute, breathing twice per stroke, and keeping my heart rate under 150 beats per minute. I’m told this is the favorite cross-training sport for American Olympic teams. I can tell you that proper endurance rowing requires perfect form starting with the first stroke. The warm-down after rowing for 45 minutes is almost enough to induce a black-out. On every stroke I imagined I was pulling in a large tuna fish. Little did I know how pertinent this was. But that is another story…

This was my beginning, not my end…

Cardiac Arrest

Paul R. Yarnold, Ph.D.

April 14, 2021

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