Thoughts While Performing Sidewalk CPR on an Octogenarian in Auckland

On a hot sunny day in Auckland, New Zealand, I am standing in a long line of tourists waiting for an extremely delayed double-decker tour bus. Someone shouts, “Is there a doctor?!” But I’m already on my way, gently nudging the flabbergasted tour guide away from the limp, crumpled body of an older man lying unconscious on the sidewalk. The man’s skin is clammy; his eyes are rolled back. No pulse, no breathing.

Instinctively, I kneel next to the man’s body and start CPR. The man’s wife is kneeling next to his body, directly across from me. She is terrified and her eyes are pleading with me. As I perform chest compressions, I silently pray, “Dear Lord, don’t let her husband die. Not now. Not here. Not this way.”

I look around for help. A kind-appearing woman suddenly appears, kneels at the man’s head, and quietly and confidently performs a jaw thrust to open fully the man’s airway. We exchange knowing glances, as if we are a well-practiced team. I feel grateful for her partnership. After what was likely only a minute or two, but seemed much longer, the man gasps and starts to breath. A thready pulse returns. Slowly, the man regains dull consciousness. In time and with some effort, he can respond by telling me his name and moving his extremities. I am immensely relieved.

As I returned to the line, the other tourists greeted me with exclamations of sincere congratulations and admiration. However, the slight glint of pride inside me was quickly stifled by humility. I have had enough experience with life and death to know that I was but a cog in this dramatic event that could have easily gone in a different, tragic direction. I shuddered at the thought that the wonderful older woman’s last memory of her long life with her beloved husband could have been watching strangers perform CPR on her husband’s pale, limp body on that Auckland sidewalk as she became a widow.

As we toured the city, I contemplated this most unusual first day of a 40^th wedding anniversary vacation trip. I am a 63 year-old medical school professor, was sleep-deprived from over 24 hours of flights from the U.S., and it had been over 30 years since I’d personally performed CPR. I was elated at the outcome and treasured the strong, tear-filled hug from the man’s wife after he was loaded into the ambulance.

However, we doctors and other care providers know this delicate, unpredictable balance all too well. A ‘code’ we had thought we had turned around, takes a sudden, awful dive. A diagnosis in the clinic in which we were confident all along turns out to be completely wrong, along with the treatment we had administered. Those of us who are introspective and sufficiently honest with ourselves may, like me, keep buried deep inside a mental ‘list’ of those cases where we think we could have, should have, done better. Except they are not cases. They were living fellow human beings. Would they have been better off had they never seen us?

Sometimes late at night my ‘list’ unexpectedly surfaces into my consciousness and haunts me. Foremost on my deeply suppressed ‘list’ is a 16 year-old girl I cared for nearly four decades ago. I was a U.S. medical student on an elective rotation in a remote, isolated hospital in Zambia. Fresh off a rheumatology rotation in the U.S. with a renowned lupus expert, I was convinced the girl had lupus. Her chief complaint was a swollen, painful right knee. My diagnosis was supported by a slight malar rash, migratory polyarthralgias, unilateral pleural effusion, an elevated sedimentation rate without leukocytosis, and clear knee and pleural taps. However, tuberculosis, the great masquerader, was endemic. Her skin test was read by all observers as ‘probably negative.’ The report from the pleural biopsy would take three weeks to receive. Following a conference with the three senior doctors, the consensus was to dispense a short course of prednisone to treat her painful, disabling knee arthritis, along with stern instructions to her and her parents to return for the biopsy result in 3 weeks. However, the prednisone relieved her symptoms so well that she and her parents decided not to return. The biopsy showed TB. By the time she was located, she had died of disseminated TB, likely activated by the prednisone I had given her. I am filled with terror. What will I say to that beautiful girl when I meet her in heaven?

While in Zambia, I successfully treated hundreds of other patients, including some who had been on the verge of death. During my career in the U.S., I have received cards, letters, and gifts from many grateful patients, attesting to the impact of my work. Still I wonder, how many of these successes are needed to balance the few painful failures?

The responsibility for serving others in life and death situations is profound and can be troubling. However, on this one day, for me, I am grateful for the octogenarian in Auckland and the unusual opportunity he gave me, through God’s grace, to help others and add one more success to the balance.

Epilogue:

Anthony, whom I cared for on the Auckland sidewalk, was released after a brief hospitalization. He was able to board their cruise ship with Angela, his wife of 56 years (Figure 1). Afterward, they returned home safely and were able to share in the joyous birth of their second great grandchild three weeks later.

Figure 1:

Anthony and Angela on board their cruise. Published with permission of the couple.