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Hospital stopover smoothes trucker’s road

By Dave Rogers | Published Wednesday, February 1, 2012

It was mid-October, a little more than three months ago, and for James Simpson, it was good to be alive.

Then suddenly, in the span of a couple of hours, the Aurora truck driver was lucky to be alive.

After another week spent steering a trailer full of cargo up and down the nation’s highways and byways, Simpson, 48, had just made it back to town and the family he loves. He was attending church with his wife, Judy, when he had a heart attack.

“It was just crazy,” he recalled. “It was a burning sensation going through my arm up my chest. I thought it was heartburn. After church, I felt so bad, I didn’t talk to anybody and went straight home.

“I don’t even remember going home, to tell you the truth. When I got home, I wanted to lay down for a while. I had to get right back up because I couldn’t breathe.”

Simpson, who weighs 185 pounds, was having the worst kind of heart attack, one heart health professionals call a “STEMI.”

That stands for ST segment elevated myocardial infarction.

A myocardial infarction (often called an MI) is a heart attack, which occurs when a coronary artery becomes at least partially blocked by a blood clot, causing some of the heart muscle being supplied by the artery to become infarcted, which is medical speak for die.

There are two types of heart attacks, non-STEMI and STEMI, with STEMI being the worst.

In a STEMI, the coronary artery is completely blocked.

Not surprisingly, getting help in a hurry is important. Both the short-term and the long-term consequences of an MI are largely determined by how much of the heart muscle dies. If treatment is given within three or four hours, much of the permanent muscle damage can be avoided.

But if treatment is delayed beyond five or six hours, the amount of heart muscle that can be saved drops significantly. After about 12 hours, the damage is usually irreversible.

Simpson nearly blew it.

First, by not recognizing that his lifestyle of greasy truck-stop food, long hours in the cab of his truck and little exercise was making him a candidate for a heart attack.

Second, by not recognizing the signs. The classic symptom of an MI is an intense pain in the chest, often radiating to the jaw or left arm.

And finally, by not calling 911.

Simpson had his wife drive him the 13 miles to Decatur and the hospital emergency room. There, he waited his turn to be seen.

“He’s a good ‘What not to do’ example,” said Casey Rauschuber, coordinator of the cardiac care unit at Wise Regional Health System.

“You still get treated, but it’s a delay.”

In Wise County, calling 911 is important.

That’s because the heart-attack protocol at Wise Regional allows the paramedics and emergency medical technicians with Wise County EMS to make the diagnosis of a STEMI heart attack.

That, in turn, alerts the hospital and makes sure that a team of heart specialists is waiting to greet the patient when he arrives via ambulance.

“EMS will fax us an EKG (electrocardiogram) when they do it, and they call it (a STEMI) from the field,” Rauschuber said. “Typically, by the time they (the patient and ambulance crew) get here, everybody we need is here.”

Simpson complained of chest pains when it was his turn.

The ER staff recognized what was happening and started the steps to save the truck driver’s life.

“I usually don’t go to the hospital for anything, but that night, if I didn’t go, I’d have been dead,” he said. “To me, that hospital’s top dog.”

A triage nurse is the first to see patients in the ER.

“When they roll in the door (to the treatment area) with chest pains, the first person who greets them is the tech that does the EKG,” Rauschuber said. “The results will be looked at by the triage nurse, and if they see ST elevation, they hand it to the ER physician. He calls the STEMI.

“They have a phone that alerts the interventional cardiologist on call for STEMI, and it alerts the cath lab (cardiac catheterization lab) team. From there, the cath lab and the on-call cardiologist will call back.”

In the meantime, the patient is prepped.

“The doctor informs him he’s having a heart attack. They go over consent forms. They will draw labs (blood samples) and do a chest X-ray,” Rauschuber said.

“Once he’s in the cath lab on the table, the physician will access the heart. He’ll go through an artery in the groin. He’ll take a look and deploy whatever stent device he needs to go with.”

A stent used in angioplasty works like a catheter in that it’s a tube placed inside a vessel. Made of wire mesh or plastic, a stent may include a balloon catheter that is used to push the clot outward to reopen blood flow. The balloon is deflated and removed but not the stent.

Upon completion of the procedure, the patient is transferred to the cardiac care unit, which is essentially an intensive care unit specially for heart patients.

“They’ll stay in the cardiac care unit for at least 48 hours,” Rauschuber said, “and if there are no irregular heart rhythms, they can go home.”

Simpson returned to his family, which includes two teenage boys at home, and was back driving his truck in just two weeks.

“People told me not to do it so soon, but I’ve got to. I’ve got to pay my bills,” he said. “But I don’t eat at truck stops now. They gave me a diet to live by, and I’m doing my darnedest to live by that. I stop by Walmart and get sandwich stuff and meals I can fix in the microwave.”

A fellow who had “never been sick a day in my life” before his heart attack, Simpson said he never was a big eater but isn’t eating as much as he used to since his scare.

“I’m just grateful for all the hospital did for me, that I didn’t leave my wife and kids,” he said. “That’s the thing I was worrying about: ‘Who would take care of my wife and kids?’

“If it wasn’t for my family’s support and the hospital that night, the doctors’ and nurses’ support, I’d have been dead.”

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