The sequence of improbable events that unfolded on May 11 at an off-leash dog park in Etobicoke and culminated at the Peter Munk Cardiac Centre (PMCC), remain remarkable to the patient, nurse and doctor involved.
It's a narrative that is best told in their own words.
"It was in the evening, and I had just biked home from work," Sylvia Wood, cardiac nurse in the coronary intensive care unit, PMCC, recounts in breathless, explicit, palpable detail the fateful evening she met Ivan de Souza. "I was talking to another person in the park who saw a man face down not moving on the ground. He said 'oh my gosh', so I turned to look. When I saw him and the way he was face first in the dirt, I knew it was bad. I ran over, and as I rolled him over his face was bloody and he was non- responsive so I ask the man with me to call 911. He was pulseless, so I started CPR."
That fateful evening
"As soon as I saw him I snapped into nurse mode. My adrenaline started pumping, all I was thinking about was making sure he got the best CPR possible and for EMS to come as fast as possible. Looking into his eyes while I was trying to resuscitate him, I truly didn't know if he would survive.
"His dogs were very concerned and were licking his face as I was doing CPR. All the dogs in the park were anxious with what was going on and so I asked other bystanders to collect the dogs, since they were all off leash. Another girl (Kelly) ran over to offer help. She said she had taken first aid. I was getting tired, so I asked her to sub in to perform CPR. She hadn't done it before, so I helped her landmark and encouraged her to compress hard and fast. We rotated back and forth giving CPR every couple minutes."
"All I remember is walking into the park and after that, complete blank, because I crashed with a heart attack. It is a miracle and I still believe that I had divine intervention."
Ivan de Souza, who suffered cardiac arrest in a dog park
Wood is a cardiac registered nurse with her BScN and member of the cardiac arrest team in the Coronary Intensive care Unit (CICU) at PMCC since 2008. She is currently covering a maternity leave in the Cardiac Catheterization Lab.
"I respond to cardiac arrests in the hospital and in the CICU on a regular basis," she says. "I've had many experiences over the years."
Even for a seasoned nurse, however, the sudden cardiac arrest of an older patient in the middle of a dog park was a first.
"I could hear the ambulance sirens in the distance and the man on the phone was trying to describe our location to the dispatcher. So, I asked another bystander (Fab) to go out to flag in the ambulance so they could find us more easily. The ambulance arrived after about 10 minutes and continued the resuscitation effort from there. They regained return of spontaneous circulation (ROSC) and took the patient to hospital. "
Uniting in Emergency
A second, sequence of life-saving events would follow when the ambulance arrived at emergency of the closest hospital to the dog park.
That's when Dr. Chris Overgaard, interventional cardiologist, PMCC, leapt into action – first, by phone.
"When I got the call from the emergency department of the other hospital late that night, the patient was doing horribly," Dr. Overgaard says. "I provided information to staff there over the phone. The fact that we all got in touch rapidly with one another – between hospitals and among physicians and caregivers – allowed us to stabilize the patient."
Then Ontario law entered the story.
"With the
provincial life and limb policy in effect, we were able to take the patient here (at PMCC), with no questions asked. Even five years ago, that would not have been the case," adds Dr. Overgaard.
The patient was rushed to PMCC thanks to the efforts of Dr. Mary Jane Esplen, Executive Director of the de Souza Institute, and Dr. John Floras, cardiologist, PMCC and Mt. Sinai, and the patient's cardiologist for more than 20 years. At that point, Dr. Overgaard and his Fellow took over.
"I was most worried about his age and down time," Dr. Overgaard says. "The chance he would wake up neurologically intact was very slim. The likelihood of surviving an out-of-hospital cardiac arrest in general is less than 10 per cent. The likelihood of surviving an out-of-hospital cardiac arrest with good neurological recovery is even less than that. It just goes to show you, you never know."
Dr. Overgaard and team performed an emergency angioplasty, a minimally-invasive procedure to open up heart blockages.
"He had terribly calcified, severely diseased and severely blocked vessels. It was like trying to open a concrete block," continues Dr. Overgaard. "You're trying your best to do as much good as possible with as little harm as possible. You're on the clock."
Normally a 60-minute procedure, Ivan de Souza's angioplasty took a painstaking three hours to complete. The medical team also had to balance existing concerns about his kidneys.
"It was like trying to open a concrete block. You're trying your best to do as much good as possible with as little harm as possible. You're on the clock."
Dr. Chris Overgaard, interventional cardiologist, Peter Munk Cardiac Centre
"It was a very complex, high-risk, very long, challenging, middle-of-the-night procedure," says Dr. Overgaard, who notes, he would never have seen the patient were it not for the life-saving efforts of others before him. "There was a lot of skill involved in the resuscitation effort administered at the dog park. He had excellent brain perfusion at resuscitation – a testament to how good the CPR was."
Tempting fate a second time
Ivan de Souza spent five days in the coronary intensive care unit, where some of Canada's most seriously ill cardiac patients receive highly specialized care.
"When I went to visit him about 72 hours after the procedure, I asked him how he was doing," continues Dr. Overgaard. "He said to me 'Terrible, they're not feeding me. I'm starving', which was an excellent sign in his recovery and pretty incredible to hear. He did dramatically better than I ever expected."
Just over a month since a handful of strangers walking their dogs – led by Sylvia, the cardiac nurse – united to save his life, the only visible sign of Ivan de Souza's brush with death are slightly swollen ankles. He was also implanted with a defibrillator.
"All I remember is walking into the park and after that, complete blank, because I crashed with a heart attack," he says. "It is a miracle and I still believe that I had divine intervention."
A businessman and philanthropist, he and Dr. Mary Jane Esplen are also the proud owners of two pure-bred poodles, Ellie and Manon.
"They tell me that when I fell and they turned me over, my two dogs were licking the blood off my face," de Souza adds, like a proud father. "They were so concerned. And when the firemen carried me off on the stretcher, they wanted to accompany the stretcher."
"When I saw him I was in shock, I just couldn't believe it. I was so unsure if he would survive, so words cannot describe how awesome it felt to see him not only alive, but awake and holding my hand."
Sylvia Wood, Cardiac nurse, Coronary Intensive Care Unit, Peter Munk Cardiac Centre
"It was tough going the first few days. I remember someone walking in (to his hospital room) and saying 'now you may have brain damage from all of that, and I stopped her short. I said, look, I don't have any brain damage. I'm going to let you know of a good test for brain damage – I'll give you all my passwords," he says with a laugh. "And I think the reason was nurse Sylvia Wood kept the oxygen going to my brain."
It was 26 years ago on May 10, de Souza suffered his first heart attack. Almost to the day, on May 11 of this year, he experienced his second.
"I feel there is a reason why I'm here on earth," de Souza quips. "There must be a purpose. And I've got to reassess where I'm going from here on. Probably slow down a little. And have a little more fun."
His prognosis, doctors say, is excellent.
Happenstance, luck, a blessing or the work of a higher power – that will remain unanswered. What is certain is the indelible mark that fateful evening has left on the lives of the patient, nurse and doctor involved.
"When I saw him I was in shock, I just couldn't believe it. I was so unsure if he would survive, so words cannot describe how awesome it felt to see him not only alive, but awake and holding my hand," Sylvia says. "Recognizing the power of all that I've learned as a nurse, I also truly appreciate all the skill, perseverance and critical judgment that my fellow nurses in CICU and the Cath Lab have taught me.
"I'm not a religious person, but somehow I feel like Ivan was not meant to die that day. The stars aligned in many different ways to save his life."
Adds Dr. Overgaard: "the most surprising thing is how many stars lined up."
