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Interviewer: We're with Dr. Troy Madsen, emergency room physician at the University of Utah Hospital. You think of the emergency room, you think of all the extreme cases that might come in, but there's another extreme situation that can happen. And I'm talking about extreme recoveries, like recoveries that maybe even the physicians didn't expect to happen. Have you ever seen any of those types of things?

Dr. Madsen: I have, and that's probably the most rewarding thing, when you do see that because a lot of times we do stuff. We'll see a lot of things, we try and take care of things, we try and help people but sometimes you ask, "What am I really doing? Am I actually making a difference here?"

Interviewer: Yeah, because a lot of those situations is it past the point of where . . .

Dr. Madsen: Yeah, a lot of times it is. You might do CPR and they might get a pulse back but then you realistically look at the situation and you say, "The chance that they're going to have a good recovery is slim to none." And that's frustrating. We'll see strokes sometimes, where you try and do what you can, but again, and they may be outside a window to actually give them medication to treat them.
So once in a while you do have those cases where it is very rewarding, and I remember one case in particular where an individual came in by ambulance, lost his pulse in the ambulance. He'd called the ambulance for chest pain, they'd started C.P.R. on him, we got him, we continued C.P.R., shocked him, shocked this heart several times.

At that point, he did get a heartbeat back and we got him upstairs and admitted. So we'd been doing C.P.R., between us and the ambulance, for about 15 minutes. Two days later, he walked out of the hospital, totally fine, back to normal. I mean, when you see that kind of thing, that's the real reward. And you say, "Wow, that's incredible."

Interviewer: So, give me perspective. Fifteen minutes without a heartbeat, right?

Dr. Madsen: Yeah. Fifteen minutes without a heartbeat.

Interviewer: How long could you normally go and expect a decent recovery without a heartbeat?

Dr. Madsen: Well, it depends if someone's doing C.P.R., and the thing that made all the difference in the world here is that it happened when he was in the ambulance and immediately the E.M.T. started C.P.R., started great chest compressions, so essentially that functioned as his heartbeat. It kept blood flowing through this body, up to his brain. We were able to continue that, very effectively, as soon as he got there. We shocked him as soon as we saw he had a heart rhythm that we could shock.
Had to do it a couple times, but got him back into a normal heartbeat, and just the fact that he continued to have that blood perfusion made the difference. Now if he hadn't had that, if he had been down for, say, five minutes without any chest compressions at all, no blood going to his brain, things would not have been the same.

Interviewer: Yeah. So after you got done treating him, did you expect that type of a recovery? Did you expect two days later he'd be walking out?

Dr. Madsen: Absolutely not. That's what was so amazing. I did not expect that. And maybe it's because we've done C.P.R. so many times. Occasionally, you will hear of the case of someone who does have a partial recovery or does okay, relative to what could have happened, but for someone to be completely back to normal two days later, walking out of the hospital, that's pretty incredible. So once in a while you do see these sorts of things.

Interviewer: Do you have another story of a miraculous recovery?

Dr. Madsen: One other story, and this individual was a student, came to the emergency department, probably the sickest patient I have ever seen from appendicitis. This was a young, healthy patient and it was so funny because he's in his room and I look at him and I think, "Wow, he is incredibly sick."
And his heart rate was up at 130; normally we expect it less than 80. His blood pressure, his systolic blood pressure, was less than 90. Typically, you're going to expect something above 120. His white blood cell count was super high. He looked sick.

Interviewer: Yeah.

Dr. Madsen: And I have never seen anyone who had appendicitis as severe as he did. The best part of all is his he had tests coming up soon. He's sitting in his room in the E.R., reading through his books to study for his test. I told him, I said, "I don't think you're going to be taking your test tomorrow. I don't think this is going to happen." He was in bad shape. We ended up giving him antibiotics, he ended up going to the operating room and he just really had an incredible recovery.
When I saw him initially I thought, "Wow." I didn't know what was going to happen. I thought, yeah, he's going to live but he's sick. He is really in a bad situation here, and like I said, I've never seen a case of appendicitis that bad, because it was his appendix that was the source of all this. It's funny because over the years I've seen him and talked to him and I've had a chance to work with him here and there and we've talked about everything that happened. So it was really incredible to see that then be able to work with him over the years after that.

Interviewer: Did you give him a doctor's note to get out of that test?

Dr. Madsen: I did. He didn't need a doctor's note. He was in the hospital and there was no way that he was leaving, even if he wanted to. I guarantee he wanted to.

Interviewer: Yeah, well, that was pretty funny. So it must be really rewarding when you go through all this extra effort, just hopefully sometimes, to see those kinds of results.

Dr. Madsen: It is. And that's another one of those things that was a case of abdominal pain, and we see lots of abdominal pain where it just ends up being nothing or we diagnose them with something and say, "Well, not a lot we can do about it." But that was a case of abdominal pain, obviously, where we jumped right on things, we got him treated quickly and I feel that made a huge difference for him. It was then very rewarding to be able to interact with him and work with him over the years after that.

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