An early-morning dash to ER and a helicopter to Toronto show health care link’s life-saving value

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Pam Devitt doesn’t remember much about Sept. 15. Her husband, John Devitt, remembers all too well: the sound of his wife crying out in pain in the early morning hours, rushing to her side and then realizing something was horribly wrong.

Ms. Devitt, who is 63 years old, begged him to phone an ambulance. But Mr. Devitt feared that by the time paramedics arrived at their home on Six Mile Lake, in a secluded part of Ontario’s cottage country, it would be too late. He picked her up, put her in his truck and drove the roughly 50-kilometre journey to the nearest hospital himself. By that time, Ms. Devitt’s unbearable pain, which had started in her chest, had moved to her legs.

“I’m surprised I didn’t get pulled over for speeding,” Mr. Devitt said. “We were going way too fast.”

At the hospital in Midland, Ont., Mr. Devitt abandoned his truck, with the doors open and his keys and wallet inside, and carried his wife to a nearby wheelchair.

His assessment of her condition must have been accurate, because the hospital staff didn’t even waste time getting Ms. Devitt’s name before taking her to an exam room followed by a CT scan.

Her diagnosis was a type A aortic dissection, which occurs when the main tube that comes out of the heart develops a tear. It’s extremely dangerous and often immediately fatal. Ms. Devitt’s only chance of survival was emergency cardiac surgery.

But the nearest heart surgeon was several hours away, in Toronto. Geography is a constant challenge for the health care system in Canada, with patients in rural, remote or Northern communities struggling to access the same level of care as people living in urban centres.

Ontario has tried to bridge those gaps through a service called CritiCall Ontario, which connects hospitals in the most remote parts of the province with urgent specialist care. The service, which is offered 24 hours a day, seven days a week, has been around since 1988. But it has been expanded many times and is increasingly focused on providing better care in Northern and Indigenous communities, which typically have disproportionately worse health outcomes, said Alun Ackery, provincial medical director of CritiCall Ontario.

According to data provided by Dr. Ackery, CritiCall assisted in more than 54,000 cases in 2022-23, with more than 19,000 of those requiring transport to another hospital.

CritiCall helps expedite the response in emergency situations, such as Ms. Devitt’s. When the medical team in Midland realized she had an aortic dissection, they knew she would need an urgent transport to a specialty hospital. They phoned CritiCall and shared her information and scans with Bobby Yanagawa, the cardiac surgeon on call that day.

Dr. Yanagawa confirmed the diagnosis, setting in motion a flurry of events that ended with Ms. Dewitt in an operating room several hundred kilometres from home just a short while later. In the past, the medical team would have had to co-ordinate with the air ambulance themselves, but now, CritiCall has taken over that responsibility, allowing the health professionals on the ground to focus on the patient.

“As soon as we get a call about a type A dissection, our adrenaline starts rushing,’” said Dr. Yanagawa, head of the cardiac surgery division at St. Michael’s Hospital, which is part of Unity Health Toronto. “It’s the most acute type of patient that we, as heart surgeons, see.”

That’s how Ms. Devitt found herself on a helicopter headed for the heart of downtown Toronto, where Dr. Yanagawa and the rest of the medical team prepared. While they were waiting, Dr. Yanagawa asked Dr. Ackery, his friend and former classmate, for an update. Dr. Ackery responded with a photo of a radar screen, showing the helicopter en route.

The surgery to repair an aortic dissection is no small feat. To pull it off, Dr. Yanagawa used a bone saw to open Ms. Devitt’s chest before cooling her to about 18 degrees in order to completely stop the flow of blood through her body for a short time to allow for the repair. During the rest of the procedure, which lasted around four hours, Ms. Devitt was on a heart-lung bypass machine to allow Dr. Yanagawa to safely complete the surgery.

Mr. Devitt, meanwhile, phoned their two daughters, one of whom was nine months pregnant, before making the drive to Toronto. Ms. Devitt was still in surgery by the time he arrived, but eventually, Dr. Yanagawa told the family the good news: She had survived.

The next several days were touch and go. Ms. Devitt, who was in an induced coma with her chest open, experienced heart failure and other setbacks. At one point, a nurse called the family to the hospital in the middle of the night, fearing the worst.

But Ms. Devitt turned a corner. Days later, she regained consciousness and slowly but surely began to regain use of both sides of her body. On Sept. 30, two weeks after that harrowing drive to the emergency room, Ms. Devitt went home.

“It’s pretty fantastic when you see a case like that,” Dr. Ackery said. “A dissection like that does not always go that well.”

As she recounts her story, Ms. Devitt doesn’t dwell on her own pain or suffering. The only time she gets emotional is when she talks about missing the birth of her grandchild, who was born on Sept. 28, two days before her discharge.

“It broke my heart,” said Ms. Devitt, her voice faltering. “I wasn’t able to be there for her or hold the baby.”

But since coming home, she has had plenty of chances to revel in newborn snuggles and reconnect with the rest of her grandchildren and other family members – at holiday and birthday celebrations.

“I’m looking forward to all of it,” she said.

Life looks different since her aortic dissection. Ms. Devitt tires more easily and finds herself short of breath. But she’s also received an outpouring of love and support from her friends and family, including her brother, who was on a trip in Italy during Ms. Devitt’s ordeal and lit a candle for her in every church he saw.

“In one sense, you’ve got to think there is a greater power,” Ms. Devitt said. “There was somebody looking after me, that’s for sure.”