You Only Live Twice

On a cold Minnesota morning, Howard Snitzer collapsed on a sidewalk. Ninety-six minutes later, he still didn't have a heartbeat. Here's how he survived.

© 2011 Reader's Digest AssociationWith a population of 1,176 and no traffic light, Goodhue, Minnesota, is a speck of a town, 30 miles from the closest city, Rochester. Luckily for Howard Snitzer, he found it.

The 54-year-old chef moved there late in 2010 to be with his girlfriend, Tammy Ryan, after being laid off from his restaurant job. He stayed busy fixing up their house and trying to shed some of his 220 pounds. With Ryan’s encouragement, he exercised regularly at a gym. She didn’t want him to end up like her late husband, who had died of a heart attack in 2004.

On the afternoon of January 5, 2011, Snitzer was home fresh from a workout. Still in his gym clothes, he made a salad and popped two tuna steaks into a marinade to be grilled later.

Halfway through painting a bathroom, he remembered that the gas grill was out of propane, so he made a run to the grocery store to fill the tank. It was 11 degrees outside, but the errand would take only a minute. He didn’t even bother to pull on a pair of pants over his shorts. He jumped into his green 2001 Toyota Highlander and headed for the store.

Minutes later, he died.

Al and Roy Lodermeier, owners of Roy N Al’s Auto Services in Goodhue, are closing up shop for the day. The brothers are longtime residents and have served for decades as volunteer firefighters. Neighbors are always coming by to shoot the breeze, so they are not surprised when a friend barges into their back room. This time, though, the news brings the brothers up short.

“Someone’s collapsed outside Don’s!”

The brothers rush outside. Across the street, a stranger is stretched out on the sidewalk near the entrance to Don’s Foods, next to the Coke machine. Another friend, Candace Koehn, is bent down trying to rouse him. Two thoughts cross the brothers’ minds. First: Why is this guy wearing gym shorts in freezing weather? Second: This is no mere slip on the ice. The man is not breathing.

Roy races to the fire hall 30 yards up the street to bring the rescue truck, which holds oxygen and a defibrillator. The survival rate for cardiac arrest victims outside a hospital is low — only 5 to 10 percent live. But if ventricular fibrillation (V-fib) has caused the arrest and if good emergency medical help can restore heart rhythm within 30 minutes, the survival rate rises to 30 percent.

Without oxygen, though, the brain begins to die within five minutes. They have to start cardiopulmonary resuscitation. But there’s a catch: Successful CPR treatments rarely, if ever, last longer than 45 minutes. It is 4:57 p.m. What these first responders don’t know is that they have until 5:42 at the latest to stabilize Howard Snitzer and get him to the Mayo Clinic in Rochester, the nearest hospital capable of handling such a serious case.

“We got to get him inside,” Al says to Koehn. He hoists Snitzer up under the armpits while she grabs his cold, bare legs. Together, they frog-step the heavy stranger into Don’s Foods.

*4:59 — 43 minutes left: Goodhue EMT Jeremy Schafer ambles into the store. He has just parked the school bus he drives and is about to buy buns for dinner. “When I walked in, I got a big surprise,” he says. “Right there, in the first aisle, next to the peanut butter, I see Al and Candace working on this guy.” Schafer immediately joins them.

5:00 — 42 minutes left: Roy pulls the truck up in front of the store and rushes inside carrying the oxygen tank and the defibrillator. Most people think cardiac arrest means the heart just stops. But sometimes it means a heart is beating too fast or erratically — that is, fibrillating — thereby preventing the ventricles from pumping blood to the lungs. The only way to save a victim is to stop the fibrillation. Al grabs an Ambu bag, a manual oxygen pump, and places it over Snitzer’s mouth and nose. With oxygen flowing, they start chest compressions to force it into his lungs and, they hope, through the bloodstream and to his brain. They are doing the job Snitzer’s heart can no longer perform.

5:01 — 41 minutes left: Now hooked up to the defibrillator, Snitzer lies vulnerable and inert. For a moment, CPR stops, and the first shock from the defibrillator shakes his body. His heart flutters — but fails to sustain a regular beat, so they resume CPR.

5:02 — 40 minutes left: Sirens are blaring outside — it’s the other Goodhue fire department regulars, soon to be followed by EMTs and paramedics from nearby Zumbrota and Red Wing. They will all be needed. CPR is often too physically exhausting for one person to perform alone for an extended period. The required pace is an unrelenting 100 chest compressions per minute. Each push must be fast, deep, and hard. The responders will each go for two minutes until their hands cramp and their muscles ache, then someone else will jump in. One by one, 23 men and women will take their turn. Snitzer finally encounters a little luck: Many of the first responders are either home or returning home. Had he suffered his heart attack a few hours earlier, they would have been at work.

5:03 — 39 minutes left: Two 911 calls are relayed to flight operations at the Mayo Clinic in Rochester: man fallen, cardiac arrest, CPR in progress. The weather has been bad all day and the helicopter grounded. But conditions have improved enough for a crew to chance it.

5:06 — 36 minutes left: Dave Schaller, a Zumbrota medic, is working on Snitzer. “Doing CPR is a very personal, intimate thing,” Schaller explains. “You are right there over a victim, your hands over his heart, your face over his. It’s not easy. Old people are soft. Children are fragile. Sometimes you break ribs in the process. I’ve seen medics cry while working.”

Snitzer’s is an unusual case. “He was a big guy, big chest,” Schaller recalls. “I felt resistance, like pushing on bagpipes or a cushion. But as much as we worked, his heart didn’t come back into rhythm.”

5:20 — 22 minutes left: In Rochester, flight nurse Mary Svoboda climbs into the helicopter Mayo One and takes a seat behind paramedic Bruce Goodman. The flight to Goodhue is 30 miles — 14 minutes — away. Once airborne, the two review the case, concluding that they “will probably not have to transport.” That is, they will not have a living patient to take back.

5:23 — 19 minutes left: Paramedic Tony Korder, from Red Wing, is starving. It is getting late, and he hasn’t eaten in a while. But he puts thoughts of dinner aside and keeps performing CPR until he tires. “Switch me!” he shouts. Another volunteer moves in. “I got it,” he says as he seamlessly replaces Korder. Another man gets ready to spell him. “I’m next,” he says quietly. Without being told, three more line up behind him. Dave Schaller calls up an app on his iPhone that runs a metronome. He sets it for 100 beats per minute to keep the CPR up to speed.

5:28 — 14 minutes left: Twenty minutes earlier, Gary Albers, a Zumbrota EMT and county maintenance worker, was home preparing dinner for his two kids and quizzing them on their day. “‘What did you learn?’ I asked them. ‘Nuthin,’ they said.” Now he is waiting his turn to give Howard Snitzer CPR. In his experience, no one has ever survived in this condition. But that doesn’t stop him from giving Snitzer CPR a total of five times. Whatever the outcome, when he gets home, he won’t tell his family about this case. He and the others consider it a violation of the patient’s privacy.

5:32 — 10 minutes left: The grocery store is crowded with EMTs and paramedics as well as curious employees. Since the crew from Mayo will arrive soon, Snitzer is placed on a gurney and wheeled to the more spacious firehouse.

5:34 — 8 minutes left: The chopper touches down in the firehouse parking lot, and the Mayo team takes charge. The first responders have done all the right things: They started CPR only minutes after Snitzer collapsed. They shocked him four times. They used an Ambu bag to provide oxygen — Al Lodermeier is still at it. And the patient is expelling CO2, which means the CPR is working and oxygen is circulating. All good. But they couldn’t insert an air tube into Snitzer’s throat, because his teeth were clenched tight. Svoboda needs to get his jaw loose so Goodman can insert the device. Goodman instructs Schaller to use an electric drill with a needle at its tip to penetrate Snitzer’s shinbone. An IV line is then inserted into the vein-rich tibia to provide a direct route for sedatives and other medications. Some in the room gather around, watching intently and quietly, careful not to interfere.

When the sedatives take effect and Snitzer’s jaw relaxes, Goodman has the difficult task of fitting a Combitube down the esophagus and into Snitzer’s airway. Once the tubes are inserted, Goodman turns on the oxygen.

5:36 — 6 minutes left: With Snitzer now getting a rich supply of oxygen, Svoboda administers epinephrine followed by amiodarone, a drug that combats rapid, irregular heartbeat. She also gives him another jolt from the defibrillator.

5:37 — 5 minutes left: Snitzer’s heart jumps to rhythmic life. Then, like a car engine flooded with gas, it sputters, hesitates, and stops. Snitzer can’t be taken to Mayo until his heart is beating on its own — there isn’t enough room in the chopper to perform CPR. So the volunteers keep queuing up four at a time to wait their turn. One of them points to Snitzer’s gym attire and deadpans, “That’s what exercise will do to you.”

5:40 — 2 minutes left: Goodman — well aware of the 45-minute CPR limit — calls Mayo for help. An ER physician advises him to give the patient another dose of amiodarone, then shock him once more. If that doesn’t work, he tells Goodman, stop treatment.

5:42: The team gives Snitzer one more dose of amiodarone and another shock to the heart. Once more, he lies still, his heart unable to beat without help.

The score of volunteers say little. The younger volunteers, for whom all of this is still new, hang back, nervously shuffling around, massaging the cramps out of their hands — whatever they can do to keep themselves occupied. One man is visibly upset. A close relative has just died of a heart attack, and this is all too soon for him.

The 5:42 deadline has come and gone. Kneeling by Snitzer’s head, Goodman asks aloud, “Is anyone else uncomfortable walking away from this?” Everyone says yes. Goodman picks up the phone again. There is one last person to reach out to.

5:55 — 13 minutes over: Dr. Roger White, a cardiac arrest specialist at Mayo, is home entertaining a friend when his phone rings. “We can’t get this guy out of V-fib,” Goodman tells him. White listens as Goodman explains the case. He has seen hundreds of similar cases. Most ended badly — in death or in brain damage.

“It sounds like a clot in the LAD [left anterior descending artery],” he says. The clot has stopped blood from being expelled from the left ventricle and has sent the heart into fibrillation. Because of the sudden, massive heart attacks that ensue, LADs are known as widow makers. They’ve brought grief to the wives of novelist John Gregory Dunne and newsman Tim Russert.

An awful situation suddenly gets worse. Such a clot can be removed only in an operating room. But Snitzer can’t be transported until his heart is beating on its own. So they keep working on him.

“So often we do CPR for the benefit of the family who are surrounding the victim because we know the chances are slim that he or she will survive,” says Sonia Stehr, a Zumbrota EMT who works for IBM. “But this man had no one there, and no one knew who he was. We were it, and though we were pessimistic about his chances, no one wanted to give up as long as he showed some signs of responding.”

6:27 — 45 minutes over: Goodman calls White for the fourth time: “He’s still in V-fib. We can’t stop it.”

“Then give him a double dose of amiodarone,” White says. “Continue CPR, and give him one more shock.”

6:31 — 49 minutes over: Svoboda gives the injection. Hands cease the relentless rhythm of chest compression. Then the team from Mayo shock Snitzer for the 12th and final time.

Nothing. Resigned to the inevitable, Goodman asks the assembled EMTs and paramedics, “Is there anything more we can do for this guy?” The question is standard medical protocol, a step on the way to stopping treatment and pronouncing the patient dead. The firehouse is silent.

6:32 — 50 minutes over: Men and women pack up equipment. Snitzer lies on the backboard, as lifeless as when they had begun their labors. His body is surrounded by spent IV tubes, packaging, and needles. Blood from his IVs has pooled on the floor. Seconds tick by in silence.

6:33 — 51 minutes over: The heart monitor beeps. It beeps again, then keeps on beeping. Snitzer’s heart has surged to life, beating on its own.

“Let’s fly, let’s go!” shouts Goodman. Snitzer is quickly wheeled onto Mayo One. As the helicopter lifts off amid muted sighs of relief, one volunteer shakes his head: “My God, I don’t believe he’s still hanging in there.”

At Mayo, White’s diagnosis proves correct. The patient’s heart has an obstruction in the left anterior descending artery, and the clot is pulled.

Five days later, Goodman checks the hospital computer to see how his former patient has fared. To his surprise, Snitzer was released from intensive care and into a general ward. But Goodman has no illusions. Snitzer, he suspects, is in a vegetative state. Curious, he visits Snitzer’s unit and finds the bed empty. I was wrong, he thinks. He’s dead.

Then he hears voices across a hallway. Three middle-aged men are sitting in the lounge area chatting. One of them is in pajamas. It’s Snitzer — coherent and alert. Goodman is astounded.

“I owe you guys,” says a beaming Snitzer.

Goodman deflects the compliments. All those volunteers, he says, “they saved you.”

“Why did you do it? Why did you keep working on me?”

“I don’t really know.”

According to the Mayo Clinic, Howard Snitzer survived without a pulse “in an out-of-hospital arrest with a good outcome” longer than anyone — anywhere — ever has. Since his ordeal, he’s back in Goodhue and back to normal. Better, really, thanks to a quadruple bypass. He even reunited with his rescuers. Dr. Roger White was there. White took one look at a grinning Snitzer and wept.

Snitzer knows he can never repay those men and women. So the chef is doing the next best thing. “I’m going to feed you until you beg me to stop,” he told them. In February, he baked a heart-fibrillating triple-chocolate mousse torte and a chocolate-chip macaroon pie for his rescuers. In May, he made mustard-crusted pork loin and sweet potato dauphinoise. In August, smoked spare ribs, jicama slaw, and “drunken beans,” pinto beans simmered in beer.

“I love these guys,” he says. “And there’s a rumor that firefighters like beer.”

* Some times are approximate.

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