EVERETT — On that Saturday morning, Pat Ward met her friends for breakfast at Jimmy Jacks on Highway 99.
The six retirees sat at their usual table, in their usual seats. She ordered her usual biscuits and gravy.
Her friends talked of the usual things as they sipped their coffee and ate their diner fare: bacon and eggs, omelets, hash browns and toast.
Ward never took a bite.
She was dead.
A rare case
A longtime chaplain, Ward’s heart stopped on April 29 after she suffered an aortic dissection, a tear in the largest artery of the body. CPR and surgery saved her life.
Aortic dissection can strike anyone, most often men between the ages of 40 and 70, according to the National Institutes of Health. It occurs when a tiny tear inside the aorta allows blood to leak between the layers of the artery. The blood literally cuts through the aorta.
If the dissection progresses, the layers rip and weaken, which can lead to rupture and sudden death.
Ward’s was a type A aortic dissection, the most severe kind, because the tear was next to her heart. Many people with type A dissection die right away. Even with surgery, about 75 percent die.
The heart condition is rare and often goes undiagnosed until it is too late.
“Half of people die within three days if they don’t get treated,” said Dr. Eric Lehr, Ward’s surgeon. “It occurs very suddenly, and so it can either lead to sudden death — which is essentially what (happened), but she was resuscitated — or if you do survive the dissection, it feels like a tearing, stabbing or sharp pain between the shoulder blades.”
Aortic dissection killed television and movie star John Ritter in 2003. Ritter became ill on the set of his TV show, “8 Simple Rules,” and was rushed to a hospital in Burbank, California. He was 54.
Ritter was misdiagnosed. He was being treated for a heart attack in the hospital when he suffered an aortic rupture. He died during surgery to repair his aorta.
Symptoms of an aortic tear can mimic those of a heart attack, including severe chest pain, shortness of breath and fainting.
Or there can be no symptoms at all, as in Ward’s case. It struck her suddenly and without warning: She lost her pulse, followed by her consciousness, and then she stopped breathing.
While there’s no one cause, high blood pressure, obesity, smoking, hardening of the arteries, and genetic predisposition are risk factors. Blunt trauma to the chest or belly, such as from a car crash, also can trigger the condition, which occurs in two of every 10,000 people, according to the National Institutes of Health.
A helping hand
It wasn’t until one of Ward’s friends got up to pay the check that they realized something was wrong. Ward hadn’t said a word during breakfast. It appeared she had nodded off.
“Two of us decided to call 911,” said Ward’s boyfriend, Bob Johnson. “We just knew it wasn’t right.” Thinking back to that day, Johnson said it was strange that the five of them didn’t notice Ward needed help sooner, because she is usually the talker of their table.
Waitress Heidi McCown noticed the frantic phone calls. She helped prep Ward for CPR, asking a customer from another table if she knew how to perform the life-saving procedure. The woman stepped back in fear.
McCown knew it was up to her. The six friends were her regulars and she wasn’t going to let them down.
“When I walked by the table, it sounded like she was snoring, which I thought was kind of odd. But I thought they were joking around,” said McCown, the mother of a 5-year-old daughter and a server at Jimmy Jacks for about four years. “I didn’t think anything of it until I saw (one of them) standing up, on the phone.”
McCown, 29, had trained in CPR years ago. The emergency dispatcher talked her through the steps over the phone: Lie Ward on her back. Give chest compressions at a rate of 100 to 120 per minute. Don’t worry about rescue breathing. Keep at it until help arrives.
Medics arrived about three minutes after the call. McCown’s work was done.
Her compressions did the trick: Blood flow was restored to Ward’s body until she could be resuscitated. Medics restarted her heart on the way to the hospital.
Johnson called Ward’s son in Ellensburg, then followed the ambulance.
Ward, of Mukilteo, was rushed to Swedish Edmonds hospital where she was accurately diagnosed with an aortic dissection. It was clear Ward needed a major heart operation — and fast — except there were no cardiac surgeons on duty. She was transferred to Swedish Medical Center-Cherry Hill in Seattle.
This time the medics called ahead and the hospital assembled a team of surgeons. Ward was on a ventilator and in a medically induced coma when she was wheeled into the operating room.
Ward’s son has her power of attorney, but he hadn’t arrived from Ellensburg to give an OK. Her doctor didn’t wait. The risk was too great.
“It was a good call,” Ward said. “I got the top dog.”
The surgery lasted seven hours.
Doctors opened her chest and saw that her aorta had ruptured; the artery also had ripped about 7 inches.
Type A aortic dissections are repaired like a sewing project: with bio glue, felt, a polyester graft, a surgical needle and thread. The dissected artery is cut out, the glue and felt are used to reinforce the two cut ends — one coming off the heart, the other leading to the rest of the body — and then the polyester graft, or tube, is used to replace the part that was removed.
“The very first (aortic dissection) surgeon went to a fabric store and sewed the tube on his wife’s sewing machine,” Lehr said. “It’s gotten a little bit more sophisticated since then.”
While operating, the surgeons discovered that Ward also has atrial fibrillation, the most common type of irregular heartbeat. It affects at least 2.7 million Americans, many over the age of 50.
According to the American Heart Association, atrial fibrillation, also known as AFib, can lead to blood clots, stroke, heart failure and other heart-related complications. Symptoms include palpitations, shortness of breath and fatigue.
Treatment includes blood thinners and medication to steady the heart rate and rhythm. In Ward’s case, a procedure called an ablation, which purposely scars the defective part of the heart to prevent it from passing on unwanted signals, was performed.
Ward was in the intensive care unit for five days and at Swedish for three weeks.
After a week at Mountain View Rehabilitation and Care Center in Marysville, however, it was clear she wasn’t recuperating as quickly as her doctor had hoped. If she climbed four stairs or walked 10 feet, she would lose her breath.
At Swedish for a checkup, Ward couldn’t catch her breath at all.
In the emergency room, doctors found out that her left lung was filled with fluid. They extracted the fluid with a 12-inch needle through her back. After that, she could breathe again.
Fluid in the lungs, known medically as pulmonary edema, is one of the more common reactions and one of the most serious complications of open-heart surgery.
With her lungs cleared, Ward could climb stairs and walk distances without gasping for breath. She finished rehab in a flash.
It took 12 weeks for her breastbone to heal. Her scar, 7 inches long and in the middle of her chest, is healing nicely.
“I bet 20 nurses have looked at it,” Ward said, “and they say it’s one of the best scars they’ve ever seen.”
Message from above
Ward has been a police and fire chaplain for nearly 20 years. She volunteers for the Mukilteo Police Department and the Lake Stevens and Everett fire departments. She also is a pastor, so she can officiate weddings, lead funerals and give the opening or closing prayer at church.
Like Ward, her doctor is a person of faith. Lehr, the hospital’s director of cardiac surgery research and education, calls her a miracle.
He estimates that doctors at Swedish Cherry Hill repair one torn aorta per week.
Lehr has been surgically repairing aortas for nine years, but he had never seen a case like Ward’s.
“She was a miracle for three reasons,” he said. “One, she suffered a cardiac arrest because of her dissection; two, because her aorta was completely ruptured and; three, she was on blood thinners (for high blood pressure), which could have easily caused her to bleed to death before she got to the hospital.
“She was very lucky.”
Ward added another reason to the list: a garage sale. She and her friends have been getting together at 9 a.m. every other Saturday for 10 years. Her boyfriend picks her up for breakfast. That fateful Saturday, she had her friends move the time up by a half-hour because it was the day of the Great Garage Sale in Mukilteo. She wanted to check out the sales afterward.
Minutes truly mattered.
“If I had been alone, and if nobody had been there to do CPR and call 911, I would have been dead,” she said. “Doctor said on that day everything that could go right, went right. Praise God.”
Ward sees her survival as a message from above.
“I must not be finished here, otherwise I wouldn’t be here,” she said. “I’m just so grateful to be alive. It’s so nice of God to let me come back.”
Since her surgery, Ward has been on leave as a chaplain. She set a goal of getting back to work by Oct. 1.
As a chaplain, Ward provides support to police officers, firefighters, victims and their loved ones through the ministry of presence. The chaplains are trained to serve alongside first responders to comfort the community in times of tragedy. Most of the time, they are called to a death scene.
Ward plans to be a chaplain for another year or two before she retires from her volunteer post.
“I love being a first responder chaplain,” she said. “I like it so much, I would have devoted my whole career to it.”
Ward became a chaplain after working in the funeral business for years. She has also lost two sons, one at 2 years old and one at 47, so she finds purpose in comforting those who are grieving a death.
‘I owe so much’
Ward is rehabbing at Providence Regional Medical Center Everett. Her 12-week program is designed to help those who’ve had recent cardiac events through the recovery process.
She goes to the hospital three times a week to work on lowering her blood cholesterol, hypertension and blood sugar levels, and to lose weight.
The physical therapists have her exercise for an hour at a hospital gym; the nutritionists want her to cut meat, white flour and anything fried from her diet.
Which means: “No more biscuits and gravy.”
Ward recently visited Jimmy Jacks to thank the waitress who gave her CPR. She brought McCown a hanging basket of petunias, a token of gratitude for saving her life.
“I owe so much to Heidi,” she said.
Although one of Ward’s friends had stopped by a few weeks after the surgery to let McCown know that she was OK, the two had yet to talk. Seeing Ward alive and well was a relief for McCown, who had often wondered about her loyal customer.
The waitress is thankful she was required to take a CPR class.
“I would have felt horrible if I didn’t do it and she passed away from me not trying.”
Sara Bruestle: 425-339-3046; firstname.lastname@example.org. Twitter: @sarabruestle