b"8Why CARES Matters:A Story of Survival from OHCAThe Importance of the 6th Link in the Chain of Survival: Recovery By Kelly N Sawyer, MD, MS June 1, 2011It was the first day of my last month of Emergency Cardiac Care fellowship at Virginia Commonwealth University. I was submitting my fellowship work focused on the idea of individualized targeted temperature management (TTM). It was the day I collapsed and received TTM treatment myself.I was walking from the parking garage to the hospital for a meeting. What followed is a blur of my own memory and what others filled in for me.Among the witnesses were two nurses, who quickly alerted the emergency department (ED). They realized the fastest way to get me treatment was to call 911 for EMS support and transport. Being indoors but at streetDr. Sawyer's young daughter will help her celebrate 10 years of level, navigating elevators and long hallways inside thesurvivorship in June. hospital would have led to significant delays.Once in the ED, my own colleagues were faced with treatment decisions that they had not expected to perform for one of their own. My vital signs were blunt, with hypotension and severe hypoxemia suggesting a cardio-pulmonary event. Bedside ultrasound of my heart revealed a large clot in the right atrium. I was taken emergently to the operating room for cardiopulmonary bypass and open-heart surgery for removal of the clot.My ED partners debriefed, the surgical team cannulated, and my critical care team tweaked drips, temperature, and ventilator settings. They all knew, as I did, that survival from saddle pulmonary embolus complicated by shock and cardiac arrest rarely survives to admission, let alone discharge. Their decisions that dayand over the next several dayswould have a direct impact on me forever. My friends and colleagues had restless nights, waiting for my awakening. Over weeks to months, I met with many of those who had been there that day. It was important to me to fill in the gaps and reflect together on what had happened. The lasting effect of my cardiac arrest on them was clear to me. This highlights the fact that my story cannot be told without acknowledging their bravery and teamwork, as well as their worry and stress.Like many successful survival stories, all conditions were met for an optimal chain of survival. I walked out of the hospital and later presented my research at international meetings. I was lucky to have been witnessed and treated in a health system with comprehensive systems of care. Although I had focused on optimizing TTM for comatose survivors after cardiac arrest during my fellowship, it was through my own experience that I realized how much room we had for improving long term recovery and rehabilitation for our patients, their families, and caregivers. Sudden Cardiac Arrest Survivorship The concept of survivorship acknowledges the holistic complexity of a critical illness. It encompasses caregivers, family, and even healthcare providers, who care for the patient and their family both outside and inside the hospital. As more people are affected by cardiac arrest and more people survive, we, as healthcare providers, have a great opportunity to impact their rehabilitation and recovery. Recovery from a critical illness is multifaceted. Invasive procedures and prolonged immobilization in the intensive care unit often lead to physical impairments. Surviving cardiac arrest also results in cognitive, emotional, and existential challenges. Patients struggle with Why me?, Why did I survive when so many do not?, and What now?."