Only Human – Episode 2 – Caoimhe

Henry Goldstein: 0:00. Welcome to Only Human, a podcast from Don’t Forget the Bubbles. This is Henry Goldstein with Becky Platt. And these the stories that reflect the diversity of our community and the multitude of life events that come our way that shape us as professionals and as humans. Dr Caoimhe Costigan is a paediatric nephrology trainee from Ireland. Her story is about her father, and a bicycle ride.

Caoimhe: 0:26 My parents are separated for a number of years now. And my dad moved only recently to a place called Moneygall, which is kind of halfway between Limerick and Dublin, I guess. Neither of us are like professional cyclists, by any manner means, but we both like cycling, and we had done a bit like we had done like mostly like kind of in the summertime, you know a bit here and there. And the year before we had done the Ring of Kerry, which is like a big first area or big like a loop around Kerry, basically. But it’s a charity cycle that they run every year. It’s really cool. It’s 180 kilometres, everybody sets out at like seven o’clock in the morning. Everybody in the different villages or towns that you stop in are, you know, engaged in the cycle. There’s big food stalls and all sorts of things setup. So we had done that the year before. So that’s usually in June, and that was probably the big first big kind of cycling event thing that we had done together. And I remember kind of being slightly worried that it was, you know, dad hadn’t done that much training really coming up to it. But sure he was grand. He flew off, I was at one point we there was quite a big group of us doing it. And he got separated at one point. And I was kind of saying to the girl that I was likely with like, ‘ should we wait? You know, I wonder where he is’. And then eventually I texted him and sure he was ahead of us. He had somehow skipped ahead of us. So we had to go extra fast. That’s a point that couldn’t possibly happen, beating us to the end. So it ended up being an absolute race up this what’s called Molls Gap, which is like a really big, hilly part of it. And I remember he had like, he was like ;I’ll just set off from the rest stop I’ll meet you at the end’ and I was like ‘you will not – I’ll catch you, you’re not finishing ahead of me’. So I was absolutely racing to the top to catch him and I caught him at the end so we finished together.

Henry Goldstein: 2:17 But not every ride was racing around the Ring of Kerry. On this weekend, Caoimhe went to visit her dad.

Caoimhe: 2:23 it’s a nice area for cycling arranged, you know it’s it’s quite rural and quiet country roads and stuff. So he brought the bike down and we would have gone for a couple of cycles when I had gone down to visit or whatever. So we probably done a bit more cycling that particular summer. And that morning I remember driving up and it was miserable weather it was like really, really dark and rainy, and I kind of, my motivation for cycling was low. So I was like, ‘oh, maybe you know, I’ll go I’ll bring the bike and everything but like, maybe I’ll go and if it’s this rainy’. But I remember, like I drove in the driveway and dad was standing on the front door in all of his cycling gear like waving and I was like ‘oh no, I’m not gonna get out of this’. We cycled maybe 10 kilometres, maybe 15 kilometres, something like that to a little town called Cloughjordan, which is not that far from Moneygall, and dad had brought like a little lunch bag thing that he had tied onto his saddle somehow. And in it he had put like a mini-Magnum ice cream. So I was like, ‘what are you doing bringing ice cream on a cycle, but like, it’s obviously going to be melted?’. But anyway, so I knew that he had brought that. So we stopped when we got to Cloudjordan, and we said we’d have the ice cream or you know, we’d have a break. And he had kind of like been a bit slow, I guess. But it had been a few weeks, probably a couple of months since we’d been out cycling before., so I just thought it was probably you know, a bit slow. He said like when we stopped we were standing just on the side of the road, and he was like ‘I don’t actually really want the ice cream’. He’s like, ‘I don’t feel’ he didn’t say he didn’t feel well but he was like ‘I don’t really feel like it’. And he said, ‘God, I’m very unfit. I just can’t get my breathing right’. And I say, he looked fine at this point. It didn’t even enter my mind that there was anything wrong. He was 66 at the time, he had just turned 66 like the week before. You know he’s a slim guy, he doesn’t smoke. I said ‘well do you want to go back? We can just go back the way we came, if you’re tired’. Because I was kind of conscious that my sisters are always like, ‘don’t be running dad into the ground there, you know, he is in his 60’s. Like they would have said like ‘don’t don’t give them a heart attack, you know, don’t be making him cycle. I’d be like, that’s like he’s grand like. So I was kind of conscious of them saying things like that. I was like ‘yeah, we don’t have to push it like if you’re tired we go back’ and he was like, ‘no, no, I’m fine. I’m fine’. I ate my Magnum and he didn’t need his and we got on the bikes and we cycled a bit more. It wasn’t that much further along and it was windy and it was kind of rainy, so he was kind of slotted in behind me because we are kind of going up a slight hill I guess. I was cycling along and I kind of looked back then, and he wasn’t behind me anymore. I got off the bike, and I could see then that he was 20 or 30 metres behind me. And he had gotten off his bike and was walking with the bike. Like, I kind of knew something was wrong then when I saw him, you know. That would be very unusual for him to admit defeat, you know, that even if he was wrecked, he would never normally stop, you know, or get off the bike, he just wouldn’t. So I cycled back and I was like, ‘are you okay’? And he was still like, you know, he was walking, he was pushing the bike. And he was like, ‘Yeah, I’m fine. I’m fine. I just, I just can’t get my breathing right’. You know, he was like, ‘I’ll be grand in a minute. I just need to catch my breath’. He kind of we put the bikes down. And I said ‘will I ring Sheila?’ Sheila is my dad’s wife. I was like, ‘will I ring Sheila to come and collect us?”. He was like, ‘yeah, maybe do that’, which I was like, ‘oh, no, he’s definitely not feeling well’. He looked terrible at this point. Yeah, he looked really pale. And I was like, ‘Oh, God’. And then I said ‘will I ring Sheila or will I ring an ambulance, like, are you really not feeling well?’ And he was like, ‘no, no, just bring Sheila, I’m fine. I’m fine’. So I rang Sheila, and I knew I’m sure she was really worried when I rang her because that she would know that that was also very strange for him to be admitting to not feeling well enough to be collected. I said to her ‘dad’s not feeling well, will you come and collect us?/ And she said, ‘yeah’, and I remember saying to her, it’s like, ‘will you try and hurry like as quickly as you can’. And so I then just got off the phone and I sent her the location because I didn’t really know where we were, you know, so I, you know, you can send your location on WhatsApp. So I dropped a pain and I sent it. Then I went back to dad, there’s like ‘dad’. At this point he kind of he had started to get sick, like, he was like, get, like retching kind of and I said, maybe he’s got like gastro or something, you know, like, but he really looked bad. And then he’s like, ‘I just need to sit down’. So we sat down against the wall. I was like ‘Dad, have you any pain in your chest or anything?’. And he’s like, ‘no’, like, he’s like, ‘no, I’m fine. I’m fine’. He kept saying that he was fine. And then he tried to get up and he kind of fell over, kind of stumbled. So then he was kind of sitting on the ground. And then it was like, it was really like, in a movie or something where somebody literally just like, puts his he put his hand on his chest, and he just fell backwards and was clearly unconscious. Then I knew we were in big trouble. I had my phone in my hand, because I had been calling Sheila. So, you know, I like shook him or whatever. And I was, you know, shouting at him. And, like, I never thought in my head, ‘he’s in cardiac arrest’. You know, start CPR, like, it wasn’t really like that. I just started doing CPR because he just, I don’t know, I didn’t really know what else to do. I just, that’s just what I did. And so I put my phone I rang like 999 on my phone. I said to them, ‘my dad has collapsed, and I’m doing CPR’. And they said, you know, like, I can’t remember what they asked me, but they asked various things, you know, like, ‘how old is he? Where are you?’ And I kind of said, ‘look, I don’t know where we are, and we’re’ I said, ‘we were cycling and we cycled here. We cycled to Cloughjordan. And then we’. I like, I remember saying to them, like, ‘we were at the Spar, which is like a convenience store. And I was like, ‘then we turned left, and we cycled for maybe like three minutes, and then we’re there. So, like, we’re on that road. I don’t know where that is;. And so that was fine. And then he was kind of saying to me, you know, ;what are you doing?’ or whatever. And I said to him, ‘I’m a doctor, and I’m doing CPR’. And he was really good, you know, because like, like, at a few times, he made kind of weird noises, you know, kind of like some agonal breaths and stuff, and I kind of was like, it’s really off putting because you’re, you’re kind of like, ‘am I panicking here like, should I be not doing CPR? Like, or what should I be doing?’ And he was really going to be like, ‘no, just keep doing, like, is he breathing?’ And I was like, ‘no, he’s not breathing’. ‘Keep doing CPR’. So I kept, you know, it’s just it was really good to hear that, you know, just have somebody to be like, ‘you’re doing the right thing. Just keep doing it’. But then he kept asking me, he’s like, ‘is there anything around that could tell you where you are?’ ‘No, like, we’re there’s a field’. He was like ‘anything at all? Is there like house?’ That’s when I was like, ‘well, actually’, I had my back to the gateway, but there was a little house there. So I was like, ‘actually, there’s a house’. At this point. I don’t even like telling you this part of the story, because I still think ‘oh, God, should I have done this? Because I probably shouldn’t have’. But I was thinking like, ‘they’re not gonna be able to find us and you know what are we going to do if nobody can find us and I can’t you know, how, how long can I do this for?’ I remember looking at the door of the house and thinking…I was doing compressions and breaths. So I was like, ‘okay, it’s probably you know, like, I don’t know, maybe 10 metres away if even. And if I do my compressions, skip the breaths, run to the house and open the door, and then run back. How long will I be off the chest for? Probably the same amount of time as if I were doing the two breaths’. So that’s how I rationalised it in my head. And so that’s what I did. And I mean, I know I’ve done all my APLS, you know you’re not supposed to go off the chest all the time, you know, all that I do know. I made a call and that’s what I did. So I ran to the door of this house, and luckily it was not locked. And I just opened it and shouted ‘help! help!’ or whatever. And like kind of almost as I was running back to be honest, and all these dogs kept running out of the house. By the time that this lady came out, I was already back on the chest doing compressions. So this elderly lady came a house and was like, ‘Oh, my God, like, what is going on?’ And she came over. And I said to her as like, ‘I just need you to tell this person where we are’. And she picked up the phone and she was like, ‘I don’t know how to use these phones’. I was like, ‘you don’t need to use it’. I was like, ‘you just have to talk’ anyway, your man it was on speaker, so the guy on the other end started talking. And then she went kinda to the roads to explain where we were. But anyway, so then it was this lady whose name I don’t actually even know. She was talking to the paramedic on the phone and me doing the compressions. It was like that then for probably another 15 or 20 minutes. Yeah, she came back and like, yeah, it was it was nice that she was there then because then we knew they were on the way, you know. And then the guy was, he said to us, ‘you know, they’re, they’re on the way they’re on the way’ and she was just there. It’s funny, because like, it’s quite a lot of time. If you’re just doing compressions and there’s nothing else. Then she started like, she started talking to me. And she was like, ‘what’s his name?’ And you know, I told her my dad’s name. And then she asked, she was like, ‘where’s he from?’ Like, I was like, ‘what? When he’s from Moneygall, but he’s actually originally from Roscrea, which is up the road’ And she was like, ‘Oh, yeah. Costigan from Roscrea’, I think I knew your grandmother. And I’m like, just like doing CPR on the side of the road having this conversation about my grandmother with this lady. It was just ‘is this actually happening?’, like, you know, it was, it was obviously not a funny situation, but it was a funny scenario, I guess. And it was nice to have her there to just kind of talk, I guess. It’s very hard to know,the timeline of like, you know, how long each of those parts took. But I know that from the time that when I looked back at it from when I made the phone call to the time that the first people arrives was 22 minutes. The whole the whole thing when we were when it was just the three of us. Yeah, so the guards, which are the police were the first people to arrive. A guarda car pulled up and three guards came out. They had just a small defibrillator, like the one you know you do for first aid or whatever. So they they came over and I remember thinking they looked really young. And they were like, ‘we’ll take over’ and I was like, ‘well, has anyone done CPR before?’ and they kind of all looked a bit shocked. So I was basically like, ‘no, you’re not doing it’. But at the same time, I was kind of conscious that I had now, I knew I had been doing it for a long time. And I remember being worried that I didn’t feel tired. I remember thinking like, ‘am I not like’. Because I’ve done CPR before and you do get really tired, you know, like, quite quickly and I didn’t feel tired at all. So I was like, ‘am I not doing this right?’ You know, ‘why am I not tired?’. But I guess it was probably just the adrenaline because I just didn’t feel tired at all. I knew that it like I had an in my head that the longer I’m doing this, probably the less efficient like compressions are so I probably need to let these guys take over. So anyway, the third guard had come. He was basically like, ‘I can take over’ he was like, ‘I’ve done CPR before’. So he took over and then I just did the airway and he did the compressions and we managed that way. So it was just funny like I just remember thinking like before they had got there felt like a long time of just waiting. You know, the lady talking and stuff was was part of it. But yeah, there’s a lot of it where you’re just saying nothing and doing nothing, and just everything is quiet. And you know, just doing compressions. But I guess like you just think about like just do it as well as you possibly can. This has to be the best compressions that you ever did, because you know if you can do them perfect, like I remember thinking like ‘people, you know people can survive like out of hospital cardiac arrests and do okay if they have good quality CPR’. I remember being like ‘what what is good quality CPR? So I I just need to get my rate right and I need to get my depth right, like that is that those are the only two things that I can do. I can’t do anything else’. Like I mostly was thinking about, ‘just keep going maybe it will be okay’. You know, like very aware that A – survival from out of hospital cardiac arrest is not good. And B – the quality of outcome is probably not good either. You know, so did I discreetly think about those things? I don’t know. But definitely like that as time went on, like that was all early on. Like after the guards came and they put the defib on and it said ‘no shock advice’ for start, you know the way it does, its analysing or whatever and it was ‘no shock advice, continue CPR’. So we continued CPR and it did that. I think it did that a couple of times. And then a fire brigade arrived with the more paramedics and they had the proper defibrillator. So they changed it to that. And they kind of took over totally at that point when they got there. I completely kind of stepped back. They, like intubated him and you know, they continued doing CPR, and they had the proper defib on but they still weren’t able to shock him like. Quite a few times there was no shock advice. Like Sheila was going to arrive here now because there was loads people there now like the fire truck, there was like two ambulances, there was the guards. So I told them just to keep an eye out for her. But she hadn’t got there yet. And I remember being like trying to get them to give him adrenaline. I was like, ‘why are you giving them adrenaline?’, you know, ‘someone needs to put in a line, like I’ll put in the line myself’. And like, it was funny, like, they’re obviously probably used panicked relatives being around, and they were just basically ignoring me at this point. And I was like rooting through their bags, trying to find stuff to put in an IV line. There was no IV lines to be found, which was weird, but eventually they put in an IO. And I remember one of them was like, ‘he has an IO now, we’ve given him adrenaline’. And I was like, ‘yeah about time’. Anyway, then eventually, somehow the shocks started to be advised, and he got a few shocks, Then they put on the LUCAS device, like, you know, the compression, like the machine thing. So they had that on him and he was intubated. The longer that went on, the more I kind of, I guess I had a bit of time to process what was happening and I was getting more worried, you know, because I was like, ‘this is really long now’. And like as it got third, shock, fourth, shock, continue CPR they were kind of all looking at each other, you know. They said ‘we’re gonna have to call; this you know, this. Like, I don’t know, maybe I imagined that, but I do remember feeling like ‘no, you can’t stop, do not stop’. And then somehow they did it. You know, he got shocked and then somebody shouted is that they could feel a pulse. If I was one of them, I probably would have been also giving that look, you would for sure. But then at the same time, I was shouting at them like ‘don’t stop, please don’t stop’ which you know, in work and things when you you know what’s best – that we stop or whatever. And I didn’t maybe they weren’t even looking at each other like that. I don’t know maybe I imagined it. But I just I thought that they were you know. Then things started to settle down, and you know, he then he had a blood pressure and things started to be a bit more calm.

Henry Goldstein: 17:24 Finally, the helicopter arrives. And Caoimhe and her father are transported to the local hospital, to the cath lab.

Caoimhe: 17:31 You got a sense you know, we really didn’t know at that point, what the outcome was going to be, you know. At this point, he was alive, and that’s all we kind of cared about at that stage. But I guess then he went ICU for the next few days and what turned out to be weeks where we’re really uncertain, I guess. He had like an aspiration pneumonia and he had a few things and he was on a lot of a lot of inotropes and stuff the first few days. It was really every time I went in, it felt like the inotropes were like up a notch. And we were quite worried about him surviving those first few days. By the time he was extubated for a prolonged period, it was three weeks from when it first happened. It was only at that point, when he got to Dublin, they decided to do an MRI brain and the Neurology guys saw him, that his legs weren’t moving. He seems from here up, you know, to be perfect. He’s appropriate, you know, when they wean the sedation, or whatever. But they said his legs, there was a problem that you can get a spinal artery infarct from prolonged downtime and a cardiac arrest. And they thought that maybe that that’s what was going on. So he ended up having an MRI.

Henry Goldstein: 18:40. Amazingly, he had not only survived. He has made a striking recovery.

Caoimhe: 18:46 He’s delighted, like that’s what he wanted to do. So he love work. He was back 10 months, maybe 10/11 months after it happened. We can’t take any massive credit for how well he did because he really did it all, you know, himself. He can stand up now and he can walk with crutches. All stuff that we would never have thought that he would have been able to do from the beginning. Yeah, like he’s really I think it’s just I really think it’s just his pure determination, you know. And he seems to still be making improvement three years later now. I mean, it’s, it’s great to see him. He’s back. He’s driving, you know. And he’s really independent. And it’s great. I always thought about going back to that lady’s house to thank her because she was really helpful. And like we sent a message to her but I never went back there.

Henry Goldstein: 19:29 Thanks for listening. You can find more episodes of Only Human as well as details of events, courses and articles at DontForgetTheBubbles.com Until next time,