Running helped Pia center herself. On this particular day she maintained a steady metronomic pace and focused on the physical acts of running and breathing. Her work, and the distinct and different social problems that Berman and George presented her, were forced to the back of her mind. Breathing in the crisp mountain air, she pushed herself to greater effort, reveling in the sensations coming from her quadriceps, hamstrings, and calves. The sun was out and felt strong against her face in the 5,000-foot-plus elevation.
The run was going particularly well, and Pia checked the running app on her iPhone, which was strapped to her upper right arm. The GPS was on, and the app marked her progress on the route, keeping logs of times and distances. As she passed a distinctive weathered pine tree, she saw that she was making great time. The activity calmed her. It was as if she didn’t have a care in the world.
Then, ahead of her in the road, she saw a male figure lying facedown, legs straight and arms stuck out to the side, as if he had been crucified and tipped off the cross and onto the ground. He didn’t seem to be moving, and Pia’s pulse, which had been holding steady at a moderate rate, suddenly picked up speed. Her intuition told her the man was in trouble, and her first thought was whether she was up to lending a hand. She’d been through medical school, but as far as emergency medicine was concerned, her training only made her aware of what she didn’t know. How to actually be a doctor was learned in residency training, which Pia had yet to do. She knew all too well that there was a reason a trainee could not get a license to practice medicine until after some level of graduate medical education had been achieved.
Controlling her anxieties as best she could, Pia ran up and knelt beside the stricken individual, who was dressed in the same running gear she was. He was Asian. Quickly determining the man was seemingly not breathing and had no apparent pulse at the wrist, Pia maneuvered him over onto his back. She shook him forcibly, trying to rouse him. Leaning over him, she put her ear close to his mouth. Now she was certain. The man was not breathing! His mouth was partially open, and along his lips she saw a bit of foam, making her wonder if he’d had a seizure.
Wasting no time, as she knew time was critical, she again felt for a pulse and found none. With the flat of her hand she pounded the man’s chest several times. She had remembered that maneuver from a lecture. What she couldn’t remember was why it was done, but she did it anyway. She then reached for her phone to dial 911 in hopes of summoning help. Thanks to the GPS device in her phone, she could give very precise details of where she was located, which she did rapidly after telling the operator she’d come upon an unresponsive man who wasn’t breathing and had no pulse. Her final comment was that she had no idea how long the man had been lying next to the road.
After being reassured that an EMT vehicle was being dispatched, Pia started administering CPR. Her first priority was thirty chest compressions, using the heels of her intertwined hands. At least she could remember the outlines of the procedure. While she was doing it, she made certain that she was getting at least two inches of chest compression. It was not difficult. The man was lanky, perhaps in his forties, and seemed in good shape and hence was supple. The rationale she knew was to propel blood through the one-way valves of his heart and out into his system to keep the man’s brain alive until his heart could be restarted with a defibrillator.
After thirty compressions, Pia stopped. Quickly she pinched the man’s nose closed, fought successfully against her reluctance to seal her mouth over the victim’s, and forced her breath into the man. She saw that his chest rose appropriately. After two good breaths she returned to the chest compressions. Following thirty more, she broke off again to repeat the breathing. Before doing so, she quickly tried for a pulse at the man’s wrist. Unsuccessful at feeling a pulse, she pushed up the man’s sweatshirt sleeve on his right arm to check for a pulse in his ante cubicle fossa — his elbow. What she saw surprised her: the man was tattooed on his forearm with a series of numbers, reminding Pia of concentration camp victims of the Nazis. She tabled the thought and moved on quickly.
To her surprise, at the elbow she thought she felt a pulse. Encouraged, she then felt for the man’s carotid artery. Here there was a definite pulse! It was rapid and faint but definite, a good sign, provided the circulation was adequate to get oxygen to the brain. With her hand on his neck she noticed something else: the man’s skin seemed hot, but there was no perspiration on his forehead. The thought went through her mind that he might have been suffering from heat stroke despite the cool outdoor temperature.
Pia was confused by the conflicting range of symptoms. In addition to his problematic cardiac status, she saw what looked like urticaria, or hives, on his forearm. It was also apparent that he had vomited, because there was some vomitus on the ground next to him. And there was that foaming at the mouth she’d noticed initially. Pia worried that despite the thready pulse, the man might be about to die of shock, possibly septic shock, with his elevated temperature.
Pia again leaned over to recommence the breathing part of the CPR and suddenly felt resistance when she tried to blow into the man’s lungs. To her astonishment, the man spontaneously started breathing. He even coughed. Pia checked the pulse at the wrist. It was stronger. Then the man quickly woke up.
As if waking from a slumber, he gazed up at Pia with obvious surprise and gripped her by the arm, shaking her as if shocked she was there, and wanted to make sure she was real. He spoke quickly and excitedly in what Pia took to be Chinese. The man then pulled on Pia’s arm in an attempt to sit up, but only managed halfway before falling back. Pia was transfixed, as if she were confronting a ghost. It had been such a sharp recovery: one minute the man was dead, as far as she was able to determine; the next he was very much alive. His eyes were darting around. He seemed terrified.
“It’s all right,” Pia said, trying to calm him. She checked her watch, wondering just how long the man had been without breathing and heart action. She also worried when the EMTs would arrive, hoping they were close by.
The runner again tried to get up. When he again faltered, he spoke quickly — what was he trying to say? The two of them had no language in common, but Pia could tell by the man’s face that his terror was mounting, not lessening.
“It’s okay,” Pia repeated. “It’s okay. An ambulance is coming. Just try to lie still.” She knew it was common for people who’d just suffered a medical crisis to be anxious, but this was different. The man was trying to get up and leave. Who was he afraid would find him?
Pia’s fear was that the man would lapse back into cardiopulmonary arrest, as nothing had been done to alleviate what had caused his heart and breathing to stop in the first place. Yet the man seemed to become more alert as the few minutes passed. When the man heard the wail of the approaching ambulance’s sirens he looked even more scared, and started shaking his head. “No, no,” he said to Pia. They were his first English words. “Please.” He sat up, and this time didn’t fall back.
“It’s okay,” Pia repeated calmly while keeping her hand on the man’s shoulder. “It’s okay. It’s okay. You’ll be safe.”
The ambulance and a Boulder Police car came to a screeching halt, and two EMTs and a police officer hurried to the downed runner’s side. It was clear they were surprised to see the victim sitting up with his eyes darting about.
“I’m a doctor,” Pia announced hastily. “Maybe not a practicing doctor, but a doctor, nonetheless. I was running and I found him collapsed on the road, not breathing, and he had no pulse. I did CPR and got a thready pulse. Then he suddenly woke up. I thought he’d be in shock, but he suddenly seems pretty normal.”