There are five days in November that Denise Leary cannot account for.
She suffered cardiac arrest, her body temperature was cooled by emergency health care workers to slow damage to her brain, and she was put into a coma.
“I remember waking up at the hospital on Saturday,” said Leary, 52. She had suffered the cardiac arrest on the preceding Wednesday.
“My family was telling me that I almost died,” Leary said. “I don't even remember being sick the night before.”
She remembers Munroe Regional Medical Center doctors telling her afterward that they cooled her body temperature about 5 degrees to slow damage to her brain. When the heart stops beating oxygenated blood, neurological damage quickly ensues.
Leary is a success story for Munroe's new program addressing cardiac arrest cases. The hospital now coordinates among its departments the cooling process that slows brain damage and gives the heart time to send new oxygen-rich blood throughout the body.
Dr. Frank Fraunfelter, medical director of emergency services at Munroe, said the cooling process isn't new. But the organized protocol — which also involves neurologists — is new.
The cooling regimen gives many patients hope that wasn't there before.
Fraunfelter said patients receiving the hypothermic treatment do between 40 percent and 60 percent better than those who don't have their bodies chilled.
Ocala Regional Medical Center said it is currently working to develop a similar cooling protocol.
To understand the severity of cardiac arrest, it's important to distinguish it from a heart attack.
A heart attack occurs when there is a blockage in the heart. But the blockage does not keep the heart from beating, and some oxygenated blood can still reach the brain and other parts of the body.
In most cases, people having heart attacks are conscious and talking, Fraunfelter said.
With cardiac arrest the heart stops beating altogether and, often within a few minutes, the patient is dead or severely and permanently impaired.
Last year, the American Heart Association published a study showing that the survival rate for someone having a cardiac arrest outside of a hospital was less than 10 percent. During that year, there were nearly 360,000 people who had a cardiac arrest.
In comparison, of the more than 700,000 people who have heart attacks in the United States annually and are taken to a hospital, 95 percent survive.
Even if a patient suffers a cardiac arrest in the hospital survival is not guaranteed. The study reported that there were 209,000 people with cardiac arrests in the hospital during 2013. In those settings, adults had a 24 percent survival rate and children a 40 percent rate.
Fraunfelter said survival tells only a small portion of the story. In almost all cases, Fraunfelter said, there is significant neurological damage among cardiac arrest survivors.
One 2008 study published in the journal Neurologic Clinics reported that only 3 to 7 percent of people surviving a cardiac arrest return to their previous level of functioning.
That is why it is important for Munroe to have a coordinated program to cool cardiac arrest patients, Fraunfelter said.
Only about a quarter of people know most of the signs of a heart attack, according to the American Heart Association.
In Leary's case, a cardiac arrest was the last thing she or her husband, Shawn, expected.
During the evening of Nov. 12, Leary wasn't feeling good. She had joint pain and felt a little pressure in her chest. She didn't sleep that night.
But instead of heart problems, Leary and her husband thought the symptoms were a result of a recent increase in her estrogen medicine.
Her doctor thought it was the flu, Shawn Leary said.
The next day he drove his wife to Express Care of Ocala on Southwest First Avenue. Shawn Leary, also 52, is a Publix grocery store employee. They thought she would get treated for the flu and leave.
Shawn Leary parked the car and started walking for the clinic's door. But his wife wasn't beside him. She was slumped over in her seat where he had left her.
“I went into a state of shock and tried to comfort her, not knowing what was happening,” Shawn Leary recalled.
By chance, there was an ambulance at the clinic. An emergency health care worker started CPR. It took two attempts with a defibrillator to start Leary's heart again.
In the ambulance, on the way to Munroe, her heart stopped again.
What the Learys didn't know was that Denise's left main coronary artery was fully blocked.
“In May both Denise and I had been through stress tests and complete cardiac workups and cleared with no complications,” Shawn Leary said.
“They started chilling her even in the ambulance … and again in the hospital,” he said. “That was scary for me too because when I touched her, she actually had a cold body.”
That Saturday, Munroe doctors stopped the cooling process and waited for Denise Leary to regain consciousness and see what the damage was.
“I was sitting beside her bed and I was telling her, 'I love you. I love you' and then she mouthed, 'I love you, too,' ” Shawn Leary said.
Denise Leary was able to respond to questions and interact with her family and medical staff.
Fraunfelter said her recovery was due to the quick care she received and the cooling process that slowed any chance of brain damage. Without the immediate care and cooling, the story would have ended differently, Fraunfelter said.
Shawn Leary gives credit to God.
“She's a walking miracle,” he said of his wife.
Denise Leary said she has no neurological problems and she's scheduled to begin a new job next month.
“I'm fine,” she said, expressing gratitude. “I couldn't have asked for any better (than the Munroe staff). It was outstanding. A great big thank you.”
Contact Fred Hiers at 867-4157 or email@example.com.