MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. - Dr. (Capt.) Patricia Vu and her husband, Dr. (Capt.) Sean Scott, both resident physicians here, were enjoying a day off from their patient care duties over Memorial Day weekend.
The pair settled on taking a hike up the five-mile Putrid Pete’s Peak trail in the Cascade Mountains near North Bend, Washington.
Vu, a 2020 USU graduate and then a Transitional Year intern accepted for a Preventive Medicine residency, and Scott, a 2018 alumnus of the Uniformed Services University of the Health Sciences and second-year Emergency Medicine resident, started out towards their destination, but their GPS had other ideas.
It directed them to the trailhead for the Ira Spring Memorial trail, a six-mile trail near Snoqualmie Pass and North Bend. Rather than turning around, they decided to go ahead with their hike on the Ira Spring trail.
The first half of the trail was uneventful, and the two reached the 4,200-foot peak of the trail in just under two hours. Based on the map, they could have continued on to Mason Lake and taken a different trail back to their car, but after assessing the trail below, which was covered in more than a foot of snow, Vu urged her husband to turn around because she did not feel safe climbing down the steep trail without adequate snow gear. They were wearing only athletic clothing and non-hiking footwear.
As Vu and Scott began their descent, they were flagged down by two hikers who asked them for help. Nearby, a man was sitting shirtless on a rock, taking sips of water from his hydration pack.
Vu said the man appeared extremely fatigued and had an increased breathing rate. One of the hikers said she had come across the man and thought he was experiencing heat exhaustion, so she had him remove his t-shirt, refilled his water pack, and gave him two electrolyte tablets.
She asked Vu and Scott if they could take over and help the man back down to the parking lot, then disappeared down the trail with her companion, leaving him in their care before the two residents could respond.
Vu and Scott asked the man to describe his symptoms.
Chest soreness. Nausea. Shortness of breath.
Vu and Scott exchanged glances, both concerned that the man was experiencing myocardial ischemia, a blockage of a coronary artery, and/or a myocardial infarction - a heart attack.
“I immediately felt compelled to ask him about his medical history, medications, and social history in an attempt to determine his risk factors," Vu said, "and communicated to him that my biggest concern was that he was experiencing a heart attack and that we needed to get him properly evaluated at a hospital.”
Scott asked the man if he was able to walk so they could get him to a shaded area. It took the man a few minutes, but he was able to stand. However, he could only walk several feet before he started feeling the soreness in his chest again. Vu and Scott asked the man to sit down and to lean against his backpack along the mountainside.
The two doctors felt the hiker needed an ambulance, but they knew it would likely take several hours to get back down to the parking lot with him, given his inability to take more than a few steps at a time.
Vu urged Scott to call for a helicopter to evacuate the hiker, and explained to the man that they were exploring options to get him down the mountain, with his safety as their top priority. The man thanked them and agreed with the call to notify emergency medical services.
Scott called 911; using his GPS and the trail map, he provided the coordinates for their location. He also gave EMS information about the trail and the road conditions leading to the parking lot and trailhead.
Vu admitted she felt completely unprepared for the situation.
“We did not have Zofran, aspirin, heparin, intravenous fluids, a sleeping bag, or even an umbrella for cover," she said. "But, that feeling of helplessness triggered a survivor instinct that my refugee parents had passed on to me, and I immediately started thinking about what I could do to make up for what we did not have.”
Vu asked Scott to use items of their clothing to shield the man from the sun and to provide padding from the rocks, and to use their ice water to help relieve his nausea. Scott helped the man put his shirt back on and offered him ice chips from their water flask. They stretched Scott’s flannel shirt out to create a makeshift shelter to shield the hiker from the sun's rays.
As the hiker lay in pain, Vu and Scott tried distracting him by talking about his work, his family, and his cat, but the chest pain had begun radiating to both arms and the hiker could not shake the nausea.
The man reached out in fear; Vu told him he could hold onto her leg for comfort.
“I would have held his hand, but I needed to hold the flannel shirt taut to provide adequate sun protection for him,” she said.
The man asked Vu to call his eldest daughter, as the pair talked to him about whether he had a designated medical decision-maker in the event he needed one. The hiker also asked Vu to call his neighbor to ensure his cat was cared for.
As other hikers passed by, they stopped to offer help. One couple brought out their first-aid kit and asked what was needed. Vu and Scott said they were both resident physicians and asked for aspirin, explaining their concern about the man’s heart; having aspirin would make a big difference.
The couple didn’t have aspirin, but started asking every hiker who passed by for some, and eventually met with success.
Scott instructed the man to chew the aspirin, and within minutes, he reported feeling some relief from the pain. At that point, Vu and Scott knew they were correct in their preliminary diagnosis of myocardial infarction.
Two hours after EMS was called, the volunteer search and rescue team, clad in their red t-shirts, were visible coming up the trail. They took the man’s medical history and used their radio to communicate with the firefighters and other EMS teams who were en route.
Another hour passed before medics arrived on the scene with a portable electrocardiogram machine that one of them had carried up the mountain.
The results showed a significant pattern of changes in the electrical signals produced by cells on the left side of the heart in response to injury, information that was relayed to the helicopter team that was also on its way.
About 30 minutes later, the helicopter came into view, ascending over the treeline below. Scott and Vu backed away from the scene to give the EMS teams room to help get the man airlifted, but before they left his side, the man asked Vu and Scott to take pictures of him being hoisted up to the helicopter. The man joked that he had never been in a helicopter before and it might be a once-in-a-lifetime event. Vu and Scott complied, and the hiker was medevacked to Seattle for care.
“As we descended the trail to get back to our car, I finally let the adrenaline fly loose and joked with my husband that I did not need an EKG or troponins to diagnose a myocardial infarction,” Vu said. “Being the kind and fair man he is, he allowed me to take full credit for being the first to make the diagnosis.
"I had never felt like more of a doctor despite more than seven years of education and training," Vu added. "I finally had a real opportunity to practice my clinical judgment without a safety net and apply what I learned from my years at USU attending lectures in military and disaster medicine to take care of a patient in an austere environment.”
Once back at their car, Vu contacted the man’s daughter to let her know what had happened. Later that evening, the daughter texted Vu to say her father was doing well.
The man himself texted Vu several days later.
“I want to express my sincerest gratitude to you and your husband for the care and kindness you provided me," he said.
"The quality of my health and recovery is attributable to your expertise and rapid intervention. I received a stent and am on track for full recovery. A rapid one, too. Everyone says it was a miracle that you and your husband found me immediately during the event…Thank you and Sean from the bottom of my heart for saving my life! I wish you well and hope our paths cross again on the trails…but not under the same circumstances!” he said.
Vu had thanks of her own to give on behalf of herself and Scott, and to offer others a call to action.
“I wanted to express my gratitude to the medical officers at USU and Madigan Army Medical Center who taught and pushed us to take our knowledge of medicine from the clinic and wards and apply it to less than ideal environments," she said. "I also want to challenge everyone in our daily lives to be more prepared for disaster management.
"Sean and I made the mistake of not carrying anything more than water and a few snacks. If it was not for the older couple who found aspirin, the man would have not received anything until the EMS arrived, which took over two hours,” Vu said.
Vu gave advice to others about planning for emergencies.
“We realized we got complacent in thinking we were young and invincible and that going on a six-mile hike would be a simple task despite years of disaster, public, and global health training," she said.
"We should all carry medical basics like aspirin, pain medication, a tourniquet, and items to protect someone from the environment in addition to adequate supplies of water and food. As a future Preventive Medicine physician, I hope to work more closely with Emergency Medicine staff and residents to emphasize wilderness medicine in our training at MAMC,” Vu added.