Medicine: Staying Alive

A heroic story of survival

The 4½-year-old boy with tousled blond hair and dark blue eyes sprints down hallways, pieces a puzzle, counts on his fingers and chats about ghosts. All quite normal in most children, but to Jimmy Tontlewicz these activities represent hard-won victories. On Jan. 15, while sledding with his father, Jimmy plunged into the icy waters of Lake Michigan. When rescuers pulled him out, he had been submerged for at least 20 minutes and had no discernible heartbeat, pulse or breathing. In Chicago last week doctors said Jimmy is progressing so well that they hope to send him home this month.

Jimmy’s life was saved through a combination of technology and his body’s natural defense mechanisms. Prominent among these may be the so-called mammalian dive reflex, which allows whales and seals to remain submerged in cold water. It is theorized that humans also have this protection. The reflex is triggered when frigid water splashes over the forehead and nose; nerves signal the brain to divert oxygen-rich blood from the limbs to the heart and brain. An even more important defense against brain damage is a phenomenon known as sub mersion hypothermia: the extreme cold of the surrounding water, and of water breathed into the lungs, cools the body (to about 85° F in Jimmy’s case), slowing down the metabolic rate and thus reducing the brain’s oxygen requirements. Says Pediatric Neurosurgeon David McLone, of Children’s Memorial Hospital: “Had he been warm, there would have been no chance.”

Increasingly, the lives of young near-victims of drowning in frigid water are being saved by techniques perfected over the past decade. Jimmy’s is almost a textbook example: fire-department paramedics at the scene of the accident immediately started cardiopulmonary resuscitation, fluids and drugs were given intravenously, and air was blown into his lungs repeatedly. At Louis A. Weiss Memorial Hospital, an emergency team labored over Jimmy for three hours. They used electric shock five times to restart his heart, put him on a respirator, and with heat lamps slowly warmed his body to 91° F in order to prevent further tissue damage.

Jimmy was then transferred to Children’s Memorial, where doctors gave him massive doses of barbiturates to maintain his coma, a technique increasingly used in head-injury patients. Reason: the drugs reduce the brain’s need for oxygen and glucose and lessen the chance of swelling.

Nine days later Jimmy woke up. Recalls Pediatrician Paulette Harar at the Rehabilitation Institute of Chicago, where the boy has been since Feb. 28: “He would lie on the bed sucking his thumb, curled up in a little ball. There commands like ‘Sit up’ or Steadfast work with therapists has helped Jimmy regain control over movement, speech and thought.

The miracle recovery is not perfect. Doctors suspect that Jimmy had learning disabilities before the accident. They hope he will return to his previous abilities. “But,” says Dr. Harar, “ask me if he’ll ever read. Will he understand how d is different from b? I don’t know.”