Cari MacLean’s near-death experience

Many people who experience a pulmonary embolism die before they make it to the ER. Cari MacLean was lucky

Cari MacLean's near-death experience

Source: Best Health magazine, March/April 2014; Image: Raina & Wilson

It was a Tuesday evening when Cari MacLean called 911. The day before, Thanksgiving Day 2012, the hockey player, marathoner and wife of 28 years to CBC’s Ron MacLean of Hockey Night In Canada, had felt a cramp in her calf.

It was the sensation she’d had the previous April, after a flight to Vietnam. She texted her friend to say she was going to skip hockey. After Ron left their home in Oakville, Ont., to play in his own game, she ran a bath to try to loosen up her calf. That’s when, overcome by nausea, she started to vomit. She pulled herself out of the tub and looked in the mirror. She was shocked: Her face, drenched in sweat, was white as soap.

From her ensuite bathroom, Cari looked over at her bed, a few feet away. She couldn’t imagine summoning the strength to make it that far. She gathered some towels and made a makeshift bed on the floor. She lay down and curled into the fetal position. Then she heard a voice. No, it said. Get up, get dressed, call 911. She felt hypnotized. Everything in her body wanted to lie down, but the voice kept insisting: Get up, get up, get up.

Cari’who had cancelled the land line years before’could picture her cellphone down in the kitchen. She pulled on what clothing she could and crawled on all fours, taking the stairs step by agonizing step. When she finally reached the phone and called 911, the operator asked if the patient was still breathing. ‘I’m the patient,’ Cari said weakly. ‘I’m in trouble.’

At the ER

When paramedics wheeled Cari in, Dr. Mangesh Inamdar knew something was very wrong. Her face was drained of colour and her pulse was almost non-existent. Most worrying was her blood pressure. For a woman her age, 50, it should have been 120 systolic. Cari’s was 60’frighteningly low. That suggested a few possibilities: ruptured aorta, internal bleeding, fluid around the heart, septic shock or a major heart attack. The possibility that Inamdar kept coming back to, however, was a massive pulmonary embolism (PE).

A PE occurs when a blood clot, generally in the calf, works its way up the circulation system and blocks the blood vessels in the lung. It isn’t pretty, and death comes quickly. Many never make it to the ER’they die at home or in the ambulance. In fact, in his 14 years as an emergency physician, Inamdar had never seen anyone survive.

But as he continued to investigate, he began to have doubts. Because a PE starts as a clot in the leg, usually a patient will have a swollen calf. Cari’s calves, however, were perfectly symmetrical. Another telltale sign is troubled breathing, but Cari told him she didn’t feel any pain in her lungs. She had felt shortness of breath, but she’d also had sniffles and had been vomiting’symptoms that pointed toward a virus.

Inamdar was confused. A CT scan could reveal the truth, but Cari was so unstable he couldn’t risk bringing her out of the ER. Another sign of a massive PE is a low oxygen level’and when Cari was checked, the results were astonishing. While oxygen levels for someone as physically fit as Cari could exceed 99 percent, the earlobe monitor was telling Inamdar that Cari was at just 30 percent. The result was basically incompatible with life.

The diagnosis

Not long after Ron arrived in the ER, things started to get worse. Cari had now been in the hospital 20 minutes and had started to shake wildly. Inamdar knew that 70 percent of patients who die from a PE die within the first hour. If that was what she was fighting, he needed to act. The treatment for a PE is a thrombolytic’a drug that dissolves blood clots and would, with a bit of luck, clear the pathway to the lungs. But if Cari didn’t have a PE and was actually suffering from some sort of internal bleeding, she would bleed out, and Inamdar and the nurses would be helpless to stop it. So, if his hunch was right, the thrombolytic could save her. But if he was wrong, it would kill her.

Inamdar conducted an ultrasound, desperately searching for new information. Cari didn’t have any blood in her belly, which ruled out internal bleeding. He looked more closely at her heart. Cari’s right ventricle seemed to be larger than her left, a sign of PE. It was the nudge he needed. ‘We’re giving her the thrombolytic,’ he said. Once he started the treatment, there could be no turning back.

Ron didn’t know what a PE was. But as Inamdar gave the order, Ron realized the situation was grave. The nurses gave Cari the drugs through her IVs. She’d now been in the ER for 40 minutes, and everyone was watching her bedside monitor. Ron didn’t know what to look for, so he and Cari locked gazes. High-school sweethearts in Red Deer, Alta., they’d been together ever since. Now, both of them understood this might be the last time they’d stare into each other’s eyes. The machines beeped and Cari’s vital signs flashed across the screen. Finally, one of the nurses smiled and said, ‘This is good.’ Cari’s blood pressure and oxygen levels were rising. She was coming back.

Minutes from death

Later that evening, when Cari was stable and Inamdar was certain she had escaped the worst, she finally got her CT scan. It showed a big clot in her artery as well as many smaller clots in her lungs. It was enough to piece together a theory about what had happened. Inamdar explained that blood had clotted inside a vein in her calf during her flight to Vietnam in April. (Because of altitude, dehydration and cramped conditions, up to five percent of air travellers end up with clots.) One broke off and slowly worked its way into her lungs, causing her fatigue and breathing troubles. As Ron and Cari studied the scan, Inamdar didn’t need to say what all of them now knew: She had been minutes away from death.

A new lease on life

For the next few months, Cari slowly came to terms with the enormity of what had happened to her. As she recovered, an anxiety remained. She felt reluctant to return to running. The idea of lungs aching for breath was too frightening. But finally, with much encouragement from Ron, she laced up her shoes again. It was spring, after a winter that seemed like it would never end, and the crab­apple trees were in bloom. As Cari jogged through her neighbourhood, past the tidy lawns and brick houses she had seen for years, everything looked new.

‘The clichés about near-death experi­ences are true,’ she says. ‘I look at things differently now. I feel like I’ve become very small and big at the same time. Small in the sense that this is what life is all about’right now, right at this moment. But I also appreciate how much bigger everything is. Our lives are just specks, just temporary.’

Warning signs

Each year, more than 60,000 Canadians are hospitalized for pulmonary embolism (PE), a lung artery blockage caused by a blood clot that has travelled from another part of the body, usually the legs. The larger the clot, the greater the danger, with more than 10 percent of cases ending in death. Risk of PE increases if you smoke, are overweight, are pregnant, take birth control pills or have recently had surgery.

‘ Small PE symptoms are unexplained calf swelling, laboured or pained breathing (caused by dead lung tissue) and coughed-up blood. Go to an ER. If caught in time, a small PE can be treated with blood thinners.
‘ Large PE symptoms are sudden light-headedness, shortness of breath, weakness, loss of colour and intense perspiration. Call 911. Any delay may prove fatal.

Tips for safe flying

Long-haul flights (four hours or more) can trigger blood clots known as deep-vein thrombosis, the condition that precedes a pulmonary embolism. Here are some ways to avoid this:

‘ A single 81-mg dose of Aspirin
a half-hour before boarding the plane can help thin the blood.
‘ While you’re on the plane, a few minutes of low-intensity activity every two hours will boost your circulation. Consider a quick walk up and down the aisle, or a simple flex-and-point exercise with your toes.
‘ Stay hydrated. Drink fluids regularly during your flight, and go easy on the booze.
‘ Be aware of changes in your calves in the months following the trip. Any swelling could be the telltale sign of a clot.

This article was originally titled "At death’s door" in the March/April 2014 issue of Best Health. Subscribe today to get the full Best Health experience’and never miss an issue!