When Seconds Count - Nancy Twenter's Story

Nancy Twenter, 69, of Lebanon is no stranger to heart trouble.

Twenter had a stent put in to open up an artery eight years ago, and suffers from angina. Her St. John’s cardiologist, David Cochran, M.D., once told her how to recognize the symptoms of a heart attack: “You’ll feel like an elephant is sitting on your chest,” she recalls him saying.

On May 19, 2006, Twenter woke up around 6 a.m., not feeling “right,” she says.

“I was uncomfortable, but I couldn’t put my finger on it,” she says. “So I took an aspirin and my blood pressure medicine and I went back to bed.”

At 8:10, Twenter awoke to a feeling she describes as “a gorilla hugging me.” She decided that was close enough to Dr. Cochran’s analogy, so she told her husband Neil to call 911. She says she was certain she was having a heart attack and sat down on the couch to wait for the ambulance.

St. John’s Communication Center in Springfield dispatched St. John’s Laclede County EMS, who arrived at their home north of Lebanon within minutes.

“Neil didn’t even have time to get dressed by the time they showed up, they got here so fast,” she says. “We called, and they were here.”

On board the ambulance in the Twenters’ driveway, EMS staff performed a 12-Lead electrocardiogram (EKG), which they transmitted via cellular technology to St. John’s Hospital’s Emergency Trauma Center. Information from an EKG may help a physician decide if a patient needs to be taken to a cardiac catheterization lab to open a blocked artery or if clot-busting medication can be administered in the ambulance.

St. John’s introduced the technology to the Ozarks in 1984. It is considered the single greatest breakthrough not only in the history of EMS, but in cardiovascular care, because of its significance for treating heart patients.

After reading Twenter’s EKG, emergency staff at St. John’s said Twenter needed to be transported to the Springfield hospital via St. John’s Life Line helicopter, which would meet the ambulance at the Lebanon airport. The Twenters’ wooded lot wasn’t an appropriate landing zone for Life Line.

“I started crying when they said the helicopter was coming to get me,” Twenter says. “I knew I was having a heart attack, but I didn’t think it was serious enough that I would need the helicopter.”

On board the helicopter, Life Line staff were also in communication with the Springfield emergency room staff about Twenter’s condition. They administered the clot-busting drug Retavase, and flew her to Springfield in about 25 minutes.

“We work to have a seamless system starting with the ground service and progressing into the hospital,” says Charles Sheppard, M.D., Life Line medical director. “We have significantly improved the quality and uniformity of care.”

Once at St. John’s, Twenter was rushed to the Cardiac Catheterization Lab, where her cardiologist, Dr. Cochran, performed an angioplasty and inserted another stent.

The ability to activate the Cardiac Cath Lab 24 hours a day, seven days a week saves time – crucial for cases like Twenter’s. Speedy care saves heart muscle and greatly improves chances for survival.
In addition to the heart attack, Twenter was diagnosed with congestive heart failure. She stayed at St. John’s for four days, one and a half of those spent in intensive care.

“Dr. Cochran came out of the Cardiac Cath Lab after he put the stent in and told me she was going to be OK, and that we would work on getting her congestive heart failure under control as she recovers from the heart attack,” Twenter’s husband Neil says. “I have to say I was impressed with everyone who took care of her that day. The paramedics who treated her at our house even stopped in her room at St. John’s later that day to check on her. That showed us they really cared.”

After she was released from St. John’s, Twenter began doing cardiac rehabilitation at St. John’s Hospital-Lebanon three days a week.

“A lot of my friends are there and I look forward to going. It’s a good program, and they have a lot of different exercise machines. I plan to keep going to exercise even after I’m done with the rehab program,” she says.

Twenter now eats a low-sodium, low-fat diet and monitors her weight closely.

“If I gain even two pounds overnight, I have to call Dr. Cochran so we can make sure I’m not retaining too much fluid. I had to cut out ice cream, but I don’t miss it any more. Fruit has replaced ice cream for me,” she says.

Because of the congestive heart failure, Twenter says she gets tired somewhat easily, but that doesn’t stop her from playing bridge and having her grandchildren over. The mother and grandmother of three is still counting her blessings and thinking about what could have happened if St. John’s emergency medical staff hadn’t acted quickly and in a coordinated manner to care for her during her heart attack.

“I realize now that I’m lucky that I survived, and even luckier that I didn’t have to have open-heart surgery. Everything – from how quickly the ambulance came and how they worked with the ER in Springfield, to how quickly the helicopter came and got me, to Dr. Cochran being at the hospital when I needed him – was seamless. If there had been any glitches along the way, I would have had severe, and maybe irreparable damage to my heart. I credit all of the people who helped me that day for saving my life,” Twenter says.