I am in the first month of my first year of residency at UCLA Medical center. It is mid-July, 1961. I have just finished one year of internship, I look like a college kid. I don’t need to shave every day yet. But I am a real doctor. I’ve been on duty all that day and night and am now taking a nap early in the morning, about 2:30 or 3:00 AM.
The intercom suddenly blares out, “Dr. Bennett, come to the ER stat for an urgent admission.” I run down to the emergency room and find several nurses attending a middle-aged male lying in bed with electrodes on his chest and an IV running, apparently having suffered a heart attack. The way they are acting towards him, I can tell this is one sick cookie.
He looked scared, and the sight of a very young, sleepy looking doctor dressed in rumpled whites coming in to attend his case, I am sure was not all that reassuring to him. Remember now, I had just completed my internship a few weeks before. Yet at 3 in the morning I was the senior Internal Medicine specialist in the entire hospital. If his wife wants a second opinion, I’m it.
The truth is UCLA in those days was very laid back. This was a new med school, this was Los Angeles after all, and many of the faculty had tennis courts or swimming pools or both. Their lifestyles did not usually include supervising young doctors in the wee hours of the morning.
I looked at the cardiogram on the monitor. He had signs of heart block and an irregular rhythm. He had medication running in via IV per protocol that the intern had started and then asked the nurses to call me. Meanwhile he had gone up to the wards to attend another emergency up there.
As I began to interview the patient he slumped down, his eyes closed and his monitor showed complete cessation of heart beats. As they say in the movies, he had flat-lined. He was clinically dead. The nurses looked at me and I looked back. (My inner voice: deal with it.)
Ordinarily at that point I would whip out my knife. You see, in those days all doctors carried a knife to cut open a patient’s chest and massage the heart until it started up again. The survival rate after this desperate act was 1 to 2% at best. I had never personally seen or heard of even one patient making it through this ghastly procedure alive. And I had never done it myself.
On the other hand, I had seen a video of the new “closed chest cardiac massage” and had practiced on a manikin once back in my 4th year in Medical School in New York, maybe 14 or 15 months before. I had never seen one done on a live patient and in fact no one at UCLA had done closed chest massage since I had been there in training starting the year before. As I found out later, this procedure had not been done before at UCLA, nor likely any where in California.
I asked the nurses if they had a board, which they quickly placed under the patient’s back. I climbed up on the bed and straddled him and began regular chest compressions. I looked at the monitor and it showed no electrical activity. This guy was dead. His eyes were closed and he didn’t seem to mind at all that I was pushing on his chest pretty hard.
I kept up the chest massages, 1 and 2 and 3 and 4…. He opened his eyes! We stared at each other. I wondered if he knew what had happened. I stopped the chest massages. He started moving around as if to get more comfortable. A few minutes went by, maybe more.
His heart stopped again! I stared at him, trying to fathom what was happening to this guy. I started chest compressions again, 1 and 2 and 3 and 4…. In a few minutes he woke up again. I talked to him. I told him who I was and why I was straddling his pelvis and pushing on his chest. I doubt if he understood. He tried to say something, maybe it was a question…. His heart stopped again! I started chest compressions again. 1 and 2 and 3 and 4….
We did this dance, start and stop, 8 or 10 times over the next few hours until my relief came in. (This was Dr. Richard Glassock, since then one of my best and most admired friends.) Now I had to go back up to the wards and start rounding from patient to patient with my students and interns. (You didn’t think I was going to get to go home to catch up on my sleep did you?)
The man survived, intellect intact. He enjoyed a relatively uneventful few weeks in the UCLA Hospital and went home to recover. The Professor and Chief of Cardiology, Dr. Albert Kattus became his doctor. I presented the case at the weekly medical conference and Dr. Kattus discussed it. We even wrote a paper (“First CPR in the Western US” or words to that effect) which compared two cases, one in which the chest was opened and this case done by closed chest massage. It was published I believe in the Western Journal of Medicine, which in those days was called California Medicine.
Sitting here, I don’t remember the patient’s name. I remember that he and his wife were grateful. I don’t think I ever identified myself as the one who first made the decision to try closed rather than the traditional open chest heart massage. We doctors and nurses had a little party to celebrate the event. We called the patient at home and exchanged pleasantries.
Forty six years later the memories of those few minutes are indelible.
Life Lesson: There it is… it is what it is. Deal with it.
Author: Cleaves M. Bennett MD FACP
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