My friend “John,” a conscientious and responsible guy, could have been killed because of a bad mistake. While driving at 60 mph, he looked down to plug in his cellphone.
John never saw the string of cars stopped ahead of him. He plowed into the back of a work van, which was propelled into the back of a large SUV, which was propelled into a car.
Only John was hospitalized – with a badly bruised chest, a broken breast bone and a couple of cuts. He hasn’t taken off his hospital identification bracelet. He says the bracelet reminds him of what could have happened, and he doesn’t ever want to forget.
Thirty years ago, I autopsied a man in Suffolk County, N.Y., who was in exactly the same sort of vehicular crash as John and died instantly.
When I did that man’s autopsy, I found no natural diseases and almost nothing in the way of injury. The only finding was a thin patch of blood no bigger than a dime on the membrane covering his heart.
The cause of death was a condition known as commotio cordis, which means “agitation of the heart.” A mechanical impact to the front of the chest can disrupt the electrically-controlled rhythm of the heart and cause it to stop pumping blood.
The most common victims are young male athletes; the most common sport is baseball or softball. In 2002, 7-year-old Nader Parman II of Marietta, Georgia, was playing ball with a 15-year-old neighbor. The older boy was hitting pop flies for Nader to catch. On one swing, he misjudged the angle of the bat. Instead of a pop fly, he hit a line drive that struck Nader in the chest and killed him.
Besides the automobile driver, I saw one other example of commotio cordis. Two curmudgeonly New York neighbors were arguing about whose responsibility it was to clean up fallen tree branches – the man on whose side of the fence the tree grew or the man on whose side of the fence the branches fell.
One of the irascible neighbors picked up a branch and whacked the other in the chest, killing him instantly.
Commotio cordis cases are rare. The amount of force delivered to the chest has to be just right – neither too little nor too much.
The impact has to be inflicted within about a 15-millisecond interval between heartbeats. At no other time in the heart cycle are the electrical pathways vulnerable to mechanical disruption.
It requires freakishly bad luck to fall victim to commotio cordis.
Back in the 1970s, I was a fan of the comedy TV show “Rowan & Martin’s Laugh-In.” One of the popular skits was the presentation of Flying Fickle Finger of Fate trophies for victims of freakishly bad luck.
The concept doesn’t seem nearly so funny now, perhaps because of all the victims of freakishly bad luck I’ve seen on my autopsy table.
What are the odds that cars will stop in front of you at the moment you take your eyes off the road? That an impact to your chest will have just the right amount of force? That it will land at just the right time to stop your heart?
The Flying Fickle Finger of Fate passed John by. He didn’t make his wife a widow. He didn’t doom his 11-year-old daughter to a lifetime without her dad. He didn’t seriously injure or kill anybody else.
But he could have.
Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland. Email her at firstname.lastname@example.org.