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Posted by MDViews on December 10, 2008

Small town medicine is personal. A winter evening splashing and playing with my children at the Friday night YMCA open swim in Burlington, IA in about 1986 found me using my CPR skills on a 12 year old boy who nearly drown. The frantic shouts of a 17year old lifeguard tore my attention away from my children as he hauled the limp body of a young swimmer from the deep part of the pool. The other lifeguards quickly directed the multitude of other swimmers out of the pool area. I sent my children out, exited the water and approached the victim and his rescuer, identifying myself as a doctor. The stark fear and anxiety on the face of the young lifeguard, who couldn’t have been more than 16 years old, eased somewhat as he realized he had done his job and would not have to revive the child. I checked. The lifeless-appearing youngster had a pulse. A good pulse. Strong. But he was not breathing. I started mouth-to-mouth, thankful for his youth and the light breaths it took to ventilate him. He started to cough and sputter after about 45 seconds. Another minute and he opened his eyes and started to struggle. He did not yet know where he was or how close he had come to death. He looked dazed and confused, but sat as the ambulance crew arrived. The hospital ER looked him over and sent him home after a few hours of observation.
At church about a week later, a very shy young man said a weak ‘thank you’ and handed me a card as he stood close to his mother. His mother was a single mom, a minority woman on welfare who had two sons. I encountered her youngest at the pool, the shy young man who delivered the thank-you card. After several years, he and his family quit attending our church and I lost touch. But that winter evening will be one I’ll not forget.
About four years later, while jogging on the 15-laps-to-a-mile track at the same YMCA, a staff member caught my attention as I rounded near the door.
“A man collapsed in the hall downstairs. A nurse has started CPR. Could you help?” he asked urgently.
I ran down the stairs three at a time (I could do that back then), through the door and into the main hall. A large elderly man lay on the floor with a small crowd around him. He probably weighed 250lbs with a barrel chest and the type of clothing you would see on a retired farmer from our area. As I moved closer, I could see blood on his face, cheeks, mouth, nose and blood splatter marks on the floor. A nurse from the hospital where I worked pumped up and down on his chest, counting “One, two, three, four…” By that time, I was at his side. I could see the nurse was getting tired. She glanced at me with recognition and said he had collapsed, falling forward, which accounted for the blood splatters and blood on his face, mouth and nose. I volunteered to ventilate, getting two breaths for each of her five compressions. The 911 call went out, but no ambulance crew came for 20-30 minutes. We switched from ventilating to chest compressions and back again as our fatigue increased. Occasionally, we felt for a pulse, but found none. Prior to my arrival, my now CPR partner ripped open his shirt exposing a long vertical mid-line chest scar, obviously from previous open heart surgery. At that time in our history, a major source of HIV was contaminated blood from transfusion. Anyone who had undergone a coronary artery bypass procedure had been exposed to at least six units of banked blood. He had undergone two bypass procedures, his frail wife relayed to us as we kept working on him. We were exposed to banked blood, at least 12 units. Both of us. When the paramedics arrived, they were able to start a line, administer meds and defibrillate him with some success. He left the YMCA unconscious with the paramedic bagging him with oxygen. And he had a pulse.
Later, I learned that he lived through the night, but died the next day. His wife sent a thank-you for our efforts. Neither of us tested positive for HIV.
Two stories, both true. Two outcomes. The common thread, using the medical skills I possess in an emergency situation. Rare situations as I’m sure you know, but who can predict events of tomorrow? For you or me? I thank God for the training I’ve received, the skills I have and the privilege to practice this most satisfying profession of medicine.

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