I’d seen a 78-year-old in cardiac arrest before.
In fact, I’ve resuscitated thousands, and run countless codes in 30-plus years as an emergency medicine nurse and doctor. I’m trained to take charge, make the most of staffing and equipment capabilities, and know what type of treatment patients have received in the field before they get to the hospital.
None of this describes my experience last November.
The “field” was the Verrazzano-Narrows Bridge, and the prehospital team included me — in the midst of running my first New York City Marathon — and a team of strangers, fellow runners. Our equipment included our hands, voices, and collective expertise.
It wasn’t just my professional background that brought me to this moment; I’d started running 15 years earlier to care for my own health. I’d developed life-threatening postpartum preeclampsia after the birth of my sixth child. This rare type of high blood pressure can occur up to 6 weeks after having a baby, whether or not preeclampsia occurred during pregnancy.
To heal physically and emotionally, I returned to my walking routine. I found myself sprinting one day for 20 or 30 seconds, just to see how it felt. It was a short trip between that first runner’s high and a new desire to just … run. That desire went from my bucket list to reality, and eventually to marathon day 2023 with my daughter.
The start of the race is a celebration with music and cheering from onlookers and volunteers. The excitement didn’t last more than a few minutes, as I noticed something in my peripheral vision. Decades working in the emergency room have left me with an unshakable sense of when something bad happens.
I sprinted to the other side of the bridge. Jumping over the barrier, I saw a runner on his knees, performing CPR on another runner. Other runners were stopping people from trampling the downed man.
I became one of several responders, including an emergency room nurse and emergency medical technician, who’d stopped to help the older man in cardiac arrest. I tore off his runner’s bib and looked at the back, hoping something in his medical history would be listed and could aid resuscitation.
I came to learn that medical tents for the marathon are stationed at the third mile of the race — and we were barely into mile 1. It would take time to get resuscitation equipment. We took turns continuing CPR and pulse checks as the minutes ticked by. I ran a code, such as it was. I asked if there were portable automatic external defibrillators (AEDs). Not yet. We shouted to runners to find out if they had EpiPens we could use. No.
After 7 minutes of CPR, help arrived on a golf cart. Medical aides came with a precious AED that indicated there was enough of an electrical rhythm in his heart to use the device. I knew the protocol: use the AED and restart compressions. Still not knowing whether his heart had restarted, we put him on a stretcher from the golf cart team, and they took him away for further care.
I looked around.
The wave of runners I’d begun the race with had gone, including our impromptu care team.
My thoughts caught up to the moment. My family was following me on the app that tracks runners’ progress — were they worried because I hadn’t moved in 7 minutes? I texted my family.
“CPR on the bridge. I don’t know what to do now.” They did. “Run.”
I was emotional as I restarted the marathon, thinking about this man’s fate. I wondered whether he’d survive or, if he did, whether he’d be impaired after having been down for so long. I wondered how his family might react. I prayed. He looked healthy, I thought. If he doesn’t make it, maybe he was doing something he loved.
I finished the race and learned that this man survived despite an abysmal prognosis. He’d started running around the same time I did, and for similar reasons. He’d been diagnosed with type 2 diabetes and took up running to manage his health. By the time I helped perform CPR on him, it was his 13th New York City Marathon.
Word from his daughter is that he’s already resumed running. His medical team at Staten Island University Hospital North says he suffered no neural damage during this “massive widow-maker heart attack,” though brain cell death typically begins about 6 minutes into cardiac arrest.
“He likely defied the odds in spite of his age because he was in great shape,” a member of his care team said. “He was at the right place at the right time. If he had been at home, it might not have been the same outcome.”
It feels miraculous to have played a role in him beating the odds. Who knows? Maybe we’ll be running alongside each other in next year’s marathon.
Teresa Murray Amato, MD, is vice president of resource management and director of geriatric emergency medicine for Northwell Health in Forest Hills, New York.