A man slumps to the ground at an L.A. Kings hockey game. Sujal Mandavia responds in seconds, knowing the man’s life hangs in the balance.
It was pre-season for the L.A. Kings ice hockey team, and Sujal Mandavia was in attendance with his wife. They were season ticket holders and Mandavia, a practicing emergency physician in Los Angeles and a senior VP for TeamHealth West, occasionally helped on the stadium’s medical team.
Call it providence, call it luck, but at one particular moment during the game, Mandavia looked away from the action on the ice and noticed something that just didn’t seem right. There was an older gentleman in his 70s sitting with his grown son just a couple rows ahead. Something about his posture set off warning bells in Mandavia’s brain.
“It’s hard to explain but ER doctors, they know the look,” he recalled later. “There’s a look people get when something bad is going to happen. People start to lose some of the muscle tone in their face. The color changes and you can tell that they’re probably not perfusing their brain as well as they should.”
He kept his eyes on the man and then quickly noticed that he wasn’t responding normally to his son, who was chatting with him while watching the game.
“That’s when I was like: Something is about to happen.”
Fifteen seconds later, the man slumped backwards in his chair, his baseball cap falling to the ground. The man’s son began shaking him, yelling, trying to wake him up. People nearby began to scream, “Oh, my God, he’s choking!” Mandavia knew he wasn’t choking – he hadn’t even been eating – but was rather having a cardiac arrest.
To Mandavia, the situation felt simultaneously familiar and foreign – a common emergency in the ED in a completely new environment, without a team or equipment. He responded instinctually, silently stepping over two rows of chairs and taking charge of the situation. As he climbed over the final chair he reached out and touched the man’s neck to check for a pulse. Nothing.
He knew that they needed to get the man into a position where CPR could be started as quickly as possible. With the help of the man’s son, he shoved the man in arrest down in between the seats, onto the ground. Within 10 seconds of the arrest, Mandavia was on top of the man, jammed between two rows of chairs, administering CPR.
The first minute passed without many words exchanged. Mandavia knew what needed to happen and worked efficiently, knowing that he couldn’t delegate the first critical steps of the rescue. But once CPR was started, Mandavia began engaging the crowd around him.
“There were so many people who wanted to help but nobody wanted to go first,” he remembers. “I’ve been doing this for a while and I didn’t appreciate the differences between what we have a comfort level with as emergency physicians and what others have a comfort level with. I was able to kind of break the ice by jumping in and getting things started. I think that’s a unique gift that we get as emergency physicians.”
Once he broke the ice, multiple qualified healthcare providers surfaced to help, including an OR nurse and an EMT.
Mandavia kept up CPR while instructing the man’s son to get security, and to find an AED. But when security arrived, they had no idea what he was talking about.
“They didn’t know what the AED was. I used about 20 different descriptors and phrases and it was just kind of blank stares.” So his wife, a Physicians Assistant, ran to find an AED – a search that took her to an entirely different level in the stadium.
While his wife was away and Mandavia continued CPR, a man approached and declared that he was a cardiologist.
“I had not told anybody I was an ER doctor,” recalled Mandavia. “I was just doing what needed to be done and kind of directing some of the volunteers. So the cardiologist comes down and says: I’m a cardiologist. Step aside. I was like: Well, I’m an emergency physician.” After observing for a moment, the cardiologist said, “I don’t think he’s getting the right quality CPR. Stop CPR. I want to check his pulse.”
“That’s when I knew this guy had probably not been to an ACLS class in about ten years.”
Four minutes into CPR – still waiting on the AED – and the stadium erupted in cheers. The Kings had scored a goal. Mandavia glanced over his shoulder at the scoreboard, it was Tanner Pearson who had scored. He knew that they were administering good CPR and if he just crained his neck over a little he could catch the replay…
“I saw a glimpse of it on the jumbotron. But I was like: No, no, I can’t – I got to stay focused.”
By the time the AED finally arrived, the entire section was standing up watching the scene unfold. Even people from the other side of the stadium were paying attention. Mandavia asked the EMT to continue CPR while he put the AED on the man. The man responded to the first shock, but he didn’t wake up.
“This was concerning to me,” said Mandavia, who had been coding the man for about nine minutes at that point.
“I just wasn’t sure; we kind of passed by that anoxic threshold and I wasn’t sure if he was going to survive long-term.”
But the man turned a corner and regained a pulse after being defibrillated. At this point, Mandavia was ready to throw him on a stretcher and get him out of the building and to an ER. As it turned out, the Kings had their own paramedic unit and ambulance on call within the building, but it was reserved for players. So instead of using the stadium ambulance, they had to simply call 911, as they would in any other emergency, and get EMS to come into the stadium.
“We’re lucky, we have good response times in downtown Los Angeles.”
In the end, the paramedics who are in-house for the players did get involved and helped with transport, from his seat to the hall and down to the basement to meet the incoming EMS team. The season ticket section breathed out a collective exhale and sat back down to watch the conclusion of the game.
Later that night, Mandavia called up the ER where he knew the man was taken to learn a bit more about his case. He knew it would be a STEMI, and new that recovery wasn’t guaranteed, but he gave his phone number to the administrator of the hospital to give to the ICU staff so that the family could call him with an update if they wanted.
Two days later, Mandavia got a phone call from an unknown number while sitting at his desk at home. When he picked it up, a gentleman said, “Were you the ER doctor at the Kings’ game a couple of nights ago?”
“I said: Yeah, I was,” Mandavia remembers. “I thought it was the son, probably calling to tell me his dad was in a coma or he didn’t make it.” He knew that the man’s odds of survival had been only slightly north of 50 percent on average.
But the voice belonged to the father. He started to tell Mandavia everything he remembered and everything he went through. He thanked Sujal for saving his life.
“It was the most amazing thing to hear this guy’s voice. I only knew him when he was arrested, when he was dead basically. I’d seen the scenario enough times.”
The man told how he’d gone into V Fib once more while in the ED, and was shocked a second time. He was taken to the cath lab and then began a speedy recovery in the ICU. When he called, he was preparing to leave the hospital, fully recovered.
As they talked, their voices began to shake slightly with emotion.
“I told him – because I really do feel this way – that I feel like what I got was a gift. It really validated everything we do as a profession, everything I’ve done individually, all the nights you toil; it’s like everything crystallized in that one moment.”
“It’s these moments, right, that’s why you went into the specialty and that’s why you do it. And what I saw is that I was never really allowing myself to fully access the opportunity that’s there; to kind of recharge your batteries. Because the other 90 percent of the time, it’s a grind. It’s these moments that actually keep you going. And I really do truly believe this is what helps prevent burnout because this is actually what we signed up for. But we don’t get to do what we signed up for very often. And if you don’t actually jump in with both feet and you don’t open yourself up in those moments, you’re not really getting back from it what you could.
Sujal met the son at the next game, their seats just a few rows apart. When the man saw the physician, he couldn’t speak. He just hugged him and began to cry.
“Quite honestly, my wife getting that AED is actually what saved his life,” said Mandavia. “I just gave him the chance to have his life saved by getting that CPR going.”
“What was great – and what we don’t typically get as emergency physicians – was the bond and an ongoing relationship with somebody’s life that we saved. I certainly don’t consider myself a hero in this because any emergency physician could have and would have done the same thing. This was a gift to me because I happened to be at the right place at the right time. He knew there were a lot of healthcare providers involved in his course from start to discharge; but he said he recognized that what I did was actually what saved his life. And that felt really amazing.”
Emergency medicine is full of everyday heroes. Lives are saved, families restored, and the emergency department staff just goes back to the rack for more. No standing ovations – rarely even a thank you.
If there’s a member of your team who deserves credit for saving a life, or simply for being an everyday hero in the emergency department, we’d love to hear their story, and consider telling it in these pages.
Write to Logan Plaster: firstname.lastname@example.org