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The Quiet Place

      One dark morning last May, I wrecked my body giving 10 minutes of CPR. My 34-year-old husband, Will, had been lying peacefully next to me, both of us fast asleep. I woke up suddenly to a loud noise I will never forget.
      At first, I thought he was snoring. I groggily nudged him, but he just continued making the horrible sound. I shook his shoulder, but he didn't respond. As reality set in, I realized that the sound had an urgent, panicked quality to it. It wasn't rhythmic or soft. His torso didn't gently rise and fall as I had watched it move so many times before. I had never heard of agonal breathing.
      I said my husband's name. No response. I shouted his name. Nothing. I put my ear on his chest and couldn't hear his heartbeat or feel him breathing. I picked up his arm and let it go. It dropped like a rock.
      That was the first time I've ever experienced an out-of-body sensation. One part of my brain understood these observations as facts. Another part couldn't make any sense of it. The objective piece watched with detachment and allowed me to stay calm, dial 9-1-1, and follow the dispatcher's T-CPR instructions. The other part watched in dismay and couldn't accept what was happening. It was as if one part was watching the other, and they would periodically switch roles in a forbidding dance on death's stage.
      I laced one hand on top of the other in the center of Will's chest and pushed hard and fast for ten long minutes. The dispatcher counted out loud to help me keep the correct rhythm. I watched my husband turn blue and then purple under my hands. I felt his ribs sink into his chest cavity and then spring back again to the rhythm of my compressions.
      Memories of our college years, when we met and fell in love, floated through my mind. We had shared so many dreams and ambitions. Our whole adult lives had been in front of us, and they held such promise. We were finally starting to live those dreams after years of graduate school, medical school, and residency. I thought of our younger selves with a crushing sadness. It wasn't supposed to end here, like this.
      I thought of our kids, ages eight and five, asleep in the next room. I knew I would have to face them in two short hours. The words I might have to say would shatter their childhood. I thought of them growing up without their dad, of holidays being grim reminders of loss and grief, and the void that would be left in their hearts.
      I realized later that I had just watched our life flash before my eyes.
      When the paramedics arrived and laid Will's gray body on our living room floor, I couldn't bear to watch. I heard all six feet and four inches of him slam on the hard wood as electricity ripped into his heart. The paramedics delivered five shocks, three rounds of epinephrine, and a dose of amiodarone before eventually achieving ROSC. They whisked him away in an ambulance before I could see him again or say goodbye.
      One of the paramedics, a man named Lt. Gregg, had been giving me updates. He told me that my husband had ventricular fibrillation resulting in sudden cardiac arrest. Lt. Gregg had kind eyes. They were all I could see beneath the hazmat suit and hood he was wearing due to COVID precautions. He explained what those terms meant and asked if I had any questions.
      “Yes,” I replied. “What do I tell our children?”
      He did his best to answer.
      It was early in the COVID pandemic, and visitors were generally not allowed in hospitals. Lt. Gregg told me I would be allowed to go to the emergency department and gave me information to show at the door. The remaining crew members packed up their equipment and left just as my children's alarm clock went off. I had just accomplished the hardest thing I had ever had to do, but that record was about to be broken again.
      I opened the door to the bedroom my daughters share. I gathered all my maternal strength to use a normal facial expression and tone of voice while I gave them the news to the best of my ability. I didn't know yet whether he would survive. Even if he did, I didn't know if he would remember anything or be able to function. I tried not to lead the kids toward those questions.
      My parents arrived for reinforcement, and my dad dropped me off at the hospital, like some first day of school gone horribly wrong. I presented the information Lt. Gregg had given me and was allowed inside as an end-of-life case.
      COVID had disrupted standard protocols, and the hospital staff didn't quite know where to put me. They escorted me to a waiting area in the radiology department, where the lead-lined walls cut off my cell phone signal, effectively isolating me from everyone I could have turned to for support. Doctors I had never met came in periodically to give me updates, but I could barely take in what they were saying.
      I was in shock and traumatized. That was the state I was in as the consulting cardiologist gave me the grim statistics around OHCA survival rates and waited for me to make decisions for my husband as his life hung in the balance. Those statistics were not helpful, and the decisions seemed impossible.
      Eventually, the hospital staff returned and told me I had to leave the building. We didn't know whether my husband or I had COVID, and they told me that my presence was “making people nervous.” I sat on a bench on the hospital campus waiting for a ride home. Staring into thin air, dripping in the trauma of that morning, I shut down in self-preservation. My husband was fighting for his life inside that hospital, and I was being sent away. He would have to fight alone. I would have to face the tremendous guilt and pain that so many family members experienced during the COVID-19 pandemic. It was excruciating to be separated.
      Thankfully, my husband survived neurologically intact. He came home and started to regain his short-term memory capability. His cardiologist implanted a subcutaneous ICD and ordered genetic testing.
      But in the days and weeks that followed, something odd happened. My mind went somewhere it had never been before. Words were just...gone. I could manage a few one-word answers, but I couldn't hold a conversation. I couldn't keep the other person's words in my mind long enough to make sense of them. I couldn't think of words for simple concepts or objects. And I certainly couldn't make full sentences come out of my mouth. My eyes and face were devoid of any expression. A close friend described it like the eyes of the “Afghan Girl” photo featured on that infamous National Geographic magazine cover.
      I didn't know how to explain to my family and friends what I was experiencing, so I used a name for the place I had gone. I called it the Quiet Place. It was a dark and empty chamber where no words were spoken or understood. If they were there, they flowed in and back out like a silent River Styx running through my brain. It was a place of grief and distress.
      Those of us who have survived trauma need our healthcare providers to meet us in our Quiet Place. We need them to find their way into that dark chamber, light a candle, and fill it with the words that build a bridge for us to walk out. I found mine in the work of Rana Awdish,
      • Awdish R.
      Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.
      Paul Snobelen,

      @PSnobelen. A thread of what I share with Lay-Responders after acting to Save a Life, based on the real life questions they ask. Feel free to use this info in your courses, talking etc. Posted September 2, 2020. Accessed June 14, 2021. https://twitter.com/PSnobelen/status/1301187168153591810

      ,

      @PSnobelen. More common Questions and Answers. Posted September 2, 2020. Accessed June 14, 2021. https://twitter.com/PSnobelen/status/1301187168153591810

      and Kirstie Haywood and Katie Dainty.
      • Haywood K
      • Dainty KN.
      Life after cardiac arrest: The importance of engaging with the 'forgotten patient'.
      They sounded like angel songs.
      More to come from our Care Partners section in 2022.

      Appendix. Supplementary materials

      References

      1. Cummins, E. How Dr Glaucomflecken Overcame Death to Get Internet Laughs. Medscape. Published March 10, 2021. Accessed September 2, 2021. https://www.medscape.com/viewarticle/947199

        • Awdish R.
        Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.
        Picador, New York2018
      2. @PSnobelen. A thread of what I share with Lay-Responders after acting to Save a Life, based on the real life questions they ask. Feel free to use this info in your courses, talking etc. Posted September 2, 2020. Accessed June 14, 2021. https://twitter.com/PSnobelen/status/1301187168153591810

      3. @PSnobelen. More common Questions and Answers. Posted September 2, 2020. Accessed June 14, 2021. https://twitter.com/PSnobelen/status/1301187168153591810

        • Haywood K
        • Dainty KN.
        Life after cardiac arrest: The importance of engaging with the 'forgotten patient'.
        Resuscitation. 2018 Jul; 128 (Epub 2018 May 1PMID:29727707): A1-A2https://doi.org/10.1016/j.resuscitation.2018.04.034