Patient Story: Thomas Keller

Thomas Keller is a correctional officer at the Rosebud Adult Correctional Facility near Mission, S.D. Working out after his shift with fellow officers, he found himself struggling after accidentally dropping a barbell loaded with 315 pounds on his chest.

“The bar slipped out of my hands and landed on my chest,” he said. “I caught the bar after it bounced off my chest and I stood up and racked it. Another officer asked if I was alright and I just told him I needed some water and I’d be fine. I walked around the weight room a little bit, and I remember it getting really dark and I went to a knee.”

A stroke of luck

Thomas’s coworkers called an ambulance, who transported him to the Indian Health Service’s Rosebud Unit Emergency Room. He had fractured his sternum and punctured his heart — a serious condition that would need specialized care. They made the call to arrange for transport to Monument Health Rapid City Hospital.

The Oglala Lakota Air Rescue service had a helicopter that had just fueled up in Winner, South Dakota, on their way home from Sioux Falls. It wasn’t a routine stop for them, so they were nearby purely by chance. The crew landed at the Rosebud Emergency Room before they had a full grasp of Thomas’s injury. Once they understood the severity of the situation, they knew they had to get Thomas in the helicopter and transport him to Monument Health as quickly as possible.

The original plan had been to fly Thomas from the Rosebud Unit Emergency Room to Monument Health by airplane. It would have resulted in another 45 minutes of transport time — which likely would have resulted in a fatal outcome for Thomas.

Racing against the clock

When the helicopter landed on Monument Health’s helipad, the team took Thomas directly to the surgical suite for treatment. Kalyan Vunnamadala, M.D., a cardiothoracic and vascular surgeon at the Heart and Vascular Institute, had already been briefed by the Rosebud Unit Emergency Department. He understood every minute spent getting Thomas to surgery was the difference between life and death.

“I spoke with the emergency room doctor at Rosebud, who said there was fluid around Mr. Keller’s heart. My concern was that this was blood pushing on his heart,” Dr. Vunnamadala said. “We had a team waiting in the operating room, including our anesthesiologist and our perfusionist who runs the heart-lung machine. All of our OR team was waiting, and as soon as Mr. Keller came in we knew time was of the essence.”

Thomas’s injury had caused pericardial effusion — a buildup of fluid inside the lining around the heart — that results in excess pressure. Dr. Vunnamadala performed a median sternotomy, which involved opening the breastbone in order to access the heart, and then cut open the pericardium to relieve the pressure.

Perspective and gratitude

“I initially thought I had just broken a rib. I didn’t know it was that severe. But when I saw that many doctors suited up and locked in, I knew it was more serious,” Thomas said. “Once they put the gas on my nose, I remember I had a sigh of relief. It felt like my fight was done. It was in this guy’s hands now, and I felt like it was all going to be okay.”

“When he came to us, Thomas was as close to death as one can be,” Dr. Vunnamadala said. “The reason he’s alive today has a lot to do with all the medical teams involved in his care. But it also has to do with the team that saw him in the emergency room who made that phone call, and having the flight crew who brought him to us immediately. Thank God the OLAR team was close because he would not have made it even another 20 minutes. That crew gave him a fighting chance at life.”