Patient returns to hospital to say thanks

ER doctor’s instincts led to George Rivera being airlifted for life-saving heart surgery.


George Rivera doesn’t remember that day four years ago. He doesn’t even remember the days leading up to it.

He was outside the Chilmark General Store on Sept. 27, 2013, taking a break from a vigorous bike ride with a friend, when he fell face first onto the pavement. His face suffered trauma, a sign there was no attempt to break his fall. He was rushed by EMTs to the Martha’s Vineyard Hospital emergency room.

Dr. Lukas Kolm, the emergency room doctor on duty that day, could have easily excused Mr. Rivera’s accident as a concussion, cleaned him up, given him some pain medication, and sent him home. Instead, he went digging for the underlying cause of Mr. Rivera’s fall, ordered tests, and when they came back showing a heart blockage, ordered a MedFlight to take Mr. Rivera to Massachusetts General Hospital, where he underwent bypass surgery.

On Thursday, Mr. Rivera, a filmmaker from New York City with a second home in Chilmark, returned to Martha’s Vineyard Hospital to say thank you to Dr. Kolm and Patricia Gazaille, RN, who was the nurse on duty that day.

“I’m appreciative someone was paying attention,” Mr. Rivera said, his smile widening. “Seriously, because a lot of people have told me that the protocol is if you fall and hit your head, unless there’s some major trauma taking place, it’s two aspirin and go home and call me in the morning.”

Mr. Rivera suffered three fractures to his face, and there was concern about one of his eyes.

Dr. Kolm, a cyclist himself, said things didn’t add up for him, including the fact that Mr. Rivera wasn’t able to remember what happened to him.

“It’s not a routine fall when you have someone out for a ride and they’re standing, hanging around outside of a place with their friends, and all of a sudden, it’s basically unprovoked circumstances and there’s a fall,” the doctor said, recalling his train of thought that day. “Technically he just got off a stress test, right? You’re out riding, and now you’re shutting down. There’s a whole of physiology that goes on during the event and post-event.”

Mr. Rivera was talking, but couldn’t remember what happened. “What’s interesting, from my point of view, is I don’t remember coming here,” he said. “I don’t remember driving out here from New York. I lost track from the garage in New York to Mass. General. Everything in between is a blur … I don’t remember the helicopter ride, and I love helicopters.”

The forgetfulness was a sign that this might be something more serious, Dr. Kolm said.

According to the Johns Hopkins Medicine website, heart blockages can restrict blood flow to the brain, causing memory loss, and is the second leading cause of dementia.

Thursday’s reunion of doctor and patient was a rarity in that emergency room doctors and nurses don’t typically see their patients again, Dr. Alam Virk, director of the MVH emergency department, said.

“We send them to another place, and we never hear back from them,” he said. “Usually the treatment teams upstairs or whatever hospital they go to, they get the credit. Or at least the thanks.”

Mr. Rivera has been back to Mass. General, but he also wanted to make a point to get back to the Island hospital to say thanks, he said. He didn’t remember who treated him that day and federal health regulations regarding privacy got in the way, he said, but he finally made his way back.

Martha Bischoll, the hospital’s director of quality management, helped coordinate Thursday’s gathering, which also included Carol Bardwell, chief of nursing.

Mr. Rivera said he’d like to do something for the hospital’s emergency room beyond giving a donation, something he already does. No definitive plans were made, but it was unanimous that it should involve food.

Leading up to Thursday’s reunion, Nurse Gazaille said, her memory was somewhat fuzzy on the incident. “Now I see you and I remember the biking gear,” she said. “I remember switching gears. It’s not trauma, it’s this.”

Dr. Kolm, a visiting physician from New Hampshire who also has a home up-Island, said the circumstances of Mr. Rivera’s case were striking to him. “There’s certain things that stick with you. I’m also a cyclist and weekend runner, and when you hear these things happen, it just rattles you,” he said.

Along his journey, Mr. Rivera kept running into doctors who are also cyclists, including his surgeon at Mass. General.

“You have pretty legs; I’m not going to cut your legs,” he recalled her saying to him. She took the blood vessels necessary for the bypass from his wrist, he said.

What Mr. Rivera, now 62, knows about the incident is what others have told him. Even the friends he was with that weekend didn’t see a difference in how he was acting, which makes him fortunate to have had the episode with so many people around.

“I was lucky to be right at the Chilmark store,” Mr. Rivera said, “50 yards from the police station, 100 yards from EMS.”

“It wasn’t your time,” Dr. Kolm said. “Everything fell into place.”