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On the first morning of November, I walked
down the long slope from my house in Squirrel Hill to the Carnegie
Museum of Art in Oakland for a meeting of foundation leaders to
do what people in my position do so many times each week: Assess
the merits of a proposal to fund a worthy public project. This
one had to do with turning an architecturally significant home
into a public museum and finding the money to pay for it.
As
I trudged over Flagstaff Hill, with Phipps Conservatory on one
side and the Carnegie Mellon University campus on the other, I
remember thinking about that civic project and the packed day
beyond. And I enjoyed, as I always do, the beauty of Pittsburgh's
green parkland and handsome architecture. The chilly air and the
thin autumn sun breaking through the clouds distracted me from
too much occupation with that week's busy schedule.
In a little
more than an hour, I would be dead — struck down by sudden
cardiac arrest that left me with no heartbeat, no pulse and no
breathing. And, a few minutes after that, I was alive again, brought
back by the heroic efforts of half a dozen people who jumped in
with cardio-pulmonary resuscitation and an automated-external
defibrillator (AED) to save me. It was a remarkable rescue that
left me among the 3 to 5 percent of people who survive cardiac
arrest with no heart or brain damage.
Several months after what
doctors refer to as the “cardiac event,” I'm still
shaken, full of enormous gratitude for all who helped me, and
still working to extract the personal lessons from the life-saving
experience. One of these is my new appreciation for the value
of growing old gracefully.
I remember arriving at the museum
meeting that day, but nothing more about the meeting itself. This
may be because of the sedatives I was given later. I have reconstructed
some of what happened through conversations with those who were
there. I had been asked by civic leader Elsie Hillman and the
museum's director, Richard Armstrong, to say something at the
end of the meeting about the exciting promise of the Frank House,
the architectural gem on Woodland Road in Pittsburgh's East End
that we had gathered to discuss. This house, the product of a
historic collaboration between the great 20th century architects
and designers Walter Gropius and Marcel Breuer, is a potential
urban Fallingwater that has excited local and national preservationists.
During my remarks I collapsed to the carpeted floor.
Several
people ran for help. Rachel Delphia and Lucy Stewart Hykes, both
assistant curators, hurried in. Neither knew that the other had
been trained in CPR, but when they saw me lying rigid, struggling
with ragged, episodic breathing, they quickly shared information
about their training.
Later, both told me they were hoping someone
else would step forward and take charge. But then I stopped breathing,
went limp and closed my eyes — the crashing phase leading
to clinical death. They began CPR, one doing chest compressions
and the other providing mouth-to-mouth breathing. Doctors said
their quick action was why I never suffered the oxygen deprivation
that causes heart and brain damage.
Richard had run down the
hall to get the AED, but no one in the room had been trained for
it. However, museum board member Alex C. Speyer III had been educated
as an engineer and had the confidence to grab the device and use
it. Amazingly, most AEDs, including the one used on me, have voice
prompts that walk you through. Open the box. Take out the pads.
Place them, after removing clothing, on the victim's chest. Wait
for the machine's diagnosis and, when the AED prompt announces
“shock advised,” get everyone away from the patient
and hit the red button.
An arc of electricity shot from one
pad through my chest, through my heart, to the other pad. The
heart is the one organ in the body that includes electrically
charged muscle, and it is the electrical impulses from this tissue
that produce the heartbeat. When the heart stops, electrical activity
begins to die down. After about six to eight minutes, it drops
to the point that the heart can't be brought back. So it's critical
that the AED be immediately available for use within a few minutes.
In my case, thanks to Richard and Alex, the shock came in about
2 1/2 minutes. One shock (sometimes it can take several) got my
heart pumping blood again.
But I wasn't out of danger. More
expert aid came from Shelli Geyer and Manual Cienfuegos, two museum
security officers well trained in emergency response and CPR.
Shelli gave me mouth-to-mouth breathing (I had not immediately
started breathing) while Manuel cleared the room and made sure
the rescue squad was on the way. Within a few minutes, I started
to breathe on my own.
Meanwhile, Elsie called UPMC President
and CEO Jeffrey Romoff, and he made sure the staff at Presbyterian
Hospital was forewarned. His assistant, Lila Decker, and Presby
cardiologist William Follansbee both beat me to the emergency
room. My wife, Peggy, who also had been called, was there ahead
of me as well. A team swung into action as I arrived.
I'm well
aware that most people don't have Elsie Hillman making calls for
them, or Lila Decker waiting in the emergency room. But I also
know from my research that the treatment I got followed all the
normal routines for emergency heart patients at the hospital,
and that those who manage UPMC pride themselves on making this
world-class care available to all.
The doctors quickly inserted
a catheter through an artery into my heart (UPMC manages to get
better than 90 percent of its heart patients catheterized within
90 minutes of the “event”), assuming they would have
to place stents in my arteries to open a blockage. But I hadn't
had a heart attack. Somewhat to Follansbee's surprise, they found
no coronary disease and no blockage. My heart had gone into fibrillation
and then stopped because of an electrical arrhythmia. The heart
doctors later explained to me there are “plumbing”
issues and “electrical” issues. Mine had been entirely
electrical, probably genetic, similar to when otherwise healthy
basketball players drop dead on the court (a compelling argument
for keeping AEDs in all gyms). Follansbee ordered that I be put
into a state of “deep-cooling” to protect my organs
from damage, an advanced medical protocol followed in most heart
cases at Presby. This medical version of hibernation came by way
of intravenous cooling fluid and sedatives so I would rest, not
shiver.
So, for the first two days, I was knocked out with no
understanding of my condition, still labeled critical. No such
peace was available to Peggy, who endured two days not knowing
if the future might bring widowhood, or something just as bad,
caring for a severely disabled husband whose limitations would
mean a marginal quality of life. She was, as always, strong and
calm, but the stress caused her to break out in painful hives.
When
I regained consciousness Nov. 3, my two sons — Ned and Will
— and Will's wife, Reni, were at my bedside, having flown
in from New England. At first, I thought I was in a dream. Then,
as I became aware of the hospital room and the monitors, I assumed
I had been in an auto accident. My speech was slurred. I was foggy
and confused. When my family repeatedly told me what had happened
and that everything would be all right, I thought they might just
be trying to calm me and that, if the slurred speech and mental
confusion were permanent, I was damn far away from all right.
But,
gradually, I came out of my sedative-induced fog and my speech
came into focus. By the time the team of neurologists arrived
to assess my condition, I was swapping jokes with my sons. The
medical team members quizzed me for an hour, and Peggy later told
me of her enormous relief when the head of the team told her outside
my room: “We have no work to do here.”
For each
of the next 10 days, Follansbee painstakingly reviewed my case
for clues to make sure no risk was overlooked. Follansbee, from
a family with a long history in this region (Follansbee, W.Va.),
brought a reassuring combination of detective skills, intellectual
rigor and military precision. Much testing led him to believe
the problem might be connected to some genetic anomaly that might
recur. Otherwise, he said, I'm in excellent health, and there
would be no order for lifestyle changes. He referred to me as
a “tough old bird” and said I might not have survived
if I had not kept myself in good shape. I exercise daily, don't
smoke or drink, eat a fairly heart-healthy diet, and pay a lot
of attention to the latest health research.
One worry is that
my sons, both in their 30s, face a 50-50 chance of the problem
if my case has a genetic cause. Both are seeing cardiologists
for the first time. I hope that before they get much older technology
will be able to predict and treat their vulnerability.
In fact,
the medical technology used on me was, for the most part, unavailable
until recent years. The Museum of Art's AED device, invented more
than 50 years ago, has been in widespread use only in the last
couple of decades. It got there through the efforts of the Laurel
Foundation's vice president, Donna Panazzi, who has worked relentlessly
to fund and manage PULSE, a program that places AEDs in offices
and public spaces and provides CPR and AED training. Without those
efforts, I would be dead.
At the end of my testing at Presby,
I was a candidate for an implantable cardioverter defibrillator,
an ICD, which now resides just under the skin on the right side
of my chest. A long, thin wire, or lead, runs from the device
through a vein directly into my heart, monitoring for any sign
of an irregular heartbeat.
Now I can return to a completely
normal life. I have resumed workouts as well as hiking and biking.
Soon, I'll go back to rowing my single scull out of Three Rivers
Rowing Club on the Allegheny River at Washington's Landing. And
I have been back to work at The Heinz Endowments downtown since
Nov. 20, just a few weeks after the Nov. 1 event. Most importantly,
I can do all these activities without constantly worrying about
the risk of another cardiac arrest. The extraordinary piece of
hardware in my chest can shock my heart back into action if it
should stop again. But it also provides more sophisticated help:
sensing the arrhythmia that precedes cardiac arrest and taking
over the management of the electrical heartbeat before the heart
quits. And it keeps a record of my cardiac activity that doctors
can review during checkups. The statistics on the benefits of
defibrillators are remarkable: Although about 5 percent of all
patients who suffer sudden cardiac arrest survive the event, those
odds shoot up to about 75 percent with the use of an external
defibrillator and to better than 95 percent with an internal defibrillator.
People ask me if I mind having this piece of metal in my body
and my reaction is: Are you kidding? Who wouldn't want that kind
of improvement in the odds of survival? I love having it.
The
important thing — and this is the first of the lessons I've
gleaned from my experience — is that public awareness of
the benefits of AEDs and CPR must be dramatically increased. That
is the value of the work of The Laurel Foundation's PULSE program
and why Peggy and I have decided to make a major financial contribution
to it in the names of the people who helped me that day at the
Museum of Art. And I've told Donna Panazzi I'm available for public
speaking to help increase AEDs in Pittsburgh's public spaces.
Another
lesson has been the great value of living in a place that offers
worldclass medical care. The UPMC system has become one of the
top hospital facilities in the country. And the cardiac care system
at Presby, under Follansbee's leadership, along with the cardio
nursing led by Kate Hannan, are among the best. Peggy and I have
also committed to make a contribution to an endowed chair in Follansbee's
name at the University of Pittsburgh Medical School, in association
with UPMC Presbyterian. This will also be in the names of those
who helped me at the museum.
It is often said that Pittsburgh
is really a big small town, and it is this intimate, small-town
sense of community — stronger than in any of the seven other
communities in which Peggy and I have lived and worked —
that makes it such an appealing place in which to make a home.
The outpouring of concern and support that Peggy and I received
from hundreds of people in this region made an enormous difference
to us. No place we've ever lived before would have provided such
help and strength. Many people have asked us if we now have anxiety
or fear. But, truthfully, we feel this overwhelming sense of gratitude,
rather than anxiety.
There is one other feeling I've had in
strong measure: the sort of generalized sense of well-being and
contentment that comes from living precisely in the moment. I
know from my reading that this heightened ability to live in the
moment frequently comes to persons who have had a brush with death.
And that, most often, it is lost with the passage of time. I'm
hoping I can hold onto it. In fact, I mean to make it my job to
hold onto it. It feels wonderful, and I'm going to make every
effort to keep my awareness of this and of its value to someone
— like me at 62 — who is entering old age. It seems
to me that a clear focus on the present, on all the immediate
joys of living, is the key to the challenge of growing old gracefully.
Old
age is like any phase of life: You've got to work at it and focus
on it in order to do it well. And it is just as important to do
old age well as it is any of the other phases. In fact, there
are few things more clearly admirable than the ability to grow
old gracefully. We know older couples — like the late Bill
and Ingrid Rea of Shadyside and the Ligonier Valley; or Elsie
and Henry Hillman of Pittsburgh, still titans in the fields of
American politics and business — who stand as models of
graceful aging.
The key to this, I am learning, is to be mindful
of all that is going on around us and to develop the skill of
appreciation. As we grow older, we tend to worry more and more
about the future and to obsess over details. Paradoxically, we
also tend to dwell in the past, to reserve our greatest appreciation
for “how much better things used to be.” Those people
who sustain grace and good humor have seemed able to keep their
focus on the present and the values of everyday life: the beauty
of the city and its wonderful architecture on a clear, sunny day;
the pleasures of a good meal with good friends; a long walk in
a city neighborhood or through the fields and woods in the country;
the satisfaction of shared work; the love of family.
For someone
like me, a worrier who is always managing details and planning
for the future, this ability to focus on the present is a precious
gift that I do not mean to squander. I want more than anything
to sustain it. And I think I've learned my lesson. This is the
future: I survived. pq
Maxwell King is
president of The Heinz Endowments, based in Pittsburgh. He also
is chairman of the national Council on Foundations.

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