It was at 10:30 a.m., just after a mid-morning work break, not a time when you expect death to visit.
Ranita Gail Smith, a career specialist at the S.C. Vocational Rehabilitation center in Moncks Corner, was walking out of her office with a client when she collapsed.
That s what someone would tell her later.
Kevin Patterson, a job coach, had just left his nearby office to look for a client who was running late.
Kevin saw a crowd.
And heard a scream: A lady is on the floor!
There are a few things you should know up front about Kevin Patterson. Even beyond the battlefield, the former U.S. Air Force combat medic had stared into the jaws of death before and risked his safety to rescue those nearly in its grasp.
When Ranita collapsed two weeks ago, he and death were running about even in the civilian world.
Death knocks
Kevin jumped over a rail and darted through the crowd. Ranita lay sprawled face-down on a concrete floor near her office.
Although he had been medically discharged in 1999 after losing part of a hand in Desert Storm, the 54-year-old s training took quick control.
First, assess.
Airway. Breathing. Circulation.
He detected no air, no breathing, no pulse. Nothing.
Co-worker Loleta Ravenell and Caleb Forte, a client studying to become a paramedic, stepped in to help.
They rolled her over. Was she having a seizure?
The 53-year-old woman had smacked the concrete floor with the traumatic force of sudden collapse. Her face swelled.
Airway. Breathing. Circulation.
No air. No breathing. No pulse. No heartbeat. Pupils dilated. Jaw shut. Body limp. Eyes rolled back. No response to commands.
Nothing.
Kevin began chest compressions and assigned tasks.
Get her shoes off. Stimulate her feet.
Get the new Automated External Defibrillator. It s in the first aid room.
Caleb, a 19-year-old volunteer firefighter, raced to his car to grab his medical kit.
Kevin tried to open Ranita s mouth to start rescue breathing. But it was clamped shut.
He tried to breathe through her nose. But it was clogged with stomach contents flowing up.
Her nail beds turned the purplish-blue of imminent death.
They placed defibrillator pads onto her chest. The machine assessed and spoke:
Stand back.
5-4-3-2-1
The shock jolted her entire body, including her heart. It began to beat. Guttural sounds slogged up from her throat.
Still, Kevin couldn t breathe air in through her mouth or nose. What could he use to clear her airway?
A pen. Yes, a pen.
It was an old trick, one Kevin had used to beat death before.
Life calling
In 1994, Staff Sgt. Kevin Patterson was stationed at Kirtland Air Force Base in New Mexico when he rushed to a wreck in which a drunken driver had struck a family of four near his home.
The father walked around in shock. Death came for the others.
First, Kevin saw the mother, bleeding profusely as she died before him in the front seat.
From the backseat, two tiny eyes watched him. He broke a window and rescued a 6-week-old baby from the crushed car.
Then he rushed to a 4-year-old girl who had been thrown from the car. Although she was gruesomely injured, he kept her alive until paramedics arrived.
The baby survived. But the little girl died hours later.
Kevin agonized. Did saving the girl mean she suffered until death came anyway?
Later, the girl s family spoke to him. The father didn t have a chance to tell his wife goodbye. But because his little girl lived briefly longer, he was able to bid her farewell.
Kevin beat death once that day. But death doesn t give up, either.
In 1995, Kevin was temporarily assigned in Egypt, where one day he relaxed by a pool with fellow Air Force personnel.
Someone pulled a drowning 13-year-old boy from the water. Kevin rushed over.
Vomit and water blocked the boy s airways.
Using a pen, he sucked the contents from the boy s airway and performed CPR until an ambulance arrived. That day, Kevin beat death decisively.
Saving Ranita
A pen. Kevin grabbed a pen, unscrewed it and dumped the contents, creating a straw-like device.
He inserted the pen up her nose to reach farther into her nasal passage. With no gloves, no mask, no universal precautions hammered home in training, he sucked the stomach contents from her nasal passages.
A guttural sound turned to the gurgling of Ranita s own effort to breathe. It was the sound of air. Of life.
Paramedics arrived then.
Kevin felt a tap and, in the slow-motion scene of the moment, stepped back as they loaded her onto a board.
Pray for Ranita
Thielen Smith, a bowl-seasoned college football coach from Charleston Southern University, was about to go for a motorcycle ride thanks to semi-retirement when his cellphone rang.
His wife s colleague was on the line, sobbing something about Ranita. Then his daughter called. Both were so hysterical he could hardly tell what they said. Something about Ranita having a seizure?
Then another co-worker called, calm and clear: Get to Trident Medical Center s ER.
The North Charleston hospital is about 15 miles from their Moncks Corner home. As he drove, Thielen thought back to his wife s checkup two weeks earlier. Her doctor saw no problems other than that she needed to eat healthier and exercise.
It was good news given that in the mid-1990s, Ranita (many people call her Gail) was diagnosed with cardiomyopathy, an enlarged heart. She also had a premature heartbeat, a kind of arrhythmia.
Her doctor had suggested she consider not working and apply for disability benefits.
But Ranita wanted purpose. She became a career counselor at vocational rehab, helping people with disabilities achieve their dreams. She would not quit. Instead, she took medication and seemed fine.
As he drove to the ER, Thielen thought: Maybe this is all overblown. But when he walked in, he saw her co-workers.
I could look at their faces and see something had really happened, he said.
When the hospital staff took him to see her, a large tube down was stuffed down Ranita s throat and a machine breathed for her. The left upper side of her face swelled, a massive purple reminder of the force of her collapse.
That night, as their six children arrived, Thielen sat by his wife s bedside. He prayed.
The preacher s son prayed that God let him see his wife s eyes open again.
God gave me a peace then, Thielen said. I knew she was going to be all right.
That night, Kevin went home alone. He needed to process. He, too, needed to pray.
Cooling time
Did she have a head injury? A blockage in her brain or lungs?
And how long had Ranita s brain been starved of oxygen?
Time is brain matter, said Lindsey Clark, a Trident ICU nurse who cared for her.
Tests showed no evidence of a head injury or heart or lung blockages. Her heart s electrical system likely malfunctioned.
To prevent further damage, intensive care staff wrapped her torso and thighs in cooling pads, lowered her temperature to 91 degrees and chemically sedated and paralyzed her to keep her from shivering. It s a process called therapeutic hypothermia, and it can prevent brain tissue damage after a loss of blood flow.
The staff kept her chilled for 12 hours and then slowly warmed it back to normal and maintained it there, Clark said.
Ranita remained unconscious for nearly five days. As she awakened, Thielen called out her name. She opened her eyes.
He saw Ranita still in there. Soon, it was clear she had not suffered brain damage.
Clark walked in and saw her patient sitting in a chair.
We did it, she thought. She survived.
It s not like on TV. Nearly 93 percent of people who go into sudden cardiac arrest outside of a hospital die. Most don t get medical help quickly enough, not when every second, every minute costs the brain.
Everything is time, said Trinka Douglas, a cardiac nurse practitioner who treated Ranita.
New bonds
Kevin did not go to Trident hospital with his other co-workers for several days, not until after Ranita awoke and her family had time with her.
He visited a week after he saved her life. He introduced himself to Thielen and met her other family.
Then he went to Ranita.
As they shared and meshed their stories for the first time hers murky, his so brutally fresh their eyes welled with the raw enormity of what just happened. And what could have happened.
The next day, she looked over at Kevin as he sat beside her hospital bed.
Thank you, she whispered. I love you.
A plum-sized bruise still pooled between her left eye and hairline, and fresh gauze covered a small chest incision where that morning a doctor implanted her new pacemaker.
Kevin reached over to touch her hand. She gripped it back.
I love my husband. I want to live a long time with him, she told him as Thielen looked on.
Unfortunately, her scans also showed a tumor on her kidney, one that likely is malignant. Fortunately, her prognosis is good, and her medical team applauded finding it early.
Had her heart not stopped, it would have grown unnoticed.
I have a second chance, she said. And I am going to use it.
Ranita plans to advocate even harder for people with disabilities striving to achieve their dreams. And she will value her already close-knit co-workers as family, Kevin among them.
The two started working together barely a month ago.
Now, they are forever bonded knowing death can visit any time. But for now they have escaped it.
Reach Jennifer Hawes at 937-5563, follow her on Twitter at @JenBerryHawes or subscribe to her at facebook.com/jennifer.b.hawes.
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