The first time I met William, it was in an emergency, and he was the center of it.

The hospital operator sounded the alarm with the emergency call words, “Code Blue, Pre-op Area! Code Blue, Pre-op Area!” Robb and I were drinking coffee in the doctors’ lounge, just around the corner and down the hall from pre-op. Like racehorses breaking out of the gate, we were down the hall and around the corner to meet our new patient in less than 30 seconds.

William was a very large man who was hypotensive, in shock, unconscious, dusky grey, and surrounded by nurses, including the ICU supervisor Vann, and my friend James Hankerson, the anesthesiologist, at the head of the bed preparing the airway for endotracheal intubation.

“What’s up, James?”

“Captain Cardiac! Good to see you here! Thanks for coming! This is Silvia’s dad. Nurse on 2East. William is pre-op for abdominal aortic aneurysm resection today at 1:00 pm, but it looks like he’s ruptured and started bleeding retroperitoneally while he was getting prepped for the OR. He suddenly complained of belly pain, dropped his blood pressure, and went into shock. Dr. Tyler, his surgeon, isn’t even in the house yet. Things couldn’t be any worse.”

“James, you shouldn’t have said that. Look at the monitor! His ST segment on his EKG has just shot up! Now, thanks to your statement ‘things couldn’t be any worse,’ you put the jinx on us, and he is having a heart attack too!” I said.

“When will I ever learn! I ordered blood for him! Should be up soon,” James explained.

“I need a cardiac echo machine and a stat U/S of the abdomen,” I yelled and picked up a phone to mobilize the techs.

“Robb, the echo machine is on its way, but the ultrasound tech refused to come because an order had not been entered into the computer! That’s the rule to charge for the procedure. What an idiot! We’ll use my echo machine to look at the belly too,” I reacted.

“We got info fast – 12 lead ECG shows acute injury, and his echo shows the LV apex is down.”

“Didn’t he have a cardiac nuclear stress test that was normal?” Robb stated.

“Oh, those stress tests are worthless. Tim Russert had a normal one and died of a heart attack a week later!”

“I’ve called Tampa Fire Rescue to transport him to TGH. They are on their way. We’ll meet them in the ER on the first floor to shorten the time. Mike, today’s ER doc, said OK.”

“The whole blood is here! Let’s start pumping it in!” Vann announced.

“Someone get the elevator. Let’s move.”

As we rolled the gurney, Sue Neil, the ER head nurse, positioned herself to block the foot of the gurney as we got ready to roll it out the door.

“No! You can’t go to the ER! Stay here and wait for Fire Rescue!” Sue stated firmly as she held her arms akimbo.

“Out of my way, damnit,” I said with equal determination.

“And I said no! It’s my ER! We can’t wait down there! We will wait here.”

“And why is that?”

“Too much paperwork if we go there.”

“Out of my way! Dang it!”

“No! Here comes Fire Rescue now. We don’t have to go there and wait.”

“That’s not Fire Rescue; that’s the fireman off the pumper which co-responded and got here first. Now move over or get run over.” As we rolled around her pivoting body and saw her spiteful face, I knew there would be payback for her filling out stupid paperwork.

Down the elevator, out on the first floor, and around to the Memorial ER. I had called TGH ER and checked out with the ER receiving doctor about the ruptured aneurysm and heart ischemia. The Endovascular stenting group was called as well. I also called cardiovascular and our senior surgeon Bill Angel who would meet us there. He was known as “Angel rushes in where fools fear to tread.”

We alerted Dr. Tyler that his patient was in extremis. Expected mortality rate with an acutely ruptured abdominal aortic aneurysm and a cardiac event: 100%! But we never give up and will fight the Grim Reaper to the very end.

Vann, Fire Rescue, and I loaded him in the ambulance. I gave paramedic Whitey his records, and he stuffed the folded abnormal ECG in his back pocket.

William had pinked up in the ambulance after 4 units of whole blood and a lot of Lactated Ringers. I believed he had tamponaded his own bleeding aneurysm by the clotted blood compressing the rupture point. He was starting to wake up.

“Hello?”

“Look, his ST segment has come down! He’s not having a heart attack too. His blood pressure has come up. I hope this doesn’t start him bleeding again. He will do so much better when we wheel into the ER at TGH.”

“Hello. Hey, you all, aren’t I important here?”

“William, how do you feel?”

“Kind of groggy, and my belly feels a sense of fullness.”

We rolled him into the ER to be greeted by a new team. I peeled loose to watch the events unfold before I went back to Memorial.

A couple of young cardiovascular surgeons strolled into the ER. They were known by the OR nurse staff for their almost every hour-exhorted expletive expressions, which earned them their nicknames of “Oh Shit” and “God Damn.”

“They said he has a ruptured abdominal aortic aneurysm and was brought over here,” OS said.

“This is our big chance to have a big case,” said GD.

Angel overheard them talking and saw his chance to leave the case to them. All he needed was another Medicare mortality, which this case surely was. He slid out a side door.

The patient was greeted by the ER doctor, and instead of sending him to surgery, they sent him to CT for a scan to see if he really had a ruptured aneurysm since he looked fine. We made him look too good. He could die in the CT scanner. The ER doc also forgot about the heart attack that I had mentioned. The Endovascular team didn’t show up. It looked like my whole plan was unraveling quickly because the patient was looking so good on his arrival to this other hospital ER. I couldn’t sit around and watch this, so I left to go back to my home base. Fire Rescue would give me a ride back.

OS and GD started the case in TGH cardiovascular OR 3, but who should show up but Dr. Tyler himself, the original surgeon? When he got to Memorial Hospital and found out that his patient had been moved, he got in his Mercedes sports car and drove over the bridge to TGH. This may have saved the day.

I followed the case by talking to my cardiologist friend at TGH: Stromy. “He made it through the surgery and is doing well in recovery with stable vital signs.”

“Let me know when he is ready to go home.”

A few days later, Stromy calls, “Wallace is ready to go home.”

“Oh no, he’s not. He still has a blockage in his LAD and almost had a heart attack. His ischemic EKG is in the back pocket of the paramedic who transported him. You need to see him and fix it!” There was no one who noticed my charted notes about the cardiac event the patient had when hypotensive.

Stromy did what I asked. He placed a stent in the severely blocked proximal LAD. Wallace went home.

A week later in my clinic, I called in the waiting room, “William the Wallace!”

He comes loping in as his very large and happy self, one of the walking wounded.

“William, what do you have to do the rest of your life? It seems like when someone doesn’t die from such terrible odds against you and wins the health lottery that you have a purpose for still being here?”

“Perhaps my grandchildren, who are not born yet?” William looked up with a smile.

As the famous Scot of “Braveheart,” William Wallace, played by Mel Gibson, said, “Every man dies, but not every man truly lives.” Our William Wallace truly lived his extended life span of 12 years to see Silvia RN give birth to 3 grandchildren and to give them a “Pappa.” He died of the same abdominal aortic aneurysm, which ruptured again, but he truly lived from his new lease on life. And William the Wallace will be forever remembered as a “Brave Heart” indeed.