How Emergencies Can Strike

Could Jack on ‘This Is Us’ Have Been Saved?

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By Henry Ford Health System Staff

WARNING: SPOILERS AHEAD.

“This is Us” fans knew it was coming. The Emmy-award winning television show alluded to beloved father Jack Pearson’s death for months.

But was the episode that finally showed how Jack died – from a “widowmaker” heart attack after breathing in smoke trying to rescue the family dog from a house fire – realistic? Or, more importantly, could Jack have been saved?

Long-time Henry Ford Hospital emergency room doctor Frank McGeorge, who also shares medical advice as a health reporter for NBC’s Detroit affiliate, WDIV, said that depends.

“While it’s not impossible for it to play out that way, it’s pretty unlikely,” Dr. McGeorge said about the show’s storyline. “The circumstances would have had to align just right for that to be an unsurvivable circumstance. More often than not, when someone has a witnessed cardiac arrest in the hospital, in the ER, and gets immediate attention, we will be able to do something. Their chances of survival are pretty decent.”

After leading his family through the flames, then escaping himself with the family dog, Jack seemed fine. He agreed to go to the hospital to be checked out, with a little coughing from the smoke. After checking him out, doctors told him it seemed he could go home.

But as his wife called their children with an update and grabbed a candy bar from a snack machine in the ER waiting room, a handful of doctors start rushing around in the background. Just as she’s ready to take her first bite of the candy bar, the ER doctor comes out to say Jack has died from a heart attack, blaming it on “the widowmaker.”

What is a “Widowmaker” and Could Jack Have Been Saved?

Henry Ford cardiologist Karthik Ananth, M.D., explains that heart condition – a  large heart attack due to sudden blockage of the left coronary artery – is possible.

“With smoke inhalation, the heart works harder to help deliver oxygen,” Dr. Ananth said. “So if you have an underlying lesion, it can precipitate a heart attack.”

But, typically, when a patient with smoke inhalation seeks medical attention, they will be given oxygen, have their vital signs and symptoms checked, and be monitored with an electrocardiogram (EKG). These would have picked up signs of an issue and signaled a need for further treatment if an acute heart attack was evolving.

“Typically, the medical team would stabilize the patient and take him or her right to the heart catheterization lab, if complete blockage is suspected in the setting of a heart attack,” he said, adding that heart monitoring after such a stressful event is a good way to rule out larger problems. “I’ve had patients in the same scenario: they had smoke inhalation, they had an EKG and blood tests, and stayed overnight before going home.”

Dr. McGeorge added that a patient with blockage that severe may already have been experiencing symptoms like chest pain, shortness of breath or heart palpitations.

Another issue from the show was timing, both doctors agreed. Although it was a dramatization, the time the doctors worked on Jack equaling the time it took wife Rebecca to make a phone call and buy a candy bar was unrealistic.

“For an average-age or younger-age person, we’ll work on them for 30 minutes or an hour, depending on the circumstance,” Dr. McGeorge said, adding that treatment entails a combination of CPR, medications and shock treatments. “It’s highly variable, and it depends on the response and the rhythm. But minimally, you would go for at least 20 minutes. But most people would try harder in a younger patient.”

Even back in the 1990s, the episode’s setting, cardiologists would have used CPR, shock treatment and catheterization to treat someone with Jack’s condition.

“The medications may not have been as advanced as they are now, but cardiac shock, the CPR concept and catheterization were all available,” said Dr. Ananth. The first angioplasty to treat blockage causing a heart attack was done in 1977; stents were first used as a treatment tool for coronary heart disease beginning in the 1986 but for a heart attack was first used in 1991, he added.

Lessons to Learn From the Episode

Accuracy aside, Dr. McGeorge said the episode is a good reality check that not all endings are happy – on television or in real life.

“Television medical dramas often depict an uncommonly rosy survival,” Dr. McGeorge said. “This is an appropriate recalibration of expectations.

“While your chances of survival in a scenario like this are decent, nothing is 100 percent,” he added. “There are things that happen in the hospital, with the best care available, that are unrecoverable situations. It does happen. And that’s an important lesson. There are things that modern medicine cannot fix. And that may have been one of those times.”

Concerned about your own or a loved one’s risk for heart attack? Take the heart risk quiz to find out. Then, schedule an appointment with your primary care provider or find a heart expert at henryford.com or by calling 1-800-HENRYFORD (436-7936).

Dr. Frank McGeorge is an emergency room doctor at Henry Ford Hospital in Detroit.

Dr. Karthik Ananth is a cardiologist, specializing in cardiovascular imaging, coronary disease and adult congenital heart disease, and sees patients at Henry Ford Hospital in Detroit and at Henry Ford West Bloomfield Hospital.

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