Gloria was 46 years old and healthy when she suddenly crumpled to the floor of her kitchen like an empty potato sack. The paramedics found her in full cardiac arrest. Resuscitated at the scene, she went into cardiac arrest again in the ER and once more in the ICU, where I caught up with her. A cardiologist, pulmonologist and general surgeon were already there.
Anoxic brain injury — oxygen starvation while the heart stops functioning — had left her unresponsive. A breathing tube had been inserted through her mouth into her airway. Her heart rhythm had been restored. Her blood pressure and breathing were being supported. She was stable, for now.
Initial lab results were all over the map. Liver function abnormalities, disordered electrolytes, elevated white blood count — all could be explained by temporary complete lack of blood flow. But I couldn’t pinpoint the underlying cause of this disaster. What had triggered the arrests? What had been the first domino to tip for this woman?
One thing I’d learned as a medical student and have hammered into the heads of my students ever since: The answer lies in the history. “Listen to the patient; they’ll tell you what’s wrong.” But this patient was in no position to tell us anything.
In the ICU waiting room, the specialists and I asked the distraught family members about her health: Prior fainting spells? No. Recent illness? No. Drug use? Yes, but she’d been clean and sober for over a decade, and her toxicology screen came back clear. Family history of sudden death? No. Palpitations, chest pains, breathing problems? No, no and no.
