Health: Almost three months after being hit with a condition that most times ends in death, Aaron Small looks back on that fateful day when his lucky stars were aligned

With their two young children fast asleep, Aaron and Jenny Small were about to settle in for a quiet Saturday evening at home.
Aaron was downstairs waiting for the puck to drop for Hockey Night in Canada and Jenny was upstairs on the living room couch, plugged into her iPod.
The day before, Aaron had enjoyed a solid day of snowmobiling with next-door neighbour Jeff Sherwood. And later that night he helped celebrate Terry Lamb's 50th birthday, complete with an SUV stretch limousine. The party went into the wee hours of the morning and was loaded with laughs.
On Saturday, the Smalls went to the hospital to visit Aaron's maternal grandmother, Isabel Fullerton - their three-year-old daughter is named after her great-grandmother - who was experiencing gall bladder complications. Later, the family of four from Rothesay stopped at Swiss Chalet for lunch.
There were absolutely no signs of trouble.
After dinner, little Kyle and Isabel went to bed like angels - Jenny assures this isn't always the case.
It was the calm before the storm.
"I came up to listen to my iPod," she said. "It was 8 o'clock and Aaron came up clutching his chest. He said, 'Jenny, I'm having chest pains and my jaw and head feel like they're going to blow off.'
"He came and sat beside me on the couch and he was real short of breath," she said. "It came out of nowhere."
"It was weird," Aaron said. "I'm a pretty healthy guy, all in all. It was definitely pretty scary. I knew something wasn't right."
As a cardiac nurse, Jenny traded her wedding band for her scrubs and swung into action.
"I said to him, 'You have two choices. I'm either calling someone to come here and I'm taking you, or I'm calling an ambulance.' "
Aaron suggested they wait five minutes and see if the pain would subside.
Jenny would have none of it. She knew every second counted.
"I see this every day," she said.
Then, as Aaron went downstairs in their split-entry home to get his coat, the pain intensified.
"I headed down the hall to change my clothes," Jenny said. "All I heard was 'Jenny, you better call the ambulance.'
"So, as I'm calling 911, I'm leaning over the top of the stairs, because I can see him at the bottom and I'm saying 'Are you passing out? Are you losing consciousness?'
"And he says, 'I think I'm going to.' He wasn't really sure. He didn't know what was what."
Just before calling 911, Jenny called Jeff Sherwood's wife, Andrea, to ask her if she could come over to look after the children while they went to the hospital. "I told her Aaron's having chest pain, can you come over? There were no questions asked.
"As I ran downstairs, I'm talking to 911 and I'm looking at Aaron and his pupils had dilated at this point and he couldn't move his whole right side. He was paralyzed on that side and kind of flailing on the left. He couldn't speak to me and that's when I thought he had stroked."
In the meantime, Andrea Sherwood showed up along with the ambulance and Const. Mary Henderson of the Rothesay Regional Police Force. Sherwood - formerly Andrea Stilwell - Small - formerly Jenny Alchorn - and Henderson - formerly Mary O'Brien - have been good friends for years, all having grown up in the Renforth area of Rothesay.
The paramedics began to hook the patient up with intravenous lines. He got up from the couch and actually started to feel a little better. He even walked to the ambulance.
"That's the end of Aaron's memory," his wife said, recalling the fateful night. "He remembers getting in the ambulance and his leg killing him but that was it until five days later."
The ambulance arrived at the Saint John Regional Hospital at approximately 8:45 p.m.
"He was so gorked on medicine, when we get into emerg, he's completely disoriented, completely agitated and his right leg is still killing him," Jenny said.
Familiar with cardiac procedures, Jenny Small had a hunch the nurses in the emergency room were testing for a dissection of the aorta. She was right.
The bad news, though, is that less than 20 per cent of people afflicted with the condition survive.
"It was the same thing that killed [actor] John Ritter," she said. "It wasn't seen on this particular test so I asked them if they were going to do a CT Scan. From the time they did the CT Scan until when we got back to emerg, the radiologist was on the phone. He saw it right away. It was an aortic dissection. It's the main vessel in your body that all of the other blood vessels come off to feed your brain, your arms, your kidneys, legs, everything. It's the main branch that everything comes off."
"Jenny's role can't be minimized," said Dr. Marc Pelletier, chief of the Department of Cardiac Surgery at the N.B. Heart Centre. "She recognized very early on that something was wrong . . . she played a very important role, not only getting him to the hospital quickly but once he was in the hospital, raising it as a potential diagnosis.
"We see about 10 patients a year arrive at the hospital who survive in New Brunswick," Pelletier said.
"We're looking at something that's very lethal. Only 10 to 20 per cent survive."
Pelletier said that up to 80 per cent of those afflicted will die and of the individuals who do make it to the hospital, 30 to 50 per cent will die, either in the emergency room or because they arrive at a smaller hospital and have to be transferred.
Dr. Peter Ross was the emergency room doctor on duty when Small arrived.
"It was a real ah-ha moment in his career," Jenny said. "Like I said, Aaron is a 36-year-old healthy guy. [Aortic dissection] wasn't in the forefront of the doctor's mind."
"Crack was in the forefront of their mind," Aaron said, referring to his unusual behaviour at the time.
"There was a lot of talk of whether he was on certain substances," Jenny said.
Ross now uses Small's case as a teaching tool during rounds.
Small was hurried to the operating room where Dr. Rand Forgie was ready to begin surgery that would last between nine and 10 hours.
Jenny said the key was not panicking and having their lucky stars aligned.
"We definitely had some sort of higher power with us," she said.
Small was hospitalized for two and a half weeks and is now on the mend.
"A lot of guys don't get off the couch," he said, referring to the mortality rate.
"All the stars were aligned for us," Jenny said. "The kids were asleep so they didn't see any of it. We were home on a Saturday night, which isn't always the case and a sense of calm came over me. It was really quite eerie. And add the fact that Dr. Forgie, an unbelievable surgeon, was on duty. Everything seemed to fall into place for Aaron."
Small said if it wasn't for his wife, he wouldn't have had the chance to even reach the operating room.
"If she wasn't there, I would have been pooched, according to the docs," said Small, who owns and operates Valley Home and Hearth on the Marr Road in Rothesay.
He said the fact that he beat such odds hasn't quite sunk in but the support he and his wife have received certainly has.
"The survival part is really good," he said matter-of-factly. "But the fact that everybody - friends and family - have been so helpful is unbelievable."
Aaron's aunt, Beth Fullerton, spearheaded a benefit dance that saw friends come from as far away as Montreal and Halifax. Others made sure their driveway was plowed and sanded and others offered hours of comfort with a steady stream of visitors to the hospital.
An avid hockey player and a familiar fixture on the blue line in the Kennebecasis Valley Gents Hockey League, Small was forced to the sidelines with all that has happened but the 6-foot-4, 200-pound defenceman - he was 230 pounds before the ordeal - hasn't totally thrown in the towel.
"His prognosis is good but he still has an abnormal aorta," said cardiologist Dr. David Bewick, who is overseeing Small's recovery. "He does require ongoing surveillance."
Bewick said it is important for Small to monitor his blood pressure and avoid any increase in sheer force, stop-and-start sports and intense weightlifting.
"I'd rather see him doing controlled exercises with a warm-up and cool-down phase."
Small admits that he looks at life differently these days.
"I've had more than my share of people in the medical field tell me that I should have been dead. So yes, it does change your outlook."
During a recent visit to the Rothesay Arena to watch young Kyle in action, the proud father stood behind the protective glass chatting with friends.
Someone walking by said, "Good to see you Aaron."
To which Small replied with heartfelt sincerity, "It's good to be seen."
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One word that comes to mind about our families, friends, colleagues, neighbours, acquaintances and community throughout this crisis would be gratitude. Since January 15th there has been an outpouring of support, including caring for our children, helping with our business, sending food, plowing, shovelling and sanding our driveway, organizing a benefit, helping out and donating to the benefit, giving of personal time, travelling from near and far (including Montreal and Halifax) to attend our benefit, and sending thoughts and prayers via phone, mail, email and texts.
We are deeply touched and overwhelmed. We know that we are, indeed, blessed to have so many wonderful people in our lives and cannot thank you all enough.
From Dr. Rand Forgie, Dr. Peter Ross, Dr. Ian Keith, Dr. David Bewick, the cardiac OR staff and the entire staff at the New Brunswick Heart Centre, everyone was just amazing.
Jenny and Aaron Small
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"Aortic dissection is a potentially lethal disorder which results from a sudden tear of the inner lining of the aorta, a tube that transports the blood ejected from the heart to the body. Conditions associated with this abnormality include chronic hypertension, atherosclerosis or 'hardening of the arteries', congenital heart abnormalities such as a bicuspid aortic valve and an aneurysmal aorta or an inherited condition called Marfan's syndrome. Patients with these predisposed conditions, which, not infrequently,they are completely unaware of and have an enlarged aorta with weakening of the aortic wall, can present with an aortic dissection. Instead of a healthy reinforced aortic wall which can withstand the pulsating ejection of blood from the heart, patients with an aortic dissection have a weakened wall, similar to wet tissue paper which can suddenly tear. Think of the aorta similar to the peeling of an orange. When an aortic dissection occurs, the blood ejected from the heart with each beat 'dissects' the peeling from the orange rather than staying inside the orange. This potentially can cause a complete rupture of the lining of the aorta and result in a catastrophic situation with sudden death. Hence, immediate diagnosis is mandatory. Approximately, two per cent of patients die every hour from symptom onset if corrective surgery is not undertaken. Once a diagnosis is made, emergency cardiac surgery is mandatory due to the lethal consequences of conservative management."
Dr. David Bewick