When I met with the Emergency Room doctor after Doug's sudden death, I asked him what happened. He said that most likely Doug suffered a malignant arrythmia that caused sudden cardiac arrest. My first reaction was "What the f**k is a malignant arrythmia?"

He explained that it is not a stroke or a heart attack. It is a powerful electrical impulse that stops the heart suddenly. (In contrast, a heart attack occurs when the blood supply to part of the heart muscle is blocked.)

As I undestand it, some types of irregular heartbeats are common and not dangerous. Others can kill you. The bad kind may not show up on an EKG (which Doug had less than 24 hours before he died because he was getting ready for shoulder surgery.)

Arrhythmias can happen to people who don't have any history of heart disease. They can happen to people who look and feel healthy - in fact they could be standing there talking to you, feeling nothing, and all of a sudden keel over. They do not show up on an autopsy.

Many people do not survive sudden cardiac arrest, even with professional medical attention shortly after they occur. Thanks to a 911 call from a passerby, Emergency Medical Technicians (EMTs) reached Doug within minutes after he collapsed while jogging. The first EMT team had an Automatic Electronic Defibrillator (AED). They put it onto Doug's chest. It read some kind of electrical cardiac rhythm - either ventricular fibrillation or pulseless ventricular tachycardia. This may have been Doug's heart quivering - it certainly was not beating at the time. The AED "recommended" or advised a shock. After one shock, his cardiac rhythm converted to a Pulseless Electrical Activity or PEA (a few electrical beats not producing a pulse), which is not shockable. Unlike what you see on TV, a flat-lined heart (called an asystole) can not be shocked into restarting. At that point, medication is required.

The paramedics switched to a full cardiac monitor. They interpreted the rhythm as continuing to be PEA. At 12:48, they noted that Doug's pupils were fixed and dilated. They treated him with medications indicated in protocols, including Atropine, Epinephrine. They continued giving CPR while transporting him to the Hartford Hospital Emergency Room. The medical team continued to try to revive him. Their efforts were futile. The diagnosis listed on the hospital report was "sudden death."

I suspect that Doug's death was related to a high blood pressure medication he was taking - Benicar HCT. Read more about sudden cardiac arrest and Benicar.

Some statistics on sudden cardiac arrests that occur OUTSIDE of a hospital setting.

• 300,000 Americans suffer cardiac arrest in a non-hospital setting each year.
  • The survival rate for those who suffer outside the hospital is less than 7 or 8 percent.
• Two thirds of survivors have severe brain damage.
• Cardiopulmonary Resuscitation or CPR cannot restart a heart that has stopped beating for electrical reasons. However, effective bystander CPR provided immediately after sudden cardiac arrest can double or triple a victim's chances. Still, the numbers aren't great - but everyone matters to someone, somewhere.

Even when cardiac arrest occurs in a hospital setting, short-term survival and long-term prognosis are not great. Research continues on how to improve survival rates and prognosis.

I wish they could have re-started Doug's heart. I wish he had been given a chance to live a long, healthy life. I do not wish that they had resuscitated him to leave him with severe brain damage or serious physical handicaps. I think that would have been torture for Doug, and I probably would not have handled it well either.

But, as they say, wishing ain't gittin. We don't get to choose. We cannot control all outcomes. I guess the only alternative is to learn to accept and come to terms with what did happen. Fourteen months later, I'm still working on that part.

(10/25/2011)

MORE

• First responders - paramedics/ambulance crew
• The end - what happened
• Hypertension and Benicar HCT
• Sudden death - what it is like for those left behind
• CPR statistics - American Heart Association
• Atrial Fibrillation - what is it (Cleveland Clinic)