Robert R. Cawley, D.O.
Dover, NH 03802
April 22 was a beautiful Sunday morning, according to John Cogan and his wife Anne. John had pitched for his men’s baseball league at St. Thomas Aquinas in Dover, and when the game ended around noon, John’s teammate Kevin Mitchell hopped in John’s car. As they started driving home, John suddenly slumped over the steering wheel, unconscious, with his foot still on the accelerator. Kevin managed to steer the car to the side of road, and immediately started CPR. Three other teammates who were following them stopped and called 911, continuing CPR before the Emergency Medical Technicians (EMTs) arrived.
John was in cardiac arrest -- a sudden and abrupt loss of heart function that is commonly referred to as the “widow maker.” According to Dr. Christopher Lawson, John’s cardiologist at Wentworth-Douglass Hospital, cardiac arrest is a medical crisis in which the heart becomes electrically unstable and no longer beats correctly. There is no recovery without the use of shock (defibrillation) to restore the heart’s rhythm, according to Dr. Lawson. John was defibrillated in the ambulance and again upon arrival at Wentworth-Douglass Hospital's Emergency Care Department.
Anne, who works at the Wentworth-Douglass Hospital Seacoast Cancer Center, says that John’s cardiac arrest changed from a “widow maker” – where some 90% of victims do not survive – to a “chain of survival.” The emergency room team immediately started the cooling process, using ice packs to prevent organ and brain damage. John was quickly taken from the ER to WDH's Cardiac Catheterization Lab, which provides 24-7 heart attack care. It was soon determined that John had a 100% occlusion – the complete blockage of a major artery.
According to Dr. Edward Williams, the emergency physician who cared for John that day, “Time is muscle. Our priority is shocking the heart back into a rhythm, and stabilizing the patient with oxygen, critical fluids, and medication. These steps keep blood and oxygen flowing to the brain while the cardiology and cath lab team prepare to open up the blockage.”
The EMT first responders were in communication with both the emergency room and the cath lab en route. Dr. Williams says that paramedics can transmit EKG readouts “from the field” well before the patient arrives at the hospital door: “Our overriding goal is efficient and effective response time, something we continuously assess, measure, and evaluate here in the Emergency Department.”
The cardiac team was ready to immediately open John’s blocked artery, restoring heart function and blood flow to his vital organs, including the brain. The early and immediate cooling of the whole body that John received is also a critical step in preventing ongoing injury to the brain. According the Dr. Lawson, “The brain is the body’s most sensitive organ, and we want to do everything possible to save it and improve mental functioning while also dealing with the emergency at hand.”
For John, this medical crisis happened like a “bolt out of the blue. I had had a physical a month before and everything was fine.” This is not uncommon, says Dr. Lawson: “Sudden death from cardiac arrest can often strike relatively young and otherwise fit adults.”
According to Dr. Lawson, “The blood holds a lot of oxygen, but you have to get blood out to the organs in a timely, consistent way. CPR compressions create a degree of ventilation that can provide steady blood pressure and supply blood to the rest of the body. Each and every step is critical – from initial CPR, to defibrillation, to body cooling, to the opening of the blocked artery. Each step has to happen and no step can be skipped. It’s like passing a baton in a relay race. No one can drop that baton. And everyone is important – from the bystander who knows CPR, to the emergency responders, to the cardiology and cath lab teams, to the rehab staff.”
Anne agrees. “Everyone played their part. I even had a social worker with me the whole time to help me stay calm and focused.”
Cardiac Rehab at Wentworth-Douglass was another critical component in John’s recovery: “I couldn’t drive so the Patient Care-Van picked me three times a week. I formed close bonds with my fellow rehab buddies, and after 11 weeks, I graduated.”
“I can’t say enough about the cardiac rehab staff, and how they helped me make major lifestyle changes – not only regular exercise, but with the help of the nutrition team, big changes in my diet. No more fried baloney sandwiches for me! When you consider the alternative, it’s really easy to eat broccoli.”
“They worked me hard. I like to call the treadmill the ‘dread-mill.’ But they were so incredibly encouraging, and I will continue to follow their excellent advice.”
Anne also talks about the impact of educational classes and the incorporation of integrative therapy, including relaxation techniques, that have played an important role in John’s recovery. As a nurse educator who works with cancer patients, Anne says that at Wentworth-Douglass Hospital, “we are trained to use best practices across department lines. My husband benefitted from the seamless transition and rapid coordination of care available at a full-service hospital. This is what we do every day.”
John agrees: “The entire team is there to talk to you, protect you, and care for you, while giving you the control you need to make good choices moving forward.”
“I have my life back. I am back working full-time, doing yard work, and playing baseball with my buddies.”
Trusted care when you need it most. Learn more about the Emergency Care Services offered at Wentworth-Douglass Hospital.
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