Hockey Tough

I have been listening to TNQ Podcast for over a year now, and I am a large supporter of the SEAL Teams and Community. I have a family friend that is a retired SEAL from TEAM 3, and DevGru. I have also become close with an individual in Tucson that does specialized swimming instruction for SEAL Teams in Virginia and Tucson. Words cannot describe the respect and deep appreciation I have for the SEAL Teams, and all military for that matter. I work in the world of professional sports, which does not compare to the intensity of the world of Spec Ops, but I feel this story might carry some weight.

This is a story of never quitting, not so much about one particular individual, although it is based around one particular individual, but rather an entire group of individuals who refused to quit to save a man’s life.

I am the Head Strength and Conditioning Coach and Assistant Athletic Trainer for the Tucson Roadrunners, which is the minor league affiliate team of the Arizona Coyotes of the NHL. It was the night of November 19 and we were preparing to square off against The Manitoba Moose at home. The players had taken the ice after warm-ups and were getting ready for the puck to drop when suddenly Craig Cunningham, our team Captain and starting right winger, collapsed to the ice. A few moments went by while Craig lay on the ice, his teammates thinking he just slipped and was laying on the ice in embarrassment, when everyone realized it was something more serious. Our Head Athletic Trainer at the time sprinted to his side, conducted an initial primary evaluation and initiated EMS response.

The EMS crew and the rest of the training staff ran to the ice to begin the first steps of many to save Craig’s life. Craig’s vitals were not steady. His pulse was weak at times, then non existent moments later. His breathing was short and laborious. We began cutting his gear off with our shears and the EMS crew applied an AED. As we began to spine board him and begin moving him off the ice to the ambulance, we had to begin chest compressions because his heart was in ventricular fibrillation. We defibrillated his heart immediately once we got off of the ice and twice more in the ambulance on the way to the hospital all while continuing CPR.

The rest written is written by Jon Gold of the Tucson Daily Star. I feel he best captured what happened the rest of the night of this incident.

Dr. Zain Khalpey got the phone call right about 7:45 p.m. on that Saturday night.

Roughly 45 minutes earlier, Cunningham — the first-year Roadrunners’ effervescent leader — had dropped to the ice from what can now be called cardiac arrest. He was quickly attended to by team trainers, medics and even a group of local firefighters who were on the ice performing the national anthem as part of a Scottish bagpipe and drum band.

Khalpey, from Great Britain, Ivy League-educated and considered a top cardiothoracic surgeon, remembers thinking that it was strange to know there was an ice rink in the desert. On the other end of the line was Dr. George Haloftis, a physician at St. Mary’s Hospital, where Cunningham was taken for emergency resuscitative procedures.

Haloftis, working at St. Mary’s with cardiologist and Khalpey’s friend Dr. Reza Movahed, told him that Cunningham was not responding to increasing dosages of Epinephrine and Levophed, and that more extreme measures were needed. Khalpey told Haloftis he was on his way to UMC to rally his team for an emergency surgery using a device called an extracorporeal membrane oxygenation machine, or ECMO .

Driving on East Grant Road toward North Campbell Avenue approaching UMC, Khalpey got another phone call.

“When I got to the fork in the road on Grant, I got a call from George saying, ‘Zain, he’s not going to make it,’” Khalpey said.

Khalpey pulled over and got the full synopsis of Cunningham’s condition: He was now bleeding from his lungs, and on a ventilator.

At this point, he’d had roughly 70 minutes of aggressive CPR, or what Khalpey calls “effective CPR,” not just “staying-alive CPR.”

“The thing that turned me was when George said to me, ‘Zain, I’ve got 40 hockey players looking at me,” Khalpey said. “And his mom. You’ve got to come.”

(** I spoke to Dr. George Haloftis briefly after he called Dr. Khalpey. I was in a waiting room with Craig’s mom, who just happened to be visiting from British Colombia, where Craig is from. He pulled me aside and told me that they typically do not do CPR for more than 25 minutes on someone. He told me that Dr. Movahed had stopped for a moment and asked, “George, how long can we keep doing this, with no signs of improvement?” and this is word-for-word what Dr. George Haloftis told me…”I looked at Dr. Mohaved and told him that there is no way I am walking out to that waiting room to tell his team and his mother that we fucking quit. We are not going to fucking quit on this boy now get back to work!.”….I still get emotional thinking about that conversation with him.**)

Khalpey called Matt McReynolds, his perfusionist — the person who runs the heart-lung machine — and told him to gear up. He ducked over to UMC, sprinted inside to the intensive care unit and snagged a handful of cannulas — tubes inserted into the groin to drain blood, which is then directed into a pump to simulate the heart’s function — because St. Mary’s would not have them. The rest of Khalpey’s team, which includes nurses and a mobile emergency bed unit, would have to meet them at St Mary’s.

Khalpey and McReynolds grabbed the ECMO machine, tossed it in the back of McReynolds’ car and raced to the hospital.

“George was on the phone with us the whole time — he’s such a sweet guy — and he opened the gates, and it was like a red carpet. They were so humbled somebody came, because now it’s been 85 minutes of CPR,” Khalpey said.

It’s one thing to hold Cunningham’s heart quite literally in his hands — it’s a whole other thing to actually carry in the equipment that will be used to save his life, as Khalpey and McReynolds did upon exiting the car.

(** Another highlighted “Never-Quit” moment of this scenario was that Dr. Khalepy and his team was not contracted to work at St. Marys hospital. He actually could’ve, and might’ve gotten into some trouble for performing the surgery he did at that hospital. He could’ve easily told Dr. George he could not do it, but he refused to quit on Craig and broke through so much red tape to save Craig’s life.**)

Khalpey and McReynolds got a quick debriefing and scrubbed in. Now came the hard part.

“Matt calmly took the device out, got the cannulas prepped, got everything sterile, but before we did that I had to talk to his mom, and told her what I had to do, with these 40 guys sitting there,” Khalpey said. “She was very stoic, had amazing composure, and I had to tell her about her son and how sick he was. I don’t think anybody had told her the depth of how sick he was, and that this would be going to make him live or not.”

Standing outside her baby boy’s hospital room, Heather Cunningham shook, her voice quivering, but her reserves steeled.

She was in town from Trail, British Columbia, visiting the night of Cunnigham’s heart attack. She watched him fall to the ice.

“I watched my son die right in front of my eyes,” she said, her voice cracking. “There was not a doubt in my mind. I thought he was gone. From the minute he hit the ice I could tell there was something not right. The waiting was awful. It was the worst. The doctors coming, going, not coming back. Every time they enter the room, you’re like, ‘Is he still here or he didn’t make it?’ It was horrifying.”

Heather credits Khalpey with displaying not just a professional, but a personal manner, in relaying the last-ditch effort that was about to ensue.

“I talked to her as I would’ve talked to any of my students, with complete transparency, as quickly and as simply as possible,” Khalpey said. “To convey that there is at least hope, that I can get him stable. I knew that. I saw what his vessels were like, that he’s an athlete, he’s got a good anatomy. I told his mom what I would tell my mom if I needed to do something. I needed to be positive, and having the realistic chances of getting him stable, I think she knew there was not a chance of me failing, because I would not fail.

“We were going to do this.”

For 85 minutes, they beat Craig Cunningham’s heart to a bloody pulp. And right around then, 40 minutes after he’d first gotten the call that would save Cunningham’s life, Khalpey felt confident.

Cunningham’s blood pressure was up, he was off sedation, moving and responding. Khalpey said it kicked into “salvage mode.” They’d need to be aggressive.

The procedure is remarkably complex, yet simple in its explanation: Cunningham’s heart was still in ventricular fibrillation, and because his lungs were bleeding, his blood was getting little oxygen. The blood in his heart at that point, Khalpey said, was black. Khalpey needed to circumvent the body’s natural blood pumping, using the ECMO machine to act as a temporary heart and lung, with the cannulas draining the side of Cunningham’s heart, the blood passing through a pump which pushed it into an artificial lung, which moved it back through the heart’s arterial side with fully oxygenated blood.

As they were doing the arterial side, Khalpey said, Cunningham crashed and CPR was needed once more. The medication increased even further. After 20 minutes, he said, everything was sewn up and secured.

Cunningham soon moved his legs.

“And then he squeezed my hand, and I was like ‘Yes, yes,’ ” Khalpey said, his voice turning into a whisper as he leaned back in his chair, closing his eyes and pumping his fist. “Can you … believe this? This is amazing.”

(** Another side not: The machine needed to save Craig’s life was the only one of three in Tucson available, and the only one available for hundreds of miles. And the only man who knew how to properly install it, Dr. Khalpey, was in Tucson. Also, this was the first time Dr. Khalpey, or anyone, had ever done this specific type of procedure…ever.**)

Cunningham was not out of the woods, nowhere even close, but he was stable, and in that moment, they all needed a win.

“I had to give his mom some semblance of one step had been done, just one thing which would allow her to breathe a little,” Khalpey said.

Cunningham would require numerous surgeries over the coming days and weeks, including a procedure on Tuesday.

The biggest scare came roughly a day-and-a-half after the original incident: Cunningham’s heart was still enlarged and needed decompression, and the circulation to his legs had been cut off.

Khalpey proposed a new technique, using the ECMO machine once more, that has only been used three other times, ever: All by Khalpey, all within the prior two weeks, most recently to a priest who just happened to have the room next to Cunningham.

So, he figured, they’ve got a little extra help on their side.

“I told his mom, ‘I have to do this, do you trust me?’ He’d be the third person to have this done in the world,” he said. “And she said, ‘Do it.’”

Khalpey grabs a plastic model heart on his desk and shows what he did next.

“I made a small incision on the left side of his chest, made a hole in his heart at the apex, took the cannula and shoved it through his heart where it sucked blood to decompress from both the left and the right side. I took his lungs out of the equation. His heart was mashed up, black and blue, and the reason I did this was I knew I could get a faster result, a better result. I had to put stitches in to make sure it was safe. But I knew I could preserve his heart.”

To that point, Cunningham had displayed little-to-zero heart function.

After that, it went from zero to 45 percent.

What’s it like, to save a man like that?

“Humbling,” Khalpey said. “And a privilege. … You can’t really compare it to anything. The acuity of that … it’s better than getting a goal. It’s better than winning a cup, whether it’s Stanley or other. It was internally mesmerizing. And it was like thank God, and not for me, but for his mom, and the kids who were out there.”

And now?

“The long-term prognosis is that his heart function is working really well,” Khalpey said. “Will he be able to move around on the ice?”

That question remains unanswered. It’s not the only one. How could this even happen to a healthy, 26-year-old professional athlete in the first place?

“That’s the million-dollar question,” Khalpey said. “We’re still trying to find out. It could be multiple causes.”

Khalpey lists a few: A predisposition to abnormal pathways, or abnormal electrolytes, if Cunningham’s potassium was too high.

“And sudden death is another thing,” Khalpey said. “But he doesn’t have the pathology for that.”

Sudden death is a hockey term.

Until, suddenly, it’s not.

Laying in a hospital bed, weak from a month’s worth of trauma but strong enough to talk, Cunningham talks about the future like it’s an open landscape.

“When I woke up, I had to readjust a lot of things in my life,” he said. “All I’ve ever known was how to be a hockey player, and it’s all I ever really wanted to do. Now that I know that I’ll most likely never play again, I’m not sure what the next door is for me.”

First is what he expects to be one of at least two stints in rehab as he works toward his first goal, which is simply to regain independence.

Second is figure out the next step in a life that was supposed to include the NHL. He’s maintained his jovial attitude, cracking jokes and sounding upbeat. His girlfriend has been glued to his side, as have his teammates. He says it is hard to watch Roadrunners games, but he basks in the presence of his teammates when they pop in, and even the opponents, when they drop in as well.

“It just shows the hockey world is such a small world,” he said.

He is humbled by the support he’s received from the community. Schoolchildren wrote him get-well cards. Roadrunners fans signed banners at games.

Cunningham is especially thankful for the medical attention he received, both in the arena and out.

“To be honest, every single doctor and nurse I’ve dealt with so far has been very personable as well as very professional, and it makes a big difference,” he said. “It makes you feel a lot better about yourself, especially going through tough times.”

And these are indeed tough times.

“The biggest thing is, it’s scary,” he said. “They still don’t know what caused it. I’m a young 26-year-old, I’m healthy, I’m in good shape, and I’ve never had any heart complications before. The scariest thing is every night before I go to bed, I don’t know if I’m going to wake up in the morning.”

He’s not the only one who has trouble sleeping.

“I go to bed every night trying to figure out what went wrong. If I went wrong?” Cunningham’s mom said. “I have no idea what went wrong. You can’t fix what you don’t know. I have two other sons, and I’m worried sick now. You put your kids in sports because you think it’s healthy, and it’s good for them and it’s going to do well, and it kinda backfired in a way on me. It’s the hardest thing to understand, something there’s no answer to.”

For now, they’ll continue to seek answers. Until then, there’s always hope.

“Now that I’ve seen him come back and be as strong as he’s been, I know that he’ll be in the NHL, maybe not as a hockey player,” Heather said. “But he will find a way to get there. I know that. That’s one thing I can say without a tear, without a shake in my voice. Craiger will make it some way, somehow.”

What this story didnt know yet was that Craig later had many complications with circulation of his left leg and had to be amputated below the knee on Christmas Eve, 2016. Craig, who had played in the NHL for the Boston Bruins and Arizona Coyotes, would never play the game again, not at that level anyways. He has been through countless surgeries, countless hours of rehab and continues to push on every day despite adversity after adversity. He know has a few different prosthetics and has been working out again with myself and another trainer. He has been hired to be a professional Scout for the Coyotes organization and maintains a positive attitude about his life.

There are even so many more details that I left out. I could write for pages to fully describe that night up until this point in time of everything Craig, his family, and our team has gone through after that night.

Like I said in the beginning, this story, mainly about Craig for refusing to quit and refusing to die and fighting so hard for those months that he was in the hospital and had his former life ripped away from him, but also about the amazing physicians who refused to quit to and stopped at nothing to save his life, and his mothers refusal to quit believing he would live and walk out of that hospital again one day (she stayed right by his side at the hospital with him for the entire 12 weeks he was in the hospital), as well as his girlfriend, and all his teammates, coaches, former teammates, and friends.

The hockey community, much like the SEAL community, is small in its own way. And when one of us falls everyone pulls together to support one another. It was amazing to see the amount of support Craig received Nationwide and still receives as he is still recovering.

I hope this story finds you, touches you, and inspires you like it has found, touched, and inspired so many others.

Best Regards,

Matt Harder

Author: Matt