Waking up in a fog, Tom Malterer couldn't understand where he was, or why someone he knew was sitting nearby.
"That's Mike," he thought. "That's Mike Lucca. I know him. Our daughters graduated from high school together."
Malterer shared his recollection last week as he sat next to his wife, Bonnie, on the deck outside their Woodland neighborhood home.
Malterer knew that Lucca was a doctor, a cardiologist, at Essentia Health-St. Mary's Medical Center. What he didn't yet know on that June day a year ago was that Lucca had just finished placing three stents in his chest.
He didn't know how close he had come to dying.
Malterer's story is a testimony to the fact that modern medical technology can get a person through even the most dangerous form of heart attack if it's available and if it's put to use. It's also a testimony that even a seemingly healthy individual can face hidden dangers - and that even if we think we're basically healthy, we should listen to what our bodies tell us.
Malterer's story starts last year on June 21, a Wednesday, when he and Bonnie were at the downtown YMCA, working out. Earlier in the day, Tom, then 71, had moved red brick tile into place for Bonnie's garden, a portion of which is designed to reflect her passion for quilting.
It was their 31st wedding anniversary.
A month and a day earlier, Tom had hiked from the north to the south rim of the Grand Canyon, a distance of 24.3 miles with an elevation change of more than 10,000 feet.
The retired soil scientist made a point of staying in shape. He was a "highpointer," well on his way to hiking to the high points of each of the 48 contiguous states. Over the previous three weeks, he had experienced some pain in his shoulders and some brief pains in his lungs, he recalls. He figured it was just incidental, age-related training pains.
A stress test five years earlier had revealed no problems. He had no family history of cardiac ailments.
Both Bonnie and Tom recall now that they had noticed a grayness to his pallor. She thought it was because he stayed out of the sun because he was at risk for skin cancer, Bonnie said. "And Tom said he just thought he was getting old and ugly."
On that June 21, they followed the routine at the Y that they follow every Monday, Wednesday and Friday. Finished, Tom checked with Bonnie, who was still on a stationary bike, and told her he'd meet her in the car.
"And (I) went into the shower and went up to reach the lock in my locker - totally went out," Tom related. "Lights went out."
It was just before 9 a.m., and Emily Boyle was wrapping up her early morning shift at the Y when she heard someone tell her supervisor that an ambulance was needed, she recalled last week. Then someone called for an AED - automated external defibrillator, used to shock the heart in an attempt to restore a normal heartbeat when an individual has gone into cardiac arrest.
Boyle, now 23, had never used an AED or performed CPR in a real situation. But she was well-trained for such an eventuality. She'd been serving as a sports medicine intern at the University of Minnesota Duluth, from which she now has graduated with a degree in exercise science.
She returned to the front desk, grabbed the Y's AED and headed toward the men's locker room. She recalls a bystander, former Police Chief Scott Lyons, shouting, "There's a girl in the room," as she arrived. But she was intent on her mission.
"It was second nature," Boyle said. "I went down on the floor, cut his shirt off while the other gentleman was doing compressions. I put the AED pads on, and then I took over with compressions."
She saw Max Rubesch, a lifeguard at the Y, next to her, performing rescue breathing. The AED, which is equipped with audio prompts, instructed her to apply a shock.
"We made sure everything was clear, and I pushed the shock button, and I delivered a shock to Tom," Boyle said. "And we started another round of compression. I don't think I even made it through five, and he had gasped for breath and come to."
Personnel from the Duluth Fire Department and Gold Cross Ambulance quickly arrived and took over. Boyle returned to the lobby, and then she realized no one had told Bonnie. She ran up the stairs to the second floor, where Bonnie was still on a stationary bike.
"How do you tell someone that her husband just had a heart attack?" Boyle recalled thinking.
Bonnie recalls getting the news from Emily and following her numbly to the locker room. She recalls the paramedics asking her questions and asking Tom if he could hear them. She heard a recorded voice, but didn't understand until later that it was the AED's prompt. She remembers Lyons and other friends gathering around.
'This lucky guy'
Gold Cross took Tom to the St. Mary's emergency room. Bonnie, now 70, retired from St. Mary's eight years ago and knew the ER pretty well, she said.
"And I was really proud of how it all went," Bonnie said. "Big team of doctors, nurses. I didn't know who they all were. But one guy said, 'Well who is this lucky guy?' "
When they heard comments about "luck," both Tom and Bonnie thought people were referring to their wedding anniversary. It wasn't until later that they understood how lucky they really were.
Tom had suffered an ST-elevated myocardial infarction episode, or a STEMI. It's considered a particularly deadly form of heart attack because it means an artery to the heart is completely blocked.
It would not be long before the Malterers would more fully understand how serious the situation had been. It happened when they were approached by one of the cardiac nurses.
"He said if this had happened any other place, in your garage, while you were driving - whatever," Bonnie related. "He said this would be a different story, and your family would be making difficult decisions."
Kim Harkins, program manager for the Minnesota Resuscitation Consortium, said the survival rate in Minnesota for someone who has suffered a cardiac arrest - meaning he or she is unresponsive - is 14 to 15 percent as a whole.
But the sooner an AED is applied, the better the outcome, she said. For every minute of delay, there's a 10 percent lower chance of survival.
"So it's pretty significant when you can have them on site in public buildings because now you see somebody collapse, somebody starts CPR and says go get the AED, by the time you get back and forth in maybe one to two minutes, you're looking at a survival rate of maybe 80 percent," she said. "If an AED is applied early, we start to see those chances of survival improving."
Tom Malterer not only survived, he thrived. Three or four hours after he was brought to the hospital, he started to feel hungry. Two days later, he was discharged from the hospital. In about a week, he was walking with his daughter to three more high points - Tennessee, Georgia and South Carolina - bringing his total to 43.
He used to gear his training toward preparing for big climbs, but now Tom trains more consistently. Wearing a backpack filled with 20 pounds of rice, he walks 3.3 miles early each morning in his hilly neighborhood. He initially wore a heart monitor at all times but now goes with a Fitbit. He stops and rests if his heart beat reaches 120 per minute, but that has happened only once. He takes beta blockers and was taking blood pressure medication, but no longer needs the latter.
In November, he asked his cardiologist if there were any restrictions on his activities.
"He said, 'No restriction,'" Tom related. "I said, 'Sometimes I'm a mountain climber.' And he said, 'Listen to your body.'"
This year, June 21 comes on a Thursday, not their normal 'Y' day. But the Malterers will stop in that morning, along with Boyle, Rubesch and the first responders who came to the rescue. They want to "celebrate the competence of all those involved," Tom wrote in an email.
The others will see what they've come to expect: a lean 72-year-old man with a healthy glow to his complexion.
That's one thing that changed right away, Bonnie said. "When they brought him back into the coronary care unit I said, 'You've got color again,'" Bonnie recalled. "Here he comes out of the cath lab, and he's got pink cheeks and color in this face."