We are surrounded every day by events that are both positive and tragic. As fire service families, we pull together and learn how important we are to each other. A tragedy changed our lives and the lives of many others in so many ways.
William: The fire service prepared me to handle all types of hazards from natural to man-made disasters, large-scale structural fires, all the way to the most horrific accidents imaginable. I was trained as an emergency medical technician in 1993 and practiced my skills as a volunteer until I was hired by the Virginia Beach (VA) Fire Department. I saw a lot of tragedy and performed cardiopulmonary resuscitation (CPR) on dozens of people; I received awards for heroic acts and even the Presidential Medal of Valor from President Obama. As a firefighter, I always felt I had complete control over any scene. I was confident that I could provide care that would affect my patients’ lives in a positive way. On April 10, 2013, however, I experienced an event that literally dropped me to my knees and left me feeling helpless despite all my years of experience.
The First Collapse
Tawnya: Billy and I have been best friends for more than 20 years. When I arrived home from working as a hospital cardiac nurse that day, we decided to work out prior to cooking dinner. I wanted to go for a long run. Billy suggested that we do CrossFit at home instead because it was already quite late. I decided to stay home and work out with Billy. The weather was unusually warm, in the 90s. As we neared the completion of our workout, I suddenly felt extremely dizzy, and I collapsed.
William: I was able to catch her and lower her to the ground. To my disbelief, I realized that she was not breathing and had no pulse. Given the heat and the fact that she has had asthma since childhood, I initially thought she had heat exhaustion or may have suffered a severe asthma attack. When I could not find a pulse, I began CPR as our two daughters, ages nine and 10, stood by and watched.
My youngest daughter ran inside to look for the phone. She could not find it. After my eldest daughter located the phone in the backyard, I instructed her to call 911. She was so frightened; she handed me the phone. I kept performing CPR with one hand while talking to the dispatcher. The dispatcher told me to stay on the phone. I told her I needed to focus on my wife, and I threw the phone into the street.
After 10 to 15 minutes of CPR, Chesapeake Fire and EMS arrived. When they took over the CPR, I collapsed in my neighbor’s arms and assumed the role of a husband instead of a firefighter. The firefighters started IVs and continued CPR, but there was no response. Their monitor/defibrillator showed ventricular fibrillation. They shocked Tawnya twice; still there was no response. On the third shock, she regained a rhythm and blood pressure, but she remained unresponsive. They loaded her into the ambulance and took off. I felt helpless and alone. I had seen this situation so many times on medical calls, but nothing ever prepared me to work on someone I loved. My neighbor drove me to the hospital; I called my family to let them know.
Tawnya’s father saw the medics taking Tawnya out of the ambulance, but medics would not allow him to see her. When I arrived at the emergency department (ED), I begged the staff to let me see my wife. I didn’t know if she was alive. When the staff let me into her room in the back of the ED, I saw her sitting up. She yelled my name across the ED. I knew then that she was at least somewhat neurologically intact. Her father and I spoke to the ED physician, who informed me that my wife had a one percent chance of survival and that if she did survive, she likely would have some significant brain damage, given her downtime of 15 to 20 minutes.
Tawnya was admitted to the intensive care unit (ICU) that evening. I stayed by her bedside the entire time. The next day, she went for a cardiac catheterization, as the doctors suspected that a blockage had caused her cardiac arrest. Tawnya and I were prepared for a stent procedure or open-heart surgery, but the cath showed a diminished ejection fraction (pumping ability) of 30 to 35 percent (normal = 65 percent) with no blockages. The cardiologists attributed the impaired ejection fraction to the trauma of the arrest. This was great news, but it was also troubling since we still did not know what caused the cardiac arrest.
On the fifth day, after much debate and a barrage of negative tests, a cardioverter defibrillator (ICD) was implanted in Tawnya’s chest. On the sixth day, Tawnya walked out of the hospital. Her ejection fraction had returned to normal.
After-Life Experience
Tawnya: I remember little to nothing of the six days I spent in the hospital, but I do remember dying. This experience was all I could talk about from the time I was in the ED. I recall going to the most beautiful place I had ever seen and did not want to leave. I saw people I loved who had died, including my grandmother Mema and Billy’s father Dan. Both told me I had to leave and could not stay. Even though I was very confused at times while in the hospital, I wrote a journal about this experience. This is an excerpt:
I think this is the scariest, but most life-changing, event I have ever experienced. Without my husband being smart and brave, I would not be here today. I have always known that I loved him, but this is indescribable. When I died, I went to Heaven. Nothing hurt, and I wasn’t scared. Everyone I love was there-my grandparents Mema, Pepa, Mum, and Poppy; my father-in-law Dan; Uncle Marty; Billy’s grandfather, Granddaddy; and Billy’s Uncle Tony-just to name a few. I immediately felt loved and wanted. I always knew there was a Heaven, but this is amazing.
I remember mostly Dan telling me that Billy needed me and that I had to return to be with him. He asked me to please go back because it wasn’t my time and I had to be with Billy forever. I also remember Mum, Poppy, and Pepa telling me that they would watch over us always.
Mema gave me a big hug and said she missed me but that I needed to go back. She said she always told me I was a great mom to our girls and said again that I couldn’t leave the girls.
It was a short visit, but it was so wonderful and amazing to have everyone I love there and taking care of me.
We left the hospital with many emotions. We were thankful and amazed. However, we were also scared and unsure. As time went on, we resumed our lives with greater normalcy.
Another Episode
The cardiologists remained unsure about what had caused Tawnya’s cardiac arrest; but since she had no further events, everyone thought it was all some sort of fluke. Everything remained normal until April 2014. We had planned a surprise one-year survivor’s celebration. It was a fabulous event; all of our friends and family were there to celebrate Tawnya’s surviving her event. Everyone believed it was a thing of the past.
William: One week later, Tawnya was out cutting the grass. I was across the street at a neighbor’s house. I noticed that the lawn mower had stopped. I turned in that direction ready to jokingly tell her to get back to work. I then spotted Tawnya lying in the grass next to the lawn mower. I ran to her side and found her exactly as she had been a year ago: unconscious, her eyes rolled back in her head, drooling and breathing agonally. I leaned over to check her pulse. She had none. Her body jolted from the firing of her internal defibrillator. I was in fear and disbelief. I yelled her name and shook her. She awakened and wanted to know why she was lying in the grass. She tried to get up. The neighbors, who had called 911, came to help. She was transported to a local heart hospital and stayed there for three days.
Once again, the doctors discharged her without giving us a clear explanation of what had happened. An electrophysiological (EP) study was scheduled to try to determine what was causing her irregular rhythms. Tawnya was told not to drive until they could find the cause of her arrhythmias.
We went on with life; but, of course, by this time, things were not “normal.” Tawnya could not drive; we had to depend on others to help. We were scared because, obviously, something was wrong, and we had no idea if or when the arrhythmias would happen again.
The EP study was able to reproduce the v-fib, but the electrophysiologist felt it was too involved for him to map or ablate. Ablation uses radiofrequency or microwave signals to effectively destroy electrical pathways responsible for dangerous rhythms. He recommended that we go to Mayo Clinic in Minnesota for treatment. Our cardiologist had already suggested this route, but Tawnya’s insurance had refused to cover it. We thought for sure that an electrophysiologist’s recommendation would get coverage approved. Her insurance company continued to refuse coverage and suggested that she change her insurance during open enrollment in January so that we could go out of network. Her cardiologist continued to argue, without success.
At this point. Tawnya was limited in her activity and still not able to drive. She had been doing some volunteer work with the American Heart Association (AHA) as a “survivor” speaker. She was asked to speak at a conference in Richmond, Virginia, to a group of some 200 AHA employees. I went with her since she was unable to drive. At about five minutes into her presentation, Tawnya paused for a moment and looked concerned. Next, she jolted and yelled my name. She had been shocked again. I ran up onto the stage and got her down to a chair, where she was shocked a second time. People came on stage to help. Someone called 911. She was transported to a hospital in Richmond and discharged from the ED about eight hours later. The only findings were low potassium and magnesium levels; the ED recommended that she take supplements. Once again, we returned home without answers. Her cardiologist renewed his fight to have the insurance company cover Tawnya’s visit to Mayo Clinic.
We scheduled a consult at Mayo for January 2015 (we had changed our enrollment status at the end of 2014 to cover out-of-network visits). Tawnya was advised to “take it easy” until then. The cardiologist tried to get the consultation moved up, without success. Life was anything but normal; we were very scared. There was virtually no telling if or when Tawnya might experience another arrhythmia. Our only reassurance was her implanted defibrillator.
Another “Code”
Tawnya: I had been out of work since August, but my department at the hospital was having its Christmas party on December 5 at a local restaurant. We were looking forward to going and seeing everyone. As we were finishing our meal, I looked at Billy across the table and said, “Billy, I don’t feel right.” My defibrillator fired seconds later. After what appeared to be about three shocks, I lost consciousness.
William: I lowered her to the floor. Three more shocks emitted from her defibrillator. Tawnya briefly opened her eyes and said, “Billy, not again.” Then, the shocking stopped. I realized she was once again in cardiac arrest.
I started CPR, thinking, “This can’t be happening again.” A coworker helped with CPR until the medics arrived. The medics administered additional shocks; there was no response. They loaded Tawnya into the ambulance. I climbed up front. CPR and advanced cardiac life support continued the entire ride to the hospital. By this time, Tawnya had been down for more than 20 minutes. I really thought I had lost my wife and best friend. I couldn’t imagine the medics getting her back after such a prolonged effort. As we turned into the ED, the paramedic noted that Tawnya had gone into Torsades, a rhythm known to respond to magnesium. He administered magnesium, and Tawnya regained consciousness as she was being taken out of the ambulance. I couldn’t believe my eyes.
She spent the night in the local hospital ICU and was transferred to the local heart hospital the next day.
After five days, she was once again discharged with no real diagnosis or any answers. Once again, her magnesium and potassium levels were critically low; she was on a potassium-sparing diuretic. Our anxiety increased. We looked forward to getting to Mayo Clinic, hoping we would get some answers and definitive treatment for Tawnya. The heart hospital explained that Tawnya’s defibrillator was programmed to fire six times and then reset itself. What we had believed was a measure of protection did not work. By now, we were all scared to leave Tawnya alone.
William: I took time off from the fire department until Tawnya’s appointment at Mayo Clinic in January. At home, our daughters were worried that something might happen when they were home alone with Tawnya. A friend from the fire department came over and taught them CPR. Although I had resolved not to leave Tawnya alone until we had some answers, this instruction helped to ease our daughters’ fears and helped them feel that at least they could help out. That night, while Tawnya was taking a shower, our eldest daughter yelled, “Dad, Mom needs help.” I ran to the bathroom. Tawnya was getting out of the shower, and her defibrillator was firing again. She was shocked six times while on the bathroom floor. The firing stopped.
Tawnya was awake, but she certainly was not feeling well. When the paramedics arrived and put her on their cardiac monitor, she was in a very fast supraventricular tachycardia (SVT) with rates well over 200. As a cardiac nurse, she became so frightened that she asked the medics to turn the monitor away so she couldn’t see it. The ambulance brought her back to the heart hospital that had just discharged her. She stayed alert and conscious the entire ride and talked and answered questions. She stayed in SVT with rates over 200 for more than 45 minutes.
In the ED, the doctors tried to slow Tawnya’s heart rate, but they could not get the heart rate to stabilize. When the rate increased, her defibrillator began to fire again. It shocked her six more times in the ED. From my chair in the hallway, I could hear her scream every time. I felt awful knowing there was nothing I could do. Eventually, the staff got Tawnya back into a normal rhythm. She was transferred to the cardiac ICU, where she had previously spent so many days and nights. To say everyone was frustrated would be a gross understatement.
Mayo Clinic
William: Finally, the insurance carrier agreed to transfer Tawnya to Mayo Clinic and to pay for a medical jet to take her there. On December 21, we left for Mayo Clinic. Leaving our children behind over Christmas added to our stress, but our family was hopeful that something would finally be done.
After an exhaustive battery of tests, Tawnya was scheduled for an EP study with ablation on December 26. We spent Christmas day in the ICU. Although we were sad and emotional, we were relieved. The Clinic staff made it as enjoyable as possible. A Christmas dinner was delivered from the cafeteria, and volunteers made the rounds singing Christmas carols. Our daughters stayed with Tawnya’s sister, whose family and friends made it a special and fun holiday for them.
The Procedure and Diagnosis
William: On December 26, Tawnya left for the EP lab at 11:00 a.m. and did not return to the ICU until 10:30 p.m. Staff called regularly to fill me in on her progress. The electrophysiologist found a large aneurysmal sac just under the mitral valve that seemed to be the main cause of the arrhythmias. He spent a lot of time doing the ablations on that area and also did multiple ablations on others areas that seemed to contribute to the “V-tach storms” that resulted in the repeated defibrillations and arrests. The doctors could not say for sure what caused the aneurysmal sac; they conjectured that it may have been there at birth or may have been the result of a virus.
A “New” Normal
William: Since December 2014, Tawnya’s health has returned to normal. She has gradually resumed power walking and bike rides. In keeping with the physicians’ recommendations, she probably won’t resume long-distance runs or aggressive workouts. She returned to work on a part-time basis.
Explanting the ICD is out of the question for us, given the events of the past couple of years. Although our family has returned to a more normal daily lifestyle, our lives are anything but back to normal: The impact of our experience has changed us in many ways.
CPR Saved Tawnya
William: Without CPR, Tawnya would not be here today. Twice, prolonged CPR kept her alive until the out-of-control rhythms of her heart could be corrected. She is living proof that CPR saves lives and that CPR training is not just for “at risk” members of the community.
Everyone, everywhere should know CPR. The sudden and unexpected nature of Tawnya’s illness taught us the importance of living every day of our lives to the fullest. Emergency responders often begin to believe that illnesses and injuries happen only to strangers and that they and their loved ones are somehow immune to the tragedies they witness day in and day out at work. Family, friends, and loved ones took on greater value in our household.
Advocacy was critical in getting Tawnya the specialized medical care she needed to find the root cause of her rhythm problems. It seems amazing that we had to battle with our health care providers, hospitals, and insurance to get the care Tawnya desperately needed, especially given our background, training, and experience. Yet, routinely, patients struggle with navigating and accessing health care resources they need. This experience emphasized the importance of aggressively pursuing solutions, not just care. Ultimately, without the specialized care and treatment Tawnya received at Mayo Clinic, it seems likely that she would have died from additional storms of arrhythmias that were progressively increasing in frequency and severity.
WILLIAM REYNOLDS is a battalion chief with the Virginia Beach (VA) Fire Department, where he has served for 22 years. He is an instructor with the Hampton Roads Fire Officers Academy and REaL Fire Training, LLC. He is a recipient of the Presidential Medal of Valor. He has a bachelor’s degree in health and physical education and is completing the requirements for a master’s degree in public administration.
TAWNYA REYNOLDS has worked for 18 years in cardiac rehab, the past seven years as the team coordinator. She is working part-time as a registered nurse in a cardio-thoracic clinic. She has a bachelor’s degree in community health and a nursing diploma degree.
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