Julie's Heart

How a caring team, new technology and miraculous timing helped save a member of the Mary Greeley Medical Center family.

On a sunny Sunday morning in August, Julie Schwery left her house for a jog around the lake at Ada Hayden Heritage Park in Ames.

But just minutes after arriving at the park, her heart stopped.

Over several crucial hours a diverse group of Mary Greeley Medical Center colleagues would work tirelessly to save Julie’s life.

Julie’s care would involve a new emergency treatment for heart attack victims called therapeutic hypothermia, which requires a patient’s body temperature to be dramatically cooled. The treatment had been approved for use at Mary Greeley Medical Center just three days before Julie was rushed into the Intensive and Coronary Care Unit (ICCU).

Here, Julie and several of the people who helped her recount this dramatic story in their own words.

Sunday, August 10

7 a.m.

Julie Schwery, Mary Greeley Medical Center clinical document specialist: In May 2011 I passed out because of a cyclical episode. But I had a full cardiac workup and had a loop recorder put in to monitor my heart for a year. I was cleared to exercise, and so I left the house that morning and told my husband that I was going on a jog.

7:30 a.m.

Brent Baerenwald, a physical therapist at Mary Greeley Medical Center Rehab & Wellness: I’m a physical therapist and live close to the park, and go there frequently to walk. When I pulled into the parking lot, I noticed someone lying down on the sidewalk. I thought maybe she was stretching. But she was face first on the cement and passed out, with a pool of blood by her face. I could tell she wasn’t breathing and wasn’t responsive.

I called 911 and assessed her again; I couldn’t get a pulse. Then another person showed up and asked me if they could do anything. Then a woman showed up and asked me if she could do anything. I had Julie on her side, and the woman helped me turn her over on her back, and then held her head while I started doing CPR. It’s the first time I’d ever done anything like that, but with all the training I’ve had, it came naturally.

Kristine Kemp, Ames resident: I had just come around the corner and saw Brent, and asked him if I could help. I held Julie’s head as Brent performed CPR. I was caught off-guard when I realized how serious it was. When Brent was on the phone with 911, I could tell by the way he was talking that he knew what he was doing.

7:40 a.m.

Aaron Topliss, Mary Greeley Medical Center paramedic: Sunday mornings are usually pretty calm, so when we got the dispatch we hopped in the truck and headed out to the park. I was in the passenger seat, figuring out which parking lot to go to, and Jeff Larson was driving. We pulled up on the scene; the firemen were already doing CPR, but at no point while we were driving did I think this could possibly be Julie. I know her and Clayton Gregg, her husband, and I knew they lived close to the park and were active. When we pulled up, I realized she looked familiar, and I said to Jeff, “That looks like Clayton’s wife.”

Brent: She had her iPod with her, and it had a return address. A police officer picked it up and said, “This is Clayton’s wife.”

Julie: When the fire department showed up, I was in ventricular fibrillation, a heart rhythm not compatible with life. They had shocked me once with a defibrillator.

Aaron: She had a faint pulse, so we got her in the back of the ambulance. She had some spontaneous respirations, but then she wasn’t breathing anymore and was going into cardiac arrest, so we gave her another shock and kept doing CPR. We were only on the scene for a few minutes. As we were leaving, Jeff said to a police officer that he needed to go to Clayton’s house and bring him to the hospital, because we didn’t know which way it was going to go.

8 a.m.

Clayton Gregg, Julie’s husband and a Mary Greeley Medical Center paramedic: I was home, watching TV, thinking that Julie should be coming back any time. She’s usually out for 50 minutes or so. The clock had just started chiming 8 a.m. when a police officer came to the front door, holding all of Julie’s things in his hands. I thought the worst—that she had died. I’m a paramedic, but it’s different when it’s your wife. I kind of went numb. I kept asking the officer how she was, but he didn’t know, and I realized he was not going to tell me anything. We had a really fast ride to the hospital.

Aaron: On the way to the hospital, she had a pulse and we were using a bag valve mask to breathe for her. We knew she had a cardiac event and that we needed to get her to the hospital, where they could figure out what happened. We brought her in, and the whole rest of the day, I was on pins and needles. Everybody was rooting for her.

Dr. Travis Mattson: Since I came here, we’ve been talking about the hypothermia protocol, which has been shown to improve outcomes. We had purchased the equipment, and the hospital staff had just completed training. The procedures, or protocols, had been approved but hadn’t been input into our electronic medical records system yet. I called my director, who had just gotten off the overnight shift, and she got the files to us so we could get the protocol started.

I knew Julie from working at the hospital. When she came in, she was fully comatose and not responding, but had spontaneous circulation and blood pressure, which was quite remarkable. She fit the protocol for the hypothermia treatment. There can’t be any signs of head trauma, no recent surgeries, and the episode can’t be due to infection. You also have to get the patient cooled down six to eight hours from arrest time, and you have to evaluate age and health status. She was the ideal patient, so we said, “Let’s get this going.”

8:30 a.m.

Clayton: I was wandering around the ER in a daze, and the doctors said they wanted to cool her down. They explained that she was young and healthy and the perfect candidate. They said they would cool her down and keep her cold for 24 hours, then warm her up and see if she wakes up. I caught his use of the “if,” and it wasn’t very reassuring. So they got her up to intensive care and started cooling her down around 9 a.m.

Amy McDonough, Mary Greeley Medical Center ICCU supervisor: I knew the protocol was 90 percent done and I was at home, but I decided to come in. I didn’t know it was Julie until I got to the room. I’ve known her since I started working here and I was surprised to see someone I knew well and who was so young.

In simple terms we put a gel pad on the chest and thighs and wrapped it around to cover most of her torso. The gel pad circulates water to bring the body’s temperature down to 33 degrees Celsius. There’s this thinking that there is a time frame where the patient doesn’t have adequate oxygen to the brain because the heart has stopped, so putting them in a hypothermic state preserves brain tissue. The body’s autonomic response to being cold is to shiver, so you give medication to sedate and paralyze the patient and keep them from warming up. But the body does different things when it’s cold. Its potassium levels change, and blood pressure is unstable, so I was there as an extra person to make sure we got the labs ordered correctly. The idea is to cool down the patient fast—in less than two hours—and then rewarm them really slowly—over the course of 16 hours.

Dr. Mattson: I called surgery to put in a central line, called an internist to write the orders, called the ICCU team, called cardiology to get the arterial line placed. A lot of people were here lickety-split—in about 15 minutes. A week later it would have been one click of the mouse. Everyone says it was a team effort, and this really was. It started at the scene; had Brent not been there, she would have died. EMS did the right thing. The team at the hospital had the foresight to try to get this through. So many little things fell into place to quickly get the right thing done.

Clayton: Once they got her down to 91.4 degrees, her forehead was cold, her skin was pale, and really, she felt dead. So it was uncomfortable.

She was on a ventilator and wasn’t responding at all for the first 24 hours.

Tuesday

5 a.m.

Clayton: On Tuesday she was still medicated and on the ventilator, but when we would rub her feet and then stop, her foot would wave at us, like she wanted more. And then I knew that although she couldn’t talk, she was hearing what we were saying. We were telling stories about her and we saw her raising her eyebrows.

2 p.m.

Clayton: We had her do things like squeeze hands and hold her head off a pillow for a little bit. I felt really good about how things were going. She had no short-term memory, but her long-term memory was good. She could remember the names of people, she was able to tell me a sister was in Jamaica, she remembered a conversation from Wednesday night.

Julie: I was blurry when I woke up, and kept asking the same questions. I was very weak and in disbelief. I have no memory of those five days—even of leaving the house on Sunday. Sometimes I go up the hill in the grass at the park, and no one would have found me for a long time. On Friday after the incident, they put in a pacemaker. My coronary arteries are clear, and they now think that I had a virus in January that traveled into my heart and affected its electrical system. If you saw me today, you would never know anything was wrong with me. I have some warrior wounds on my face, hands, shoulder and knees, but I’m the same person I was.

Clayton: Every day she kept getting better, and she was discharged on Monday, so we spent eight days there. While she was in the hospital, someone asked if I was going to keep her at Mary Greeley. I hadn’t thought about taking her anywhere else. They were doing all they could do for her at Mary Greeley.

The big thing for me is encouraging people to learn CPR. People have said that if they came across her, they wouldn’t have known what to do. From our point of view as a paramedic, that’s the key for us to have a chance to resuscitate someone. I’m proud to be part of Mary Greeley and of the care they gave her.

Epilogue

After her hospital stay, Julie completed a cardiac rehab program at Mary Greeley Medical Center. She continues to exercise on a regular basis. She makes sure to carry some form of identification with her at all times, and has placed address labels on her cell phone, iPod and bicycle helmet. She also makes a point to let her husband know her planned exercise route. Most importantly she regularly encourages everyone to take a CPR class.

“I’m so appreciative of both Brent and Kristine,” says Julie. “There’s a new bond that we will share, and you can’t describe the emotion you feel. They really did save my life. I’ve been so impressed with the health care at Mary Greeley, and almost overwhelmed with the caring and people and support. People will see me in the hallway and tell me, ‘It’s good to see you alive.’ Most people don’t get to feel that. It’s so unique to be here at Mary Greeley, with the specialized care and personal touch. It’s been exhibited for me in a whole new way.”

What Is Therapeutic Hypothermia?

New procedure for heart attack victims is now available at Mary Greeley Medical Center.

Therapeutic hypothermia is supported by the American Heart Association for people who have suffered ventricular tachycardia (VT) or ventricular fibrillation (VF). For a hospital the size of Mary Greeley Medical Center, this is a fairly uncommon therapy. Nonetheless, having the therapy (and its necessary equipment) available for patient care was considered important because of its possible effects on improved neurological outcomes post-cardiac arrest.

When the body is quickly cooled, therapeutic hypothermia can slow damage to the brain due to decreased oxygen supply. Hypothermia therapy also slows the metabolic rate in the brain, decreasing the amount of oxygen needed, and suppresses free radical production, thus protecting the cells in the brain.

The body is quickly cooled to 91.4 degrees Fahrenheit, then slowly rewarmed to normal body temperature. Shivering is suppressed with sedatives.

Mary Greeley Medical Center purchased hypothermia therapy equipment in May 2011, and staff training was completed in July 2011. The therapy complements the hospital’s interventional cardiac cath lab and 24-hour hospitalist program. “While our volume of patients who would benefit from this is not likely to be high, the potential outcome for these patients is worth our investment,” says Dr. Sherri Clewell, who encouraged the hospital to acquire the equipment. “We have about a 30-minute transport time to Des Moines, and I felt that if we could perform therapeutic hypothermia here as an adjunct to our interventional cardiac cath program, we could potentially improve the outcomes for many cardiac arrest patients. We can get them to the cath lab, open their vessels, and be cooling them at the same time.”

Julie’s story proves the value of the investment. “Her return to her life as she knew it before her cardiac arrest has been amazing. It is an awesome feeling to know that the hard work everyone did developing the protocols months ago, and then all the paramedics, nurses, and physicians who cared for Julie all came together to have such a great outcome,” Clewell says.

Clewell Is a Hospital Hero

Cited for her work in emergency services.

Dr. Sherri Clewell, medical director for the Mary Greeley Medical Center Emergency Department and ambulance service, was named a 2011 Hospital Hero by the Iowa Hospital Association. The award honors “any Iowa hospital employee or physician who has performed a heroic deed or tirelessly given of their time, talent and expertise to improve their organization and the world around them.” Chris Perrin, paramedic supervisor, nominated Clewell for the award. In his nomination, Perrin credited Clewell with helping emergency medical services providers improve care; providing leadership to the development of a new ambulance service in Huxley; and establishing a therapeutic hypothermia program at Mary Greeley Medical Center.

CPR Training At MGMC

CPR for Friends and Family Anytime is a non-certification course offered by Mary Greeley Medical Center. You can take a one-hour introductory course or purchase a take-home kit and learn on your own time. The course costs $35 and includes the CPR Anytime Kit. For more information, call 515-956-2875.

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