Destiny's patient: A heart-stopping story of survival at UT Southwestern
February 28, 2020
Paul Garner remembers nearly every detail of the day he died.
It was June 21, 2019 – a Friday. He was in Dallas, delivering some packages to the SPCA near I-30 and Hampton Road. Temperatures topped 97 degrees that afternoon – one of the first real scorchers of the summer.
When Paul began feeling nauseous and a cold sweat soaked his shirt, his first thought was heat exhaustion. He went to the restroom to splash water on his face, but five minutes passed, then 10, and he just kept feeling worse. This was not heat exhaustion.
His first instinct was to get to Parkland Memorial Hospital, a well-known trauma center, as quickly as possible. Paul grew up in Dallas and knew it wasn’t far, so instead of calling for an ambulance he climbed into his truck and headed north for what would be the most harrowing five miles of his life.
Racing against time and rush-hour traffic, the independent delivery driver based in Ladonia, Texas, darted into every open lane and floored it through every green light. As fate would have it, the last arrow pointed him toward UT Southwestern’s William P. Clements Jr. University Hospital, “the only place that could have saved me,” Paul says.
He pulled up to the valet station and stumbled into the emergency room. The rapid-response team quickly attended to Paul and determined he was having a full-fledged STEMI heart attack – the most serious kind. His right coronary and left circumflex arteries were completely blocked, while the other left artery – aka “the widowmaker” – was 95% blocked.
When a nurse asked him to rate his pain on a scale of 1 to 10, Paul told her it was a 20. That’s the last thing he remembers.
He was rushed to the cardiac catheterization lab, but as he was being transferred from the gurney to the operating table, his heart stopped. So did his breathing.
For 30 minutes.
That same Friday, Dr. Dharam Kumbhani was working late, finishing paperwork, when he heard the STEMI page go off.
The cardiologist on call was at home and knew time was of the essence, so he texted his friend, Dharam, to see if he could help.
Dr. Kumbhani rushed to the cath lab at Clements University Hospital to try to restore at least some blood flow to the patient’s heart, but before he could get started, the call went up: “Code blue!”
The ER team immediately began CPR, and the cath lab became a hive of lifesaving activity: nurses, doctors, anesthesiologist, OR and ER staffs, all working in concert in a “full-court press” strategy to save Paul, who, despite the dire situation, had several factors working in his favor:
- He was relatively young, only 52, and there was a good chance his organs could bounce back if the team could revive him.
- His heart attack occurred in the hospital, where he received exceptional CPR and heroic care within seconds of his cardiac arrest.
- He had Dr. Kumbhani, Director of Interventional Cardiology and the Cath Lab Director at UT Southwestern and a nationally recognized expert in minimally invasive cardiac catheterization techniques, in the room ready to unclog his blocked arteries.
- And the cardiothoracic surgery team was on the way to connect him to a miracle machine called ECMO (Extracorporeal Membrane Oxygenation) that could keep his heart pumping and lungs breathing, even while he couldn’t.
As the rapid-response team continued vigorous chest compressions, Dr. Kumbhani made a small incision in Paul’s groin and threaded a catheter into his blocked arteries, inserting two long stents. The procedure is delicate under the best of circumstances; in this pressure-packed atmosphere, with limited vision and intensive CPR in progress, it was a high-wire act.
Next, the cardiac surgery team sprang into action.
Dr. Michael Wait, Chief of Cardiovascular and Thoracic Surgery and one of the country’s foremost experts in the use of ECMO, also happened to be working late that Friday. Entering through the same incisions Dr. Kumbhani had made to insert the stents, Dr. Wait placed plastic tubes that connected Paul to the hospital’s ECMO machine, which pulls blood out of the body, oxygenates it, and returns it – bright red and warmed to body temperature.
ECMO can keep a patient alive for days, sometimes weeks.
The life-support device is typically reserved for children or patients awaiting a transplant. Fewer than 275 hospitals in the U.S. have ECMO, and some of those don’t have the cardiac surgery teams capable of attaching it. But Dr. Kumbhani said there was no other choice for Paul.
“When someone is crashing, you need ECMO,” Dr. Kumbhani says. “Paul was dead for 30 minutes. The odds were stacked against him.”
Even with ECMO, the survival rate for patients receiving cardiopulmonary resuscitation is 29%. But at least now he had a chance.
ECMO: The Miracle Machine
The Extracorporeal Membrane Oxygenation (ECMO) machine can keep a patient alive for days, sometimes weeks. It is typically reserved for children or patients awaiting a transplant. But Dr. Kumbhani said there was no other choice for Paul.
Waiting and praying
Kimberly Garner started her Friday by posting a smiling selfie on Facebook: #TGIF. But when she got a frantic call from her husband late that afternoon, days disappeared into weeks of waiting and praying for him to survive. Updates on her Facebook page chronicled the family’s ordeal:
June 21: “Paul had a heart attack while in Dallas working. He is back for surgery. I don’t know anything more than that. Asking for prayers, good vibes, lit candles. Whatever you have.” (Friends in Ladonia, a tiny town about 80 miles northeast of Dallas, quickly started a GoFund Me page for the family.)
June 22: “They are not sure what damage has been done to his other organs, including his brain. Won’t know for some time yet.”
June 23: “He is forming a lot of clots, so they upped his blood thinners. We are getting through this hell, one day, one minute at a time.”
June 25: “Paul is being put on 24-hour dialysis; it’s going to help his kidneys work better and get some fluid off of his other organs.”
June 26: “Best news yet! They have taken him back for surgery to remove the ECMO. Soon his heart will be beating 100% on its own. The doctors are optimistic.”
June 28: “He’s awake! He gave me a thumbs-up. I tried not to, but I started crying. It’s about time we had happy tears.”
Feeling 20-30 years younger
Nearly two weeks after he staggered into the ER, Paul was moved out of intensive care. A week after that he was discharged. Nurses told Kimberly they’d never seen a recovery like his. But life would not necessarily go back to normal.
Paul would need dialysis three times a week, and his heart was functioning at only about 30%. The stress of a heart attack can decrease blood supply and cause kidney damage. Dr. Kumbhani wanted to give Paul’s kidneys the best possible shot of getting better before returning to the cath lab to insert another stent in the left anterior descending (LAD) artery, where there was still 95% blockage.
Four long months later – the week before Christmas – Paul was off dialysis and back at the cath lab at Clements Hospital.
This time, his heart was beating on its own, and Dr. Kumbhani made a very small incision in Paul’s wrist to access the blocked artery and place a stent. Transradial angioplasty, another of Dr. Kumbhani’s specialties as an interventional cardiologist, has fewer complications and allows for a quicker recovery time.
Paul calls the procedure truly life-changing.
“I told my wife when I woke up that next morning that I felt 20-30 years younger,” he says. “Looking back now, I realize that I’d been dying for a long time and I’ve had heart problems for decades. But it mostly flew under the radar. I had high blood pressure, but I’d never been hospitalized. Never a surgery.”
“I’m going to tell you right now, nobody else would have been able to do what they did to save me." – Paul Garner
Dr. Kumbhani says Paul’s newfound energy is a sign of his physical and emotional resilience.
“More blood flow certainly will mean that his heart is feeling better,” he says. “But also, it was such a traumatic experience for him the first time around. I think the relief that it went so well is part of the reason he feels so much better. Some of it is physical, but some is psychological as well.”
Paul has worked with a UT Southwestern dietitian to adopt healthier eating habits, and just after the new year he went back to work. Soon, he will begin cardiac rehab. He is determined to get up to 10,000 steps a day. Dr. Kumbhani said seeing Paul doing so well is particularly gratifying.
“I told him how incredibly happy I feel for him,” Dr. Kumbhani says. “He was very sick, and I’m just very grateful we had the right team and the right technology and the perfect timing to help him. He is a constant reminder of why I became a doctor and why we do what we do.”
After cheating death, Paul Garner believes it was destiny that made him turn toward UT Southwestern on June 21.
“I’m going to tell you right now, nobody else would have been able to do what they did to save me. A lot of doctors would have given up on me. And who could blame them? I went into a cardiac arrest for 30 minutes. I had 100% blockages in two of my arteries and a 95% blockage in the third.
“It’s really been nothing short of miracle after miracle,” he says. “If I would have gone to any other hospital, I wouldn’t be alive today.”