Early in the evening last St. Patrick's Day, Jim Meis stood up from his chair, looked his longtime partner, Trudy Lohre, in the eye and said, "I'm going to die." "Oh no, you're not," she said, leaping for the phone to dial 911. Then he said it two more times - "I'm going to die" - and collapsed at her feet.Lohre threw down the phone and started pressing his chest until the ambulance arrived.
Lohre was right. Meis, 60, didn't die that day. About an hour after he collapsed at his home in Monticello, he was landing on the helipad at Abbott Northwestern Hospital in Minneapolis, pumped full of drugs and with a breathing tube down his throat.
Meis' survival that harrowing night is the story of a community with a rare combination of medical assets: civilians trained in CPR, state-of-the art emergency care and cutting-edge cardiac medicine.
But his longer story -- a dozen near-death experiences since he was a young man -- also describes three decades in the evolution of heart disease and cardiac medicine. It also explains why deaths from heart attacks are on the wane in the United States -- while a very different cardiac ailment, chronic heart failure, is a growing epidemic, and the demand for heart transplants is relentless.
"We are the victims of our own success," said Meis' cardiologist, Dr. Mark Houghland.
Meis had his first heart attack at 32. He was digging fence post holes in a field near New London, Minn., when he felt chest pain and shortness of breath. His mother had died of a heart attack when she was just 52, so he knew the signs.
He turned to his co-worker in amazement and fear. "I think I'm having a heart attack," he said.
They drove to a clinic in New London. His doctor called an ambulance, and Meis was treated at a community hospital.
Meis doesn't recall exactly what care he got that first time. But Dr. Bill Scheig, the emergency room physician at New River Medical Center in Monticello who cared for Meis on St. Patrick's Day, said heart attack care was very different then. Patients got drugs to dissolve the arterial clots that were depriving the heart muscle of blood. They would be admitted to a hospital for a couple of days and were then referred to a cardiologist.
A lifetime of heart disease
That first heart attack permanently injured some of the muscle in Meis' heart and set the stage for a lifetime of heart disease and high-tech care.
Meis' first problem was cardiovascular disease: High cholesterol narrowed the arteries to his heart and caused three or four more heart attacks by the time he was 40, each one aggravating the damage to his heart. Meis concedes now that he probably could have done better with his diet.
His downfall? His own homemade fried chicken.
At 40, Meis had surgery to repair all four of the major arteries around his heart. That stopped the heart attacks, but the damage had been done. His weakened heart muscle didn't do a good job of pumping the blood through his body or transmitting the electrical signals that make it contract.
His next appointment with cardiologists came while he and Lohre were living in Phoenix. He was driving trucks for a construction firm. The heavy physical labor in blazing temperatures didn't help, Lohre said. But advances in medical technology did. Doctors implanted a combination pacemaker and defibrillator to regulate his heartbeat and shock the organ back into action when the electrical signal became so erratic that his heart stopped contracting.
A year later he was back in the hospital in Minnesota because the defibrillator malfunctioned. Houghland, an Abbott cardiologist who also works at the New River Medical Center, replaced it. It was Meis' third surgery.
By that time his heart was contracting with only one-fifth the strength of a healthy heart. He had trouble breathing because his lungs filled with fluid. His feet were always cold.
"A person with that condition has a high risk of what cardiologists call sudden death," Houghland said.
Which is exactly what happened on St. Patrick's Day. Meis' heart just stopped.
The best care
If it had happened in another city he could have died. The quality of emergency cardiac care varies around the country, said Dr. Chris Granger, director of cardiac care at Duke University Medical Center in North Carolina. But the care he received was among the best in the country, said Granger, who also advises the American Heart Association on a program to improve cardiac emergency response nationally.
It started with Lohre. Last year, with Meis' health condition in the back of her mind, she had signed up for training in CPR. When Meis dropped at her feet she knew she had to keep his blood circulating so oxygen could reach his brain.
The ambulance was there in seven minutes, along with paramedics trained to do the kind of treatments that used to be done in hospital emergency rooms. A heart monitor told them his defibrillator was firing, but it wasn't doing the job. But one shock from their more powerful, portable defibrillator jump started his heart, and they got a pulse. They injected him with blood thinners and blood pressure medications, loaded him in their rig and, with sirens howling, headed for the emergency room. On the way, they ordered a helicopter ambulance.
Meis was one of some 300,000 Americans who suffer cardiac arrest each year. Only 5 percent survive, and many of them suffer irreversible brain damage from oxygen deprivation. But when Meis got to Abbott they used one of the latest techniques to save his brain and his life -- they cooled his body to 92 degrees. Doctors have found that cooling therapy allows some people to survive much longer periods without oxygen.
"He was about as sick a man as I've ever seen," Houghland said.
He was in a coma for two weeks, but when he came out of it his brain was just fine. After weeks in intensive care and physical rehabilitation, he went home to Monticello.
Deaths and hospitalizations because of heart disease have dropped sharply in the United States in the last two decades -- precisely because of the types of therapy Meis received. At Abbott, for example, the number of people hospitalized as a result of heart attacks is down 14 percent since it created its Level One program, an effort that has accelerated and improved emergency care and now includes 33 hospitals.
"It's changed cardiac disease in this state," said Dr. Kevin Graham, head of the Minneapolis Heart Institute at Abbott.
Chronic heart failure, on the other hand, is on the rise, fueled by rising rates of diabetes, high blood pressure and the long-term effects of coronary artery disease. It now exceeds 500,000 new cases a year, and the number of deaths has more than doubled since 1979, averaging 250,000 annually.
So even though they'd saved Meis' life and his brain, the doctors could not save his heart. A week after he went home from the St. Patrick's Day episode, Meis was back at Abbott because his damaged heart wasn't giving his body enough oxygen.
One hitch: Meis had been too sick to work and lost his health insurance in 2009. Even Abbott couldn't afford to give away the hundreds of thousands of dollars in care he needed. So when he was admitted in March, hospital social workers helped him apply for Medicaid, the publicly funded insurance program for low-income people.
That also made it possible for him to get the last, best possible treatment -- a heart transplant and the promise of another decade or two of life.
Meis is home now. His feet are warm for the first time in years. Last week three of his five grandchildren came to visit, and his sister came over to pickle green beans from the garden.
Lohre said she has no idea how they will pay the medical bills that are still rolling in from when he was uninsured.
"But we'll do the best we can even if it takes the rest of our lives," she said. "At least he's alive."
Josephine Marcotty • 612-673-7394