By Aaron Collins

By the time Irene O’Hearne became a West Coast big city mayor’s wife, she was considered by many to be a pretty tough character. Central Casting couldn’t have found anyone better for her no-nonsense supporting role in the political drama that was her life.

But those who had known her over the years witnessed the ongoing eclipse of her otherwise light-hearted, unassuming demeanor. Due to all the dutiful campaigning, numerous public speaking engagements, and social demands, stress had taken a toll on her easy laughter and a sweet, shy side. Her husband thrived in the limelight, but it was not her natural habitat.

Away from the spotlight, many politicians’ spouses endure periods of crushing boredom and unrelenting anxiety. And Irene was no exception. No matter how resilient she seemed in public, the duties that frequently took her husband away for long periods of time meant that loneliness was inescapable. Irene, though in her 50s much younger than many in her position, would pay the price for the burdens of public life.

Though Irene endured a life of quiet desperation on the sidelines of public political life she managed to avoid becoming notorious herself, like former First Lady Betty Ford, the patron saint of suffering politicians’ wives. Ford’s struggles and recovery are enshrined by the addiction medicine clinic bearing her name—thereby placing in the historical record a political wife’s sufferings perhaps on par with her presidential husband’s accomplishments.

But like Ford and many other political spouses, Irene hitched her wagon early on to a fate beyond her control: to the whims of the electorate. Irene married Peter—handsome son of rural immigrants and future mayor of one of the largest cities on the West Coast— when he was a common-as-dirt ranch hand with barely two nickels to rub together. She was young and pretty, and they were both ambitious. And they could hardly wait to get out of the small cow town where they met to head for the big city.

In retrospect the roots of Irene’s troubles are traceable. The O’Hearnes’ religion meant ten kids were the norm. And over seventeen years’ time they met that reproduction quota as Peter ascended the ranks of the big city political machine that would eventually grind Irene up and spit her out.

When Peter’s political career took off, so many others wanted aboard his bandwagon, that there was little room for Irene. She felt bumped off or worse—thrown under. While her obligations as mayor’s wife demanded a smiling public game face and grace under pressure without fail, jealousy and loneliness were overwhelming. No such demands could be placed upon Peter’s many mistresses, who, to Irene seemed to get only the benefit of Peter’s political life. She resented them bitterly.

After Peter was elected mayor, he frequently traveled overseas on junkets. While he spent long hours at City Hall, Irene was left home alone raising their litter of ten with little money to feed them. Out of public view, she smoked like a coal plant. She ate when stressed. She drank more than she should. She rarely exercised, aside from the exhausting task of tending such a large family.

As her kids grew older at the edge of their father’s constant media spotlight, a few veered into delinquencies. Publicly embarrassing to Peter, these youthful indiscretions caused Irene considerable private pain.

By her late 50s, Irene was casting a pretty wide shadow. Yet she was a shadow of her former self, the young bride on the ranch with Peter. Her large Irish blue eyes twinkled as ever, but she was often anxious. Worse, she showed some of the same quirks that her large brood quietly feared were the telltale signs of impending mental illness that seemed to beset the women in her family, at a certain age.

In short, she was a stress mess.

By the time voters sent Peter packing in an upset election, Irene was a ticking time bomb, about to become one of the casualties that few count when entering the brutal arena of politics. One of the downsides of having power is that no one may intervene. As happened with John F. Kennedy Jr., only later some would say that maybe he was too inexperienced to be flying in the conditions in which he and two others lost their lives. But when one hails from one of the most famous political families in the country, no one wants to tell you when you’re heading for a fall.

Similarly, no one wanted to tell the big-fish mayor’s wife, “You’re killing yourself.” No one spoke up, save for her physician—whose voice was largely tuned out.

So that is when the first responders entered the story. Irene’s lifestyle was just too much for her fifty-something-year-old body. Her heart had had enough. By the time emergency personnel arrived on scene, she was in full cardiac arrest.

Her fate was again in someone else’s hands. Her life would depend on the outcome of each of the following crucial stages of care.

Any responsible health care professional would say, prevention is the truest and best first step in any cardiac arrest survival strategy. Best to avoid risk factors like smoking and lack of exercise in the first place. But Irene was the poster girl for what not to do. Those preventative steps were forgone long ago. Her choices began with her advance to the first official stage that unfolded in a whirlwind all around her: Pre-hospital care.

Stage 1: Recognizing the Symptoms

Perhaps the one thing Irene had done right in advance was to learn what constituted heart attack symptoms. Unlike some sufferers, she knew that she was experiencing an acute myocardial infarction, though she may not have known the technical term.

Women can have different heart attack symptoms than men. Instead of, or in addition to, the familiar symptoms such as chest discomfort and shortness of breath, women can experience breathing difficulty and dizziness that can appear with symptoms that are more flu-like than the typical chest clutching that TV has trained us to associate with heart attacks. In fact, some afflicted do not even know they are experiencing this too-common heart ailment. And women are more likely than men to die from a first heart attack.

Stage 2: Engaging the Authorities

One thing Irene knew from her husband’s role in establishing public policy: Where you have a cardiac arrest matters. If you are in a city known for advanced medical care like hers, you are much better off. But even less urban areas like Central California are known for high-quality response and above average survival rates.

So for Irene two important factors worked in her favor: she recognized the symptoms and she experienced them in a place where qualified help was close by. If only those had been the only factors at play.

Dave Sanbongi, RN, the prehospital EMS coordinator in the Emergency Department at Kaweah Delta Health Medical Center in Visalia, attributes a city’s success in heart attack response to citizen awareness and training. When “a high percentage of citizens are trained in CPR” a city will have “a high survival rate for victims of cardiac arrest,” says Sanbongi.

Irene knew that calling 911 was her best bet. Her conditioning on the stump for her husband had engrained a presence of mind in stressful situations that enabled her to calmly answer the questions from the 911 operator, and to listen to the operator’s instructions prior to the ambulance’s arrival.

She was little more than 15 blocks from two of the best cardiac care facilities in the nation. EMS personnel arrived on the scene in less than five minutes. But if she had been on the ranch where she once lived, she would have been 45 minutes from the nearest small town hospital. Even so, Irene’s healthy survival was not assured.

Minutes were precious as EMTs began treatment. In cardiac arrest, for every minute that passes without defibrillation, the chance of survival decreases by 10 %. But with qualified professional help so close at hand, Irene wouldn’t need her neighbors to drive her—or worse, to drive herself—to the hospital, as some dangerously choose. That’s the choice of last resort for someone in Irene’s shape.

Once Irene was stabilized on scene, ambulance personnel, staffed by a paramedic and an EMT-1, had the job of getting her to the hospital.

Stage 3, ER Diagnosis: Assessing the Severity

As with her early self-assessment, early accurate diagnosis in the ER was crucial to Irene’s advancement through the emergency response system. Because she had been stabilized and was conscious, she was able to offer information, and her flock of children who had descended at the hospital filled in the gaps. ER staff was able to piece together the nature of Irene’s problem, her medical history, and the treatment already rendered, etc. The attending ER physician ordered diagnostic studies like blood tests, 12 Lead EKG, chest X-ray, etc. The Emergency Department staff monitored her overall condition, vital signs and heart rhythm.

In other words, everything went right, under the circumstances—up through that stage.

Stage 4, Charting a Course in the Cardiac Catheterization Lab

Once the ER had stabilized Irene, she went on to the next department in the process: the Cath Lab. By injecting dye into her vascular system, the physicians were able to locate the blockages that required stents, the balloon-like devices that reopen a coronary artery through the process called angioplasty.

The hospital had an “interventional” facility to treat patients experiencing active heart attacks. This widens the range of treatment options, such as the choice to administer clot buster medication. But not every patient has the medical history to undergo this course. In the most severe cases, coronary artery bypass surgery may be needed. Irene was one of them.

Sadly, Irene’s story came to an end there.

Irene made it through surgery, but the anti-clotting drugs were not enough to prevent a stroke during her recovery, and that stroke was massive and fatal. The brain pressures had built up, forcing her into the autonomic convulsions that signaled the very end for her. With her large clan at her side, Irene succumbed as they sang her favorite songs, offering comfort perhaps more to one another than to her.

Epilogue

In considering Irene’s untimely death, it is important to underscore just how avoidable many of her risk factors were. Her inactivity, the smoking, the lack of stress management, and her failure to manage her weight all took a decisive toll that even the best health care providers could not counteract. Flummoxed by depression, her mental health state made it that much harder for her to escape those physical manifestations of her emotional state. Despite quality emergency care that went right at every step, as did her surgery at the hands of one of the nation’s most respected doctors, she entered her end-stage crisis at a great disadvantage.

It’s tempting to think she’d have survived if she had been in better shape to start with, but it is impossible to say. All that is certain is that Irene’s mortality fit the statistics of people with identical risk factors with alarming yet obvious precision.

If you believe you may have experienced a heart attack, or are concerned about your cardiac health, see a health care provider. If symptoms merit, a cardiologist may give you an electrocardiogram to detect any heart damage from a previous heart attack and will assess your risk factors so that you can make the best decisions about how to protect your health.

Heart attacks are survivable, but mortality from full-on cardiac arrest from any cause, (anaphylactic shock, drug overdose, or any of the many other causes of total heart stoppage) depends on the combination of precious minutes and random circumstance of the emergency. But the knowledge and systematic responsiveness of those on scene—professional, layperson, and bystander alike—are the result of choices that greatly affect the difference between a dramatic episode in your life, or a final scene.

Have you prepared?

Editor’s note: To protect family privacy, names were changed and, while based on a true story, some details fictionalized.

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