CODE BLUE:  A DOCTOR’S VIEW OF HIS OWN NEAR DEATH EXPERIENCE

SRCarson, M.D.

© 2013 S.R.Carson

FORWARD

Reading Code Blue:  A Doctor’s View of His Own Near Death Experience undeniably forced me to consider my own priorities and relationship to Christ.  Any reader of this medical doctor’s own story will make the same assessments.

Because I am a pastor, I have the opportunity to talk with people about such matters of life and death on a regular basis and I work with people in all stages of Christian maturity.  Some of these people only know that Jesus died for them and they really need Him and love Him.  Clearly, their faith is new and exciting.  It’s fun to work with people who at the drop of a hat would give up all for their new friend Jesus.  Others have walked with the Master longer than I have been alive.  These people are so committed that my faith is dwarfed by their sincere and proven trust that only comes from a lifetime of walking with Christ.

Most others however, are somewhere in between.

These “tweeners” attend church, give some money and time, have a belief system and gladly call themselves Christians.  Yet, “giving all” can be intimidating, even a bit fanatical, that is, until a dramatic life – changing experience causes them to rethink their faith and relationship to God.

Either they are blessed beyond their wildest dreams with circumstances or wealth or their world has come crashing down in a dramatic fashion.  For example, the loss of a loved one, unemployment, a relationship breakup, or financial ruin can create a new vision.  In other words, when something drastic does transpire, it develops a paradigm shift when it comes to faith.

When this occurs, I have seen people either become bitter or better.  Volumes have been written and vast amounts of energy and research have been expended to try to discover why some react in a growth-oriented matter while others find themselves in a negative downward spiral.

This true story is not a theory.  It is a testimony about a man who made a significant choice about his faith.  Forget the speculations of why.  In a desperate hour, he heard from God, “All that matters is love.”

Dr. Carson has responded in a positive, productive way.  His colleagues, friends and even his foes hear and see it in his voice and actions.  He is not in between and there is no fence for him to sit on.  All that matters is love.

Eric Batteiger

Senior Pastor, Sunnyside Christian Church, Colorado Springs, Colorado

As a physician, I’ve helped save quite a few lives in my career and that feeling is gratifying, to say the least.  It’s what medicine is all about; a calling that we physicians accept without expectation of accolades or awards.  However, there’s one life that I absolutely couldn’t save no matter what: My own.  Instead of commanding the emergency with calm confidence, thinking of multiple treatment options and potential complications while acting with speed and technical skill, I found myself helpless, completely at the mercy of my colleagues.

Prior to this event, I was in my work zone at the hospital, concentrating on accomplishing my surgeries and making sure my patients were receiving the best medical care possible. Luckily, I’m surrounded by colleagues and staff who make me a more effective physician. I respect and admire their skills, but unfortunately, I don’t make that clear to them as much as I should or would like to.  Occasionally I tell a few anecdotes or humorous experiences I have experienced in the past, coupled with some “gallows” humor in times of stress to put the staff at ease.  The bottom line is that the nurses, respiratory therapists and other ancillary staff are not my family and they need respectful treatment as colleagues. So since they’re not family, I kept a solid wall between their personal life and mine, and that’s the way I knew it should remain.  But I was wrong in some ways. I was oblivious of this hospital family concept and my hectic world was about to shatter, potentially dragging with it the emotions of my skilled colleagues.

The day before, I’d felt an unusual sensation in my chest.  It wasn’t the classic, crushing substernal pain that is often described with a heart attack – also known as an MI, but instead, a band-like tightness coinciding with mild trouble breathing.  I’m an active swimmer and former long distance runner and thus no stranger to the feeling of a chest tightness similar to exercise–induced asthma.  This felt similar and not particularly alarming, so I figured maybe it was stress, although when had stress stopped me in the past?  Maybe it was my acid reflux acting up again from too much coffee during morning rounds.  But I knew my patients and colleagues depended on me to complete my duties that day for critically ill patients.  I had no time to be sick and a personality that wouldn’t let me drop the ball.  That stubbornness was nearly fatal.

I lay down in the on – call room for about 30 minutes and it passed, allowing me to resume my hectic hospital schedule without a hitch.  I told myself that going downstairs to the busy ER for an ECG, cardiac enzymes, or even an evaluation for a blood clot to the lung arteries would be a waste of time with such brief symptoms. At the same time, I knew I had patient care responsibilities that I thought I couldn’t hand off. After all, I was a healthy man without obvious cardiovascular risks.  While my symptoms didn’t appear to be specific for any disease process, several came to mind: coronary artery disease with atypical angina, pulmonary embolus or blood clot, and of course acid reflux. I hadn’t made any long plane trips to produce clots and I had no family history of cardiovascular disease.  Frankly, although I was relieved that the chest tightness and strange numbness had passed, there remained within me a lingering foreboding that something wasn’t quite right.

The next day I found myself totally immersed in procedures, ignoring everything around me except the patient treatment details I’d pounded into my brain over the years.  The events of the previous day completely deleted themselves from my memory.  After completing morning rounds successfully, I decided to forego lunch so that I could squeeze in a tracheotomy procedure at noon to get ahead on the day. The family wanted the procedure as soon as possible for their son.  It was a little bit stressful, as many can be, but it was successful. Afterward, the nurses told me they saw some perspiration on my forehead, and a little bit of a tremor, which they had never seen me display before.  Shrugging that off, I walked over to the nearby cardiac intensive care unit so that I could dictate the procedure report on a patient there.  I was in the middle of dictating, when a wave of nausea enveloped me, accompanied by a cold blanket of numbness across my chest and arms.

I winced in pain, and apparently this caught the watchful eye of my first angel, an ICU nurse, Bonnie, who descended upon me immediately.

“Dr. Carson, you’re pale; is everything okay?”

Her words immediately drew the attention of several other experienced ICU nurses.  I tried to respond with composure and dignity. That’s when I realized I wasn’t able to smile at her anymore. “No Bonnie, something isn’t right. Maybe my blood sugar is a little low from not eating all day.  Would you check my um, sugar please?”

The blood sugar was normal at 106, much to my chagrin, because hypoglycemia would have been an easy fix.

“Dr Carson, how bout we take you into an empty patient room and hook you up to a heart monitor and pulse oximetry?” The second nurse, Rita, suggested.

After an initial weak hesitation, I said, “Sure,” I said, “why not?”  It was clear that whatever my answer they were taking me anyway.

Several experienced nurses quickly escorted me to the empty cardiac care unit room, sat me in the only chair in the room and had me hooked up to the cardiac monitor and pulse oximetry within seconds.

“Are you having chest pain, Dr. Carson?”

My eyes met hers, and I nodded yes. Seeing the fear in her eyes, I looked up above my head at the cardiac monitor and all of us in the room immediately knew the diagnosis and calmly described my diagnosis to the nurses attending me. I was having an acute inferior Myocardial Infarction or heart attack. Even now, I find it difficult to comprehend how calmly I accepted this potentially lethal diagnosis without anxiety or panic. I picked up the hospital cell phone in my scrub shirt pocket and called my nurse practitioner, Claudia, who was nearby somewhere in the ICU.

Trying to appear calm, I said, “Claudia, I’m having an MI. “Call the cardiologist on call and get them here as soon as you can.”  Turns out, I was so calm she thought I said, “Claudia, I’m examining someone with an MI, get cardiology here.”  From then on, pandemonium was the best descriptor of the scene.  Claudia ran to the room, expecting a patient only to find the nurses swarming around me, trying to hold me up to keep me from falling on my face while placing an IV.  It was Dr. Carson who was in the midst of an MI! She ran to my aid, picked up her phone and called my partner, Dr. Rick Rolland who was in the office across the street.

“Dr. Carson is having an MI!  Get here now!”

She hung up before she heard him reply, “He doesn’t need my help; he knows what to do with MI patients!” And before she could explain to him that it was his partner having the MI, not a patient, I remember telling the people in the room that I was going to go down quickly.  Apparently at that moment, Claudia caught my fall, called an emergency “code blue” then simultaneously threw her phone across the room to the ICU administrative clerk and screamed, “Call Dr. Rollands and Cardiology and get them here now!”  Unfortunately, the flying phone hit a respiratory therapist in the head, causing a concussion, but she ignored the pain and continued to rush to treat me.

“I’m going down people,” I said, “I suggest we get a bed in here before I hit the floor.”

“No way we’re letting you hit the floor Dr. Carson!” said Claudia.

I remember the room spinning around and almost floating towards the floor but my brain remained engaged, at least so I thought.  Admittedly, I don’t remember the bed, or anyone putting IV’s in me or giving me drugs.

When Dr. Rollands finally got the second call and realized it was his partner in trouble he said, “Shit” then threw the phone. I was told later that all five of my partners dropped what they were doing immediately, tossed their patient charts, and ran across the street to the hospital.  In fact, one partner called cardiology immediately. “Carson’s having an MI now, Len.  Get over there; I think we may lose him.”

“I’m starting a case soon, but I’m just down the hall…”

“Damn it, drop what you’re doing, we need you, Len.”

Dr. Leonard was in full sprint down the hall to the ICU and was there within one minute of the call.  The next image that I remember is a surgeon colleague of mine, looking me in the eyes while I lay in bed, squirming in accelerating pain, legs kicking back and forth, making it difficult for the nurses to place the IV’s.

“Carson, should I give you some Atropine?”

“No,” I replied, “I would wait until I’m in shock or my blood pressure tanks.”

I heard the order for one amp of atropine.  Apparently, he didn’t want to tell me that my heart rate was between 30 and 40 with some long pauses and my blood pressure topped out at 50 systolic. Most likely, he wanted me to shut up so they could do the work they were trained to do.

“I’m sure I’m dry, so you could push some fluids, then if you need to, some dopamine.”

It was unclear if anyone was listening to my analysis of my own dying process at that point, but from what I was told later, within minutes of diagnosing my own MI, the room filled with 22 people, all concentrating on saving their colleague, partner and friend.  Despite being in shock from a failing heart, I remember many of the sounds and voices during my cardiac resuscitation.  I thought I was still conscious and still in this world because my thoughts were so clear, yet maybe I wasn’t conscious anymore, as we understand it.  My arms and legs now felt separated from my body, but the chest pain knifed through from the sternum to my spine, causing me to writhe like a struggling snake uncontrollably on the bed.  My breathing accelerated to the point that I couldn’t keep up with my dire need for precious oxygen.  What I couldn’t see was the stress on the faces of the nursing staff, respiratory therapists, doctors, and other staff who realized that there was a definite chance they were going to lose their colleague.  One of the respiratory therapists positioned himself directly above me, one hand on top of the other above my chest, preparing to begin CPR.  The other senior respiratory therapist was swiftly adjusting my oxygen therapy.

While the exact sequence of the remaining events of my resuscitation aren’t clear, I learned later that it was a terrifying situation for my medical colleagues to see and participate in.  Parts of this description are from my recollections, and other parts are from what others have told me afterwards.  Without question though, the voices and faces of my friends and colleagues are etched permanently in my brain.

“Pulse ox is 70%, I’m switching to venti – mask.”

I clearly knew what that meant. The normal pulse oximetry machine measurement of blood oxygen is 90% or greater.  I was in respiratory failure too; they were having trouble oxygenating me. I knew what the next step was for the respiratory therapists. And sure enough, the smell of the oxygen mask was kinda like chocolate, similar to many of my patient’s descriptions.

“Sats dropping into the 60’s, put him on 100% non – rebreather!”  The senior respiratory therapist looked me in the eyes. “Dr. Carson,” she said, in a calming way, “everything will be okay.”  I wasn’t convinced of that, but I appreciated her kindness and I remember reaching out to take her hand, as well as the arms of others around me while I struggled.

Were my lungs filling with fluid from my failing heart?  Was my right heart failing and causing not only shock but left heart failure too?  Then I heard the loud, but calm voice of the hospital public address system.  “Code Blue, Room 3775, ICU.”  Then repeated four times.  “Code Blue, Room 3775, ICU.  I’d rushed to thousands of code blues before, but this time I knew the code was for me and it signaled my imminent death.  I’ll never forget the feeling of peace while I was floating around the room, relaxed, looking at the faces of my skilled but anxious colleagues.  I searched for answers in their eyes, one by one, but it seemed they ignored my curiosity and hid their terror quite well.

While this feeling of peace and acceptance of death may have been partly due to the morphine they were pushing into my collapsing veins, I’d experienced the floating sensation even before the IV’s were inserted.  I knew I needed a tube immediately inserted into my trachea so a machine could ventilate my failing lungs due to cardiovascular collapse. I had done this for patients in respiratory failure countless times, but now, I was about to experience it myself.  I accepted it as part of the code.  I remained in a peaceful place, floating around, again, and the faces I saw for the most part were not frantic, but skilled professionals who were trying to hide their fear.  Not only was I a close colleague, but I learned later that the staff considered me ‘family’.  How is family able to separate personal feelings for me from the near death experience happening in front of their eyes?

While I floated, I made eye contact with Dr. Leonard, and said, “Rick, I’ll sign the consent for the catheterization.”  At least I thought I said that to him, or perhaps it was simply thought transfer or telepathy.  I remember him saying, “Carson, we need to intubate you.”

I thought I said, “I know, but be aware that I have a sensitive gag reflex.” It was just a matter of fact statement stemming from my previous experience putting tubes into partially - awake patient’s windpipes.  Or maybe it was just my subconscious communication with him, but I knew I had no fear at that point, just acceptance of possible death and peace. Interestingly, not all the verbal communication I thought I was having with the staff occurred, just pieces of it, apparently.  I was in and out of consciousness, but until I was sedated and paralyzed, I clearly was aware of everything.  I heard my partner, Rick, behind me, at the head of the bed, barking out orders in that voice I knew so well.

“People, he’s just a patient, you’ve done this a thousand times before, so just forget who he is and do your jobs!”

Then Dr. Leonard noticed there were too many people in the room. “Anyone without a specific job needs to leave the room now!”

I learned later that hardly anyone left.

“Give me 100mg of Succinylcholine and 30mg of Etomidate stat!” said Rick.

When I heard that, I knew those drugs were necessary to sedate and paralyze me for intubation and Rick inserted the tube into my trachea perfectly.  I was told later that my last words before intubation were “Oh shit!” I was told later that this exclamation definitely was heard.

The initial resuscitation lasted only minutes, but according to the staff I interviewed later, it felt like a century.  Multiple people sprinted down the hallway with me, following Dr. Leonard to the cardiac catheterization lab whose staff was preparing for the emergency.

My heart proved perilously close to stopping. The staff prepared for CPR at any moment. Dr. Leonard prepped and entered my femoral artery with lightening speed while my blood pressure was hovering close to 50.  The catheterization lab overflowed with people: My cardiac surgeon colleagues, multiple cardiology consultants, ICU nurses and respiratory therapists.  How Dr. Leonard was able to perform this miracle under pressure is a thing of beauty that will be discussed for years to come.

He quickly found two severe lesions in my right coronary artery, with a complete occlusion distally with a long clot.  The cardiologists and the cardiovascular surgeon debated openly about what the next step should be - emergency life–saving open-heart surgery or putting in stents and removing the clot.  Dr Leonard confidently pulled out the clot within a few minutes and placed 2 stents perfectly in my right coronary artery. Simultaneously I regained a decent blood pressure associated with a rising pulse rate.

It took no more than 19 minutes from my chest pain symptoms, shock and near death to a normal blood pressure and pulse.  There are those who say this must be a new world record, and therefore the reason I not only survived, but also suffered no significant cardiac muscle damage.  Dr. Leonard mentioned that this fast time doesn’t count in the record books because there was no actual “hitting the ER door” time to record.  I was already in the hospital, in the Cardiac Intensive Care Unit at the time my symptoms occurred. It doesn’t matter. I still give Dr. Leonard and all the hospital staff involved credit for a new world record.  They are all my heroes and angels.

After eight hours of sedation while recovering in the ICU on the ventilator machine, the breathing tube was removed from my trachea, and I was removed from the ventilator successfully, without incident or discomfort, much to the credit of the respiratory therapists, nurses and skillful instructions on weaning off medications by my partner, Dr. Rolland.  Surprisingly, at least for me, I was told that despite having a tube in my trachea for eight hours, I immediately opened my eyes, looked at my good friend and the nurse on duty that night and said, “I now understand that nothing else matters in life but love.”

I find that fascinating. It didn’t sound like me at all. You’d think after nine hours on the life support machine I would say something like, “I’m thirsty, and I need something for my sore throat.”  Or, “Where am I and what happened?”  It seemed to me that I understood what happened, that all was well, and that all that mattered in life was love, almost as if a spirit gently placed the words in my mouth.

This has intense meaning for me now while I continue to grapple with why all this happened, and why I was saved, unlike so many others who don’t survive with this type of lesion.

I stayed in the ICU for several days and the nursing staff guarded my security and privacy like bulldogs.  Multiple well-intentioned hospital staff apparently attempted to come to visit me to wish me well, and nearly all were turned down except for close friends and select staff.  Dr. Leonard wanted me to have privacy and calm after this major event, and that is exactly what I received. They even gave me a fake name on the patient board in the nurses’ station to avoid curious eyes:  Erika Johnson.  In fact, I felt so good that boredom set in, and the nurses had to be careful that I didn’t take off through the halls of the hospital.  The  second day, I relished the opportunity to sit out on the deck outside the ICU, wrapped in blankets given to me by the respiratory therapist and nurses, enjoying the cool air, and my new life in this world. I walked through the ICU, thanking the staff while wearing my heart monitor, walking slowly but devouring every morsel of life I could.  In fact, I even had a shower while wearing my cardiac telemetry, with an angel nurse standing outside the shower room ready for any adverse event, yet kindly allowing me to enjoy the shower and feeling of cleanliness.

Turns out the only casualty during my near death experience was my angelic respiratory therapist who suffered a hit to the head by the flying phone, yet continued as if nothing happened and thankfully, she didn’t require medical treatment except for Tylenol for a headache.

Several weeks later after I recovered at home and before I started cardiac rehabilitation, I arranged to meet with all the staff that had cared for me.  Approximately ten individuals came to the meeting room, all sitting around a semi – circular table with me in the middle.  It wasn’t clear to me what I would say, but I started by thanking each one of them by name for saving my life.  The response initially, by every individual was, “It’s our job, Dr. Carson.”  But later, when I asked each to share any thoughts about that day for the group, what I learned gave me a sense of love and belonging that I believe few can ever experience. Several broke down in tears during their stories, but it became clear that they considered me not only as Dr. Carson who works with them on a daily basis, but also as a family member whom they cherished.  Several actually blamed themselves for not seeing early warning signs on my face or from my actions earlier in the day, and I quickly told them that was not the case.  No one was to blame; it was an act of God who introduced me, albeit in a painful way, to the angels whom I saw daily with my eyes but whose importance I was too blind to recognize.

Without question, if I had suffered this heart attack in the parking garage, at home, or even on another hospital ward or restroom, I would have most likely died, or at best, suffered irreversible disability.  Because I suffered this heart attack in the Cardiac Intensive Care Unit during patient care rounding, I survived without complications and I am back to work now, doing what I love with the colleagues that brought me back from death.

Yet it wasn’t just the location that saved me.  It was the perfection of the process - a perfect combination of individual skills by a large group of professionals I now consider not only colleagues, but also family. Yes, I was wrong, I do have a hospital family. Clearly, if one thing went wrong during my resuscitation, it would have gone horribly wrong for me.  Nothing went awry.  Everything was perfect, efficient and speedy.  Within my immediate vicinity were my sharp–eyed nurse angels, who immediately perceived that I was pale and in discomfort, though stubbornly trying to hide it.  It’s obvious that all of the staff, nurses, respiratory therapists, physicians, my partners and ancillary personnel acted with world-class professionalism, and I am lucky to have had those heroes in my hospital to save my life. And of course, Dr. Leonard probably performed the fastest interventional cardiac catheterization and stents ever done, and damn, he did it on little old me.  And for that, I’m sure he’s now a legend in this city, although he is too modest to admit it.

I experienced what is called a “NDE” - near death experience. Although I didn’t experience the beckoning of the white tunnel that is often described by others, I did experience a floating experience, and I’m pretty sure it was my spirit.  I was at peace, scanning the process happening below me and observing the expressions on my colleagues’ faces.  I felt I was communicating with some of the people next to my bed, but later the nurses told that it would have been physically impossible for me to see them from my position, lying in bed.  So interpret that the way you wish, but I know my soul was briefly in another dimension.

I accept what has happened, although I don’t necessarily understand it, and my experience has changed my life.  Although I still consider myself a strong man with a type A personality, I know it’s not a weakness to talk about love.  In fact, nothing else matters in life but love.  Nothing at all.  That love could be for family, kids, wife, friends, colleagues or even pets. It is a non – judgmental love that never ends, a love that searches for ways to give, expecting nothing in return.  By all scientific opinions, I should have died, but apparently, God didn’t want me to leave this earth yet.  I’ve tried to interpret this and integrate it into both practical and spiritual terms, and what I’ve determined isn’t complete yet.  First, there is the practical realization that I was in a perfect place in the world to have my almost certainly fatal heart attack.  Second, is that I was surrounded by highly professional medical heroes.  Third, is that I finally learned something that nurses have known for a long time.  Always comfort a critically ill patient, no matter whether you believe he or she is conscious or not; talk as if you know the patient hears what you are saying. I certainly did.

Death’s grip started with excruciating pain, but then, eventually faded into peaceful bliss.  I didn’t have time to say goodbye because death would not wait for my wishes.  I wasn’t ready, but it didn’t matter; it was happening no matter what.  Death came to me, ready or not.  I touched him and felt the terrible burn, but at the same time, enjoyed the blissful wave of peace within my soul.  I heard the words around me, uttered by people I knew and worked with, the words carrying a struggle between life and death that few people will ever hear, understand, or if they did, survive to remember them.  But I was filled with calm.

Finally, on a deeper, more spiritual level, I believe God taught me a lesson about life and gave me a second chance to prove that I was still of value on this beautiful earth. God chose me to have my MI in an absolute perfect place so that he could guide the hands of my angels and heroes to save my life.  I’m sure these people now understand how blessed they are with these skills and feel even more confident to handle any stressful situation thrown at them in the future.

How lucky I am to enjoy life again!  When I awoke and grabbed the breath of life back into my lungs again, the love of others overcame me.  Once again, I would be able to walk through the pine forest after a fresh rain, listen to the waterfall crash onto the rocks below and wonder at the beauty and dignity of the bald eagle soaring quietly above.  I would once again feel the warm lips of a woman on mine.  Yes, God decided to send heroic angels to save me.  There is no other explanation.  In my profession, I have been lucky to have saved some lives over the years, but I understand that those skills are only possible through the Grace of God.  Thank you God.

Over the years, I listened to the words of the pastors in church, about the love of God and the grace of God and that is all that matters.  But they were just words that sounded nice and pretty but didn’t have real meaning to me until now.  Without question, they mean everything to me in my new life.  Those words I now understand to the point that they are the food that I eat and the breath that keeps my cells alive.  It took an actual near death experience for me to realize that I was blind for all these years, almost ignoring the truth that was previously placed gently before me.

Unquestionably, I carry a certain peace within me now that I find difficult to define, and I believe people notice the change in me. In fact, one nurse who works on a different floor than the Cardiac Critical Care Unit, has started to call me “Mr. Happy Pants.”  Puzzled with this phrase, I asked her, “Why do you call me that?”

“Dr. Carson, you’re Mr. Happy Pants because you’re always smiling even though you’re exhausted from on call and all the stresses around you.  Seems things don’t bother you anymore.  Wish I could feel that way too.”

I laughed and said, “Well I don’t recommend you go through what I did though, to feel the happiness.”

It’s a feeling of calmness that erects a firewall against the stresses in life that we can’t change.  I don’t fear death because I have looked it in the eye, tasted it and defeated it with the help of a large group of unsung heroes and angels guided by the hands of God. Interestingly, although I was fully aware of my imminent death, and the resuscitation process unfolding around me, I felt nothing but peace. I am lucky to have life again, and am thankful for the opportunity to contribute again.

Perhaps someday I will be able to comprehend why God chose me as one of the rare individuals to survive an event that kills almost 90% of its victims.  However, in the pure joy of the intervening moments, I will always remember that I am lucky to be alive to continue full time in my chosen profession and to enjoy the gift of life and cherish the blessings of love God has shown me, while realizing it is I who must return the love with a happy heart.

Nothing else matters in life but love.  I got it.  I feel it.  I breathe it.