Patty Storm knew there was something wrong as soon as she straightened up and felt the terrible pain in her chest.
"There was no warning, it was just like a hatchet to the sternum," said the Export resident about that Feb. 17 evening. "I yelled to my husband to call 911, got myself into the kitchen and fell on the floor. And that's the last thing I remember."
FAMILY: Husband Larry and son Ben, 16
QUOTABLE: "This was my warning. You have to stick to diet and exercise, and take all the tests. I just look forward to doing my own vacuuming again."
Mrs. Storm, 52, had just returned home from a computer course she was taking at Westmoreland County Community College and was leaning down to check the snow melt under her vehicle in her attached garage.
She and the Murrysville Medic One ambulance crew who arrived eight minutes later assumed she was having a heart attack. They didn't know her condition was far more serious.
Mrs. Storm had had an aortic dissection, a sudden rip in the heart's most important vessels, an event that has a mortality rate as high as 80 percent to 98 percent.
"I've been a paramedic for 26 years, and I've seen some aortic dissections," said Darrick Gerano, 41, of Penn Township, the Medic One administrative director, who went on the call to help Mrs. Storm.
"But all the rest I've learned about from the autopsy reports. This was the first time I've seen a positive outcome."
First on the scene were Jennifer Edder, who had received her paramedic's license 10 days earlier, and emergency medical technician Brooke Lauffer.
Ms. Edder, 27, of North Apollo, had been an EMT for four years before being certified as a paramedic. But she said she realized quickly Mrs. Storm's condition was something special.
"The chest compression, nausea and radiating jaw pain she was feeling were classic heart attack symptoms," Ms. Edder said. "But the heart monitor wasn't showing much, which was odd for someone in so much pain. And we couldn't get her pressure up."
She called for backup, and Mr. Gerano, paramedic Jerry Chellman, EMTs Steve Mcilrath and Rocky Rzodkiewicz responded, along with a fire truck needed to clear the heavy snow blocking ambulance access to the home.
Mr. Chellman, 51, of Greensburg, said Mrs. Storm's low blood pressure seemed to indicate "she was bleeding out somewhere, but we couldn't find where."
While Ms. Edder and the emergency medical team administered fluids and medicine, trying to stabilize Mrs. Storm, they called ahead to the Forbes Regional Campus of West Penn Hospital, in Monroeville, so a cardiac physician would be ready to examine her.
Upon Mrs. Storm's arrival, cardiac physician Dr. Paul Kleist administered tests that showed her aortic dissection.
She was immediately taken into surgery for a double bypass to repair the 4-inch tear in her aorta, an eight-hour procedure performed by cardiac surgeon David Haybron.
Dr. Michael Culig, chief of cardiac surgery at West Penn's Ed Dardanell Heart and Vascular Center, said several things were unusual about Mrs. Storm's case, while other circumstances fell into place that helped Mrs. Storm survive.
Dr. Culig said an aortic dissection occurs when the extremely high pressure exerted by the heart makes a small tear in the lining of the aorta, allowing blood to flood between the layers of the aortic wall, "like a rip in the lining of a garden hose."
Predispositions include a history of high blood pressure, a connective tissue disorder, or previous heart surgery, none of which was the case here.
But while the tear was serious, obstructing her coronary artery and coming close to her aortic valve, it was not so large as to cause immediate death. The people around Mrs. Storm, including her husband, Larry, and son, Ben, the ambulance team and the West Penn doctors and nurses, all acted quickly and kept alert for signs of something unusual about her condition.
"She was very fortunate," Dr. Culig said. "She's recovering very well."
Despite contracting a MRSA infection (methicillin-resistant staphylococcus aureus) during her three-week stay in the hospital, Mrs. Storm said she thought she received excellent care.
"The caliber of the doctors and nurses has been incredible," she said, adding that she knows good medical care because she is a nurse.
Mrs. Storm said she also knows she faces a long recovery. Because one aortic dissection puts her at an elevated risk for another, as well as additional heart problems, she will need to be closely monitored for the rest of her life and take several medicines. She is going for cardiac therapy three times a week.
"This was my warning," she said. "You have to stick to diet and exercise, and take all the tests. I just look forward to doing my own vacuuming again."
On April 21, before a Pirates game at PNC Park, the Murrysville Medic One team and Mrs. Storm were honored by West Penn's "Great Saves" program, which brings together emergency response teams with former patients and their families.
Mrs. Storm said she felt "incredibly grateful" toward Ms. Edder and the rest of the team. "What do you say to people who saved your life?"
For the team, it was a chance to see a more positive result of their work than usual.
"It's very unusual for us to meet a patient after we care for them," said Ms. Edder. She also said the experience with Mrs. Storm has made her more aware of the dangers of leaping to conclusions about a diagnosis.
"That night, I was really scared, and I'm still scared, every day.
"But the earlier we can get there, the better chance a patient has. And that's why we're here."
Kate Luce Angell, freelance writer: firstname.lastname@example.org .