Shopping centers at Christmas evoke images of mall Santas, tinny carols playing overhead on a loop, and, if you’re old enough, that little dustup over at the Nakatomi Plaza in 1988. Places like Costco, where one can purchase anything from muffins to hearing aids, serve as rural meccas for retail access.
For nurse and cardiac arrest survivor Anne Montera, a routine holiday trip to Costco brought her story full circle.
The holidays were fast approaching, and the Montera clan had much to celebrate. There were weddings, homecomings, and the anniversary of Anne’s cardiac arrest secondary to an accidental opioid overdose (see Part 2). Restored to her normal dynamo self, both she and her paramedic husband, Chris, had a renewed respect for the frailty of life and worked even harder to appreciate their time.
Moving with purpose toward the checkout lines, Anne noticed a small group gathering around a man on the floor who appeared to be shaking. Rex had collapsed just before Anne came into view. He must be having a seizure, she thought. A local sheriff’s deputy on scene recognized her and called her over frantically: “We need a nurse!”
Ditching her cart full of holiday cheer without a second thought, she hurried over to find the man on the ground in cardiac arrest. The chain of survival was already at work: Someone had run to locate an AED, and 9-1-1 was contacted. Another bystander had begun compressions, a set of dog tags around his neck jingling like tiny twisted bells. The AED arrived, and a local EMT jumped in to assist. Anne applied the AED: Shock advised. Rex received his first defibrillation in less than two minutes from his collapse in a major retail establishment.
Ironically, the store staff had just recently completed their CPR and AED training. Prior to this incident the manager was already asking for a second AED to be placed at the back of the store. Where Rex collapsed that day played a role in his eventual outcome.
Face to Face
The motley bunch of rescuers fell into the rhythm of resuscitation. As they worked, waiting for help to arrive, time stretched itself into a five-minute eternity. Anne glanced at his face. Rex’s vacant eyes stared up at the ceiling. Her breath caught in her chest, and she realized in that moment he was not just a patient.
He was a mirror.
After her own resuscitation, as she tried to work through what had happened to her, she’d asked her family questions. How did she look? What was her skin like? Was there any noise? They told her about her eyes, that flat, empty gaze perfected by dolls and the dead. It’s hard to relate to when it comes to yourself. Now she could see it, face to face. Her entire clinical career had revolved around infants and children. This was an adult in his 40s. Her peer.
By this time a crowd had gathered, many calling out advice or asking questions. There were so many people talking, it became difficult to hear the AED prompts. She had taken on the role of leading the resuscitation, now she was taking on the crowd.
Rex’s eyes fluttered, and the EMT at the head cried out, “He’s moving!” They went to stop, but Anne wasn’t convinced it was the right time—his eyes were still empty. She went with her gut and insisted they keep going. With high-quality CPR, movement and, in rare cases, consciousness are possibilities.1 It didn’t mean they were successful—not yet. Turns out she was right.
At the next AED prompt, another shock was advised; they did it again and continued. The EMS crew arrived a short time later. Anne’s husband, Chris, is not only a paramedic but the CEO of the local EMS agency. The crew was understandably surprised to see who was on the ground working on the patient. “Hey, Greg,” Anne called out to the first medic. “How are you today?”
Now Rex had started moving again, this time with purpose. The paramedics stepped in and relieved the exhausted shoppers, taking over care and getting a 12-lead done. Rex was talking at this point, confused. They got him moving and on the stretcher. Anne gathered his things, helped where she could. She hugged her fellow rescuers, and they had a moment of shared success.
As the crew took Rex out of the building, she snatched up the AED and sent it with him, remembering it was their protocol and so the hospital could have access to what had occurred. The device’s feedback would later confirm that Rex did not, in fact, have a perfusing rhythm when he first started moving. The call to continue was the right one.
Crisis averted and Christmas cookies paid for, Anne called her husband to tell him what had happened, but Chris was in a meeting. She went on with her day. They’d advised him about the public cardiac arrest and told him a “bystander nurse” was on scene working on the patient. He had no idea that nurse was his wife. When they spoke later, he asked her what she was doing at Costco. “Oh, nothing,” came the breezy reply. “Just saving lives.”
How Far Our Reach
This is a very dramatic story if you are a lay person. If you are an EMS provider, it’s just a good story. After all, resuscitation is our business, and while we all like our wins, by all accounts this is a v-fib sudden cardiac arrest that played out as it likely should with successful treatment.
With all its testament to the hands-only CPR campaign, public education, and access to AEDs, the Christmas cardiac arrest isn’t the point of the story—Anne’s contribution is.
Just one year prior, with no warning, her husband had come into their bedroom to find her blue and without a pulse. The people closest to her had to drag her limp body onto the floor, with her flat, vacant stare, and compress her chest. Her own daughter raced to retrieve the AED. Because of their immediate actions, Anne survived.
The day after the incident at Costco, Anne was home. She replayed the event in her head, this time focusing on what Rex looked like, what he felt like. For the first time she had a true understanding of what her own family had gone through. She was very much a visual learner, and being told what it felt like never fully equated—until now. It answered so many questions she didn’t even realize she had. She broke down, crying inconsolably. Her son held her and prayed.
It is vitally important to understand that events create impact. CPR in its purest form is a simple physical action in response to a set of conditions. It is only as you build in the layers of humanity around it that you begin to understand just how important those two-minute cycles really are. What is routine to us, CPR or otherwise, may be a traumatic and ultimately life-altering event to that person on the ground, couch, or stretcher.
Where there is impact, there is also damage, sometimes residual and long-lasting. Anne’s guilt over putting her family through a similar ordeal amplified what she was already dealing with, ripping wounds open again. Guilt is a sinister emotion and can strike from the oddest directions, bringing fault where none exists.
Anne’s teenage daughter struggled for months after her mother’s cardiac arrest. It wasn’t until much later they discovered she felt enormous guilt over the defibrillator not working. There had been no shock advised. She was unfamiliar with the device and thought she had somehow failed her mother by applying it incorrectly.
Just because we can walk away from an incident doesn’t mean everyone will be as lucky. More than 50% of lay providers report significant psychological impact from participating in a resuscitation, with 13% of them reporting that impact as severe.2 We can’t change what occurred, but when possible we should be able to reassure or mitigate the feelings of helplessness.
Rex’s event never went beyond internal commendations for the staff at Costco. It didn’t make the papers; there was no feel-good news story, no social media hurrah. What there was was a 41-year old man who made it home to his family in time for Christmas. His gift was a brand-new AICD and a second chance.
Rex’s wife found out who Rex’s rescuers were. She contacted Anne at Christmas, calling her a “guardian angel” and thanking her for helping save him. She shared pictures of their two young girls, spared having to go through life without their father.
Rex was transported to the same hospital that treated Anne so poorly the year before (see Part 3). The same facility that branded her an addict, disregarded her history, ignored her pleas for treatment, and dismissed her as less than a person provided him with a new lease on life. Despite it all, the fact remains, if Anne had not been resuscitated, if she had not survived her overdose, then she would not have been there to assist Rex.
As EMS providers it can be easy to lose sight of just how far our reach is. When we treat a patient, we are working the cumulation of a lifetime of interactions and relationships. Our decisions resonate outward and impact untold numbers in the days to come. What an honor that is.
The work we do is seismic. Make your impact the best one you can.
Author’s note: It has been an honor and privilege to relate Anne’s story to you. Sharing such a personal journey with the world requires a level of bravery most of us will never achieve. I am grateful to Anne and Chris for their candor and openness and hope their story will serve as a reminder of the importance compassion and empathy play in all levels of care. Stay safe out there.
1. Rice DT, Nudell NG, Habrat DA, et al. CPR induced consciousness: It’s time for sedation protocols for this growing population. Resuscitation, 2016 Jun; 103: e15–e16.
Tracey Loscar, BA, NRP, FP-C, is chief of operations for Matanuska-Susitna (Mat-Su) Borough EMS in Wasilla, Alaska. She is a member of the EMS World editorial advisory board. Contact her at email@example.com.