My last memory of “Big Mike” (six foot three, 265 lbs) was of him being wheeled out of the hockey rink in Las Vegas on a gurney flashing the “thumbs up” sign to both teams as the paramedics took him to the local emergency. Mike, age 40, died later that day.
I still get emotional thinking about it and I’m not totally sure why. I’m not a stranger to death—I’ve been an emergency department physician for 18 years so I’ve seen more than my fair share, but this was different. I still think about it constantly.
What I do know is that Mike looked well when he left the arena—so much so that when the fire department and ambulance arrived, there was absolutely no sense of urgency to get him to the ER, although I told them that I was quite worried. Here’s why.
When our two teams lined up at the beginning of the second period of the tournament finals, one of the opposing players mentioned that they had a guy on their bench who was acting a bit “out of it.” My teammate asked a few more questions and was worried enough to get me involved.
When another teammate, Scott Wood (a nurse), saw Mike we were immediately concerned. He looked pale and sweaty, and his speech was slow and weak. He felt nauseated but didn’t vomit. He’d played a hard first period but denied any chest pain until he sat on the bench between periods, and he said the pain was not severe. Mike had no cardiac history and had never smoked. This was the fourth game in three days for all of us at the tournament, where we play all day and stay up all night—not exactly heart healthy.
We laid Mike on the ground and gave him a baby aspirin to chew. He improved over the next 10 minutes and by the time the emergency services arrived, Mike looked well. He apologized for “holding the game up,” said goodbye to his teammates and flashed that thumbs up. I shook his hand and wished him good luck—I was very concerned that his pain was cardiac in nature, but I never thought that he would be dead in 12 hours, leaving behind a wife and baby girl.
I’d never been at a hockey tournament in all my years where someone died on the ice, but two days before Big Mike’s death, a 45-year-old man died at centre ice in the same tournament with his wife watching from the stands. It was a very, very quiet plane ride home for our team and a brutal reminder of our mortality.
According to the Hockey Heart Study published in the Canadian Medical Association Journal (Feb. 2002), more than 500,000 men and over 70,000 women (the latter number growing rapidly) play recreational hockey. I’ve played for many years in a mens’ noon hour league and many of us arrive at 11:50, hurriedly throw on our equipment and bound on to the ice without a warm up. We play hard for an hour, then rush back to work. Also not exactly heart smart.
No wonder stories like Big Mike’s are becoming increasingly common. So for all you hockey players who love the game and don’t have time to take care of yourselves (present company included), here are some warning signs to heed:
1. Pain or pressure in the chest that is worse with exertion. We get especially concerned if there is radiation to either or both arms, and if the pain radiates to the jaw and/or teeth.
2. Upper abdominal pain and nausea and/or vomiting brought on by exertion—surprising as this may seem, this can be cardiac in nature.
3. Decreased energy levels and fatigue out of proportion to what you would expect with activity that you’ve done all your life. Many cases of “sudden unexplained death” have been preceded by the patient simply feeling a bit fatigued a day or two prior.
4. Pay attention to shortness of breath out of proportion to what you would expect. Listen to the “little guy” on your shoulder—he’s usually very wise.
5. And finally, if you smoke—think again about quitting, and don’t stop thinking about it until you’re successful. We as physicians can help, and there are few things in medicine that make me happier than hearing about a patient who has been able to quit smoking!
If you’re a hockey player or any athlete and you experience these symptoms, no matter how subtle, visit your family physician or emergency department. I understand that none of us has the time to sit for hours upon end to get “checked out,” but the alternative is unthinkable.
I’m glad I’ve had this opportunity to tell Big Mike’s story. I’ll never forget him, I wish I could have done more, and I hope this little bit of medical advice will prevent some similar stories.— Mike Ertel, MD