By Dawn Brazell
Public Relations

It was Dec. 13, late afternoon on a warm Tuesday, a good day for a run or so Justin Repshas thought. The College of Charleston senior had finished a tough exam and needed a break before studying for his next test.

Meanwhile, MUSC College of Nursing student Meg Skeele was having a very bad day. She was exhausted between exams and work and just felt out of sorts in general. A friend coaxed her to go out to eat to cheer her up. She agreed.

In an unusual turn of events, MUSC research fellow Michael Bernard, M.D., Ph.D., was able to leave work early — a very rare event — to go Christmas shopping for his wife at a cookware store downtown.

Dr. Michael Bernard, Justin Repshas and Meg Skeele meet at MUSC to celebrate how well Repshas is recovering following his collapse Dec. 13.

How they all happened to end up on a side street downtown just when Repshas' life depended on it, no one knows. Repshas is just glad they did. The three recently got to meet at MUSC, celebrate how well Repshas is doing and share their stories.

On Dec. 13 Repshas, 22, an avid runner and soccer player, only remembers slowing down. Then he blacked out.

As Skeele was driving by, she remembers seeing a crowd of people around someone lying in the grass, someone who looked somewhat like her younger brother. Her 'gut' told her to stop, and her friend didn't mind. She assessed the situation and realized he needed CPR. "He was just helpless on the ground and no one was doing anything. His pulse was thready, and he had stopped breathing."

She dropped down to begin compressions, silently singing the Bee Gees' tune "Staying Alive" as she had been taught to do in trainings. She laughs. "It has the right rhythm."

Mentally freaking out, she tried to remain composed. "It's totally different from simulation lab," she said.

Then Bernard, who specializes in heart arrhythmias, drove by after having no luck in getting a gift. He saw someone doing CPR and stopped to help. Though Skeele knew EMS had been called, she said it was such a relief to see him arrive and have a "senior official" there.

Bernard monitored Repshas' pulse and Skeele continued to do compressions. Help from the Charleston Fire Department and EMS arrived in what seemed an eternity to Skeele, and Bernard briefed the emergency technicians on Repshas' condition. At the time, Skeele and Bernard thought the patient, who had no identification, would be taken to another hospital.

Skeele said she got in her car and sat for awhile in shock. Later, she tried to find out how he was, but patient privacy laws kept her from being able to get any information on his condition. Frustrated, Skeele accepted she may never know the young man's fate, but then she saw an email from her nursing college that let her know Bernard was looking for her.

Repshas ended up at MUSC for treatment since he had no identification. Bernard said he noticed a 22-year-old was in ICU who had avoided sudden cardiac death. Bernard thought who else could that be?

In all the craziness he had forgotten Skeele's name, but the family wanted to meet her. When Skeele came to visit, the family was in the waiting room. She was introduced and the mom, Chris Bernock, beamed at her saying, "This is the one. Let me give you a big hug."

Skeele said it was one of the most emotionally-charged moments she's ever had and she instantly liked Bernock. "His mom was so calm and pulled together. It was fantastic meeting her. I met his sister, too."

Though Bernard was not directly involved with Repshas' care, he did end up putting in his implantable cardioverter defibrillator before Repshas was discharged. Repshas has a very rare (1-2 per 1,000,000 people) condition called left ventricle noncompaction cardiomyopathy. Bernard said there are doctors who've been at MUSC for three decades who haven't seen this type of case. It's an abnormal development of heart muscle where the muscle fibers do not form a compact layer. Instead the muscle fibers are loosely packed in almost a sponge-like manner, which can lead to heart failure, arrhythmias and other heart disorders.

Repshas was treated with a hypothermia protocol where the body core temperature is cooled for 24 hours and then slowly rewarmed to a normal temperature. During this time, Repshas was sedated in a drug-induced coma and carefully monitored in the ICU. Bernard said the procedure has been shown to reduce brain injury after cardiac arrests.
Bernard praised how Skeele handled the situation, encouraging everyone who can learn CPR to do so.

"She provided prompt CPR that probably made the difference in his outcome. Providing early and sustained CPR is one of the most important factors in survival. After sudden cardiac death, there is a very narrow window to successfully resuscitate somebody. After only five to 10 minutes, survival approaches zero percent. The fact that she recognized the situation and acted accordingly saved Justin's life."

As for Skeele, she said the event changed her life. She has found nursing takes her heart and soul. "It takes everything about yourself. I've learned a lot about myself and what people have to go through when they're sick. This experience has changed me. It's connected me to what I want to do."

She knows now more than ever that she has chosen the right profession. In school nursing students hear how they will make a difference in patients' lives, but having it actually happen was inspirational for her, she said.

Repshas, who has returned to school, said the experience has changed him as well. "I feel very, very lucky to come out as strong as I was before. It was very scary."

He's very grateful that Skeele and Bernard showed up when they did, and the support he got from emergency personnel, the City of Charleston police and friends who helped to get him identified and MUSC staff.

"Words can't explain how grateful I am. They saved my life. It was a really fortunate series of events that day. It gives you a different outlook in life. The small things in life matter more. I couldn't be happier to be here with my friends and family."

The Diagnosis:
Repshas has left ventricle noncompaction cardiomyopathy. It's an abnormal development of heart muscle where the muscle fibers do not form a compact layer. Instead the muscle fibers are loosely packed in almost a sponge-like manner, which can lead to heart failure, arrhythmias and other heart disorders.

Occurrence:
Repshas condition is very rare (1-2 per 1,000,000 people). Bernard said there are doctors who've been at MUSC for three decades who haven't seen this type of case. Repshas is treated with hypothermia protocol.