'I Consider Myself a Miracle'
Justin Smith doesn't remember much of his survival story, but his family, friends and doctors do, and they're still amazed it's not an obituary.
Justin, 25, looked frozen solid the morning of Feb. 21, 2015, when his father found him near Tresckow Road, in Tresckow. Don Smith believed his only son was dead.
Justin was lying unconscious in a foot of snow, his blue eyes open and empty, his face purple, his body rigid.
He likely had been there overnight as the temperatures plunged to a frigid -4 degrees F. He had no pulse and wasn't breathing; he showed no signs of life. "I held him and sobbed, 'Justin, don't leave me,'" Don Smith says.
"Then I called his mother and told her, 'Justin's dead.'"
How he got there
An avid golfer and sports fan, Justin had been in the snow for some nine hours, coatless, after leaving a fire hall in Tresckow. He drank beer with his buddies, remembering his best friend who had died 10 years ago in an auto accident that Justin had survived.
A paramedic on scene called Lehigh Valley Hospital (LVH)–Hazleton's emergency department for guidance from emergency medicine team. They ordered the first responders to begin CPR and rush him to the hospital.
Hours earlier he was quite alive. Justin recalls having a few beers, then leaving the fire hall around 9:30 p.m. He blacked out on his walk homeward, two miles away. Or was he headed to the spot where the fatal car crash had occurred in 2005? Regardless, he didn't get far from the fire hall.
Hours of CPR
In LVH–Hazleton's emergency room (ER), they were unable to get a body temperature because Justin was so cold. Fifteen ER colleagues took turns doing two hours of CPR, performing emergency life support, slowly rewarming his body and providing exhausting lifesaving measures. Then Justin took an 18-minute flight via a MedEvac helicopter to LVH–Cedar Crest. Don Smith said a tearful goodbye to his son, telling him, "I'll see you down there. I love you."
Tim Hickey, RN, flight nurse, recalls thinking during the trip, "People in this situation don't survive." Throughout the flight, he and paramedic Mark Hopwood performed 100 chest compressions per minute, then ventilations, to keep blood flowing to Justin's brain. Still they saw no sign of life.
Shortly after MedEvac landed at LVH–Cedar Crest, cardiothoracic surgeon James Wu, MD, connected Justin to a machine that would warm and oxygenate his blood. Called extracorporeal membrane oxygenation (ECMO), this technology normally is used as a last-ditch effort to save patients whose lungs and heart are damaged by the flu or a heart attack.
A 50-50 chance
Wu knew this was Justin's sole chance for survival, but he wasn't overly optimistic. "I gave him a 50-50 chance for recovery," Wu says. He told Justin's family to be prepared for the worst. However, in 90 minutes, Justin's body was warming, and soon his heart was beating on its own.
Neurologist John Castaldo, MD, examined Justin and found no signs of brain activity. He was being kept alive by machines and medicines, and he was in a coma. "There was little hope for functional survival," he says. A few days later, tests, scans and exams surprised Castaldo and his team, showing that Justin's brain was normal.
"We were jubilant," Castaldo recalls. "We believed there was a miracle unfolding in front of us."
Still, they wondered how far Justin would recover. Castaldo monitored him daily, thinking Justin might stay in a vegetative state because of the long time without oxygen. "At first, he had no awareness of his surroundings," he says.
A glimmer of hope
Justin continued improving physically. Family and friends kept a vigil at his bedside. A month passed, and one day Castaldo looked into Justin's eyes for signs of brain function. "His eyes followed me; they tracked my face," he says. This gave Castaldo hope his patient's brain was recovering.
He needed care because neither his kidneys nor his lungs were working, and his toes and pinkies had to be amputated due to gangrene—all from the cold. But slowly his happy-go-lucky personality reemerged, and awareness and some memory returned. He was on an unmapped road to recovery.
Justin had to relearn to use his hands and walk with his toeless feet, his new normal. After months of recovery, he was playing golf, rooting on the Phillies and planning to return to college to finish his degree in psychology, perhaps to help others who suffered accidents like him. The mysteries of Justin's long night out may be frozen in his brain forever, Castaldo says. But he's alive to hear his tale of miraculous survival—leaving others to fill in the blanks—and to warn people to beware of the extreme cold.