Craig Cunningham lies in his hospital bed at Banner-University Medical Center on Monday night facing an uncertain future, staring up at the fire alarm high above his bed.
He nods toward it.
โThe only thing I remember from being sick was that fire alarm right there,โ says the 26-year-old Tucson Roadrunners team captain, hooked to a heart monitor, wires tangled in every direction. โI thought it was a spaceship or something.โ
He is surrounded by family and friends. Cunningham is quiet but attentive. Beeps break up the silence.
Cunningham says he is thankful for their presence and, in his words, โextremely lucky that Iโm still here today.โ
The next step in this arduous journey โ which began back on Nov. 19, when Cunningham suffered a heart attack just before the opening faceoff of a matchup with the visiting Manitoba Moose โ is expected to happen this week. Barring setbacks, Cunningham will be released from UMC to a local rehabilitation center.
As they have for a month, his teammates and even a few opposing players have stopped by, all just hoping to catch a glimpse of the guy they call โCraiger.โ
โItโs been tough, man,โ Cunningham told the Star in his first interview since collapsing on the Tucson Arena ice. โIโm just trying to take it day-by-day. I donโt really know whatโs next or whatโs in my future, but Iโm extremely happy to be alive.โ
And so is the doctor who helped save him.
โHeโs not going to make itโ
Dr. Zain Khalpey got the phone call right about 7:45 p.m. on that Saturday night.
Roughly 45 minutes earlier, Cunningham โ the first-year Roadrunnersโ effervescent leader โ 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. Maryโs Hospital, where Cunningham was taken for emergency resuscitative procedures.
Haloftis, working at St. Maryโs with cardiologist and Khalpeyโs 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.
โWhen I got to the fork in the road on Grant, I got a call from George saying, โZain, heโs not going to make it,โโ Khalpey said.
Khalpey pulled over and got the full synopsis of Cunninghamโs condition: He was now bleeding from his lungs, and on a ventilator.
At this point, heโd had roughly 70 minutes of aggressive CPR, or what Khalpey calls โeffective CPR,โ not just โstaying-alive CPR.โ
โThe thing that turned me was when George said to me, โZain, Iโve got 40 hockey players looking at me,โ Khalpey said. โAnd his mom. Youโve got to come.โ
Khalpey called Matt McReynolds, his perfusionist โ the person who runs the heart-lung machine โ and told him to gear up. He ducked over to UMC, sprinted inside to the intensive care unit and snagged a handful of cannulas โ tubes inserted into the groin to drain blood, which is then directed into a pump to simulate the heartโs function โ because St. Maryโs would not have them. The rest of Khalpeyโs team, which includes nurses and a mobile emergency bed unit, would have to meet them at St Maryโs.
Khalpey and McReynolds grabbed the ECMO machine, tossed it in the back of McReynoldsโ car and raced to the hospital.
โGeorge was on the phone with us the whole time โ heโs such a sweet guy โ and he opened the gates, and it was like a red carpet. They were so humbled somebody came, because now itโs been 85 minutes of CPR,โ Khalpey said.
Itโs one thing to hold Cunninghamโs heart quite literally in his hands โ itโs 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.
Khalpey and McReynolds got a quick debriefing and scrubbed in. Now came the hard part.
โMatt 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,โ Khalpey said. โShe was very stoic, had amazing composure, and I had to tell her about her son and how sick he was. I donโt think anybody had told her the depth of how sick he was, and that this would be going to make him live or not.โ
โI watched my son dieโ
Standing outside her baby boyโs hospital room, Heather Cunningham shook, her voice quivering, but her reserves steeled.
She was in town from Trail, British Columbia, visiting the night of Cunnighamโs heart attack. She watched him fall to the ice.
โI watched my son die right in front of my eyes,โ she said, her voice cracking. โThere 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, youโre like, โIs he still here or he didnโt make it?โ It was horrifying.โ
Heather credits Khalpey with displaying not just a professional, but a personal manner, in relaying the last-ditch effort that was about to ensue.
โI talked to her as I wouldโve talked to any of my students, with complete transparency, as quickly and as simply as possible,โ Khalpey said. โTo convey that there is at least hope, that I can get him stable. I knew that. I saw what his vessels were like, that heโs an athlete, heโs 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.
โWe were going to do this.โ
โThis is amazingโ
For 85 minutes, they beat Craig Cunninghamโs heart to a bloody pulp. And right around then, 40 minutes after heโd first gotten the call that would save Cunninghamโs life, Khalpey felt confident.
Cunninghamโs blood pressure was up, he was off sedation, moving and responding. Khalpey said it kicked into โsalvage mode.โ Theyโd need to be aggressive.
The procedure is remarkably complex, yet simple in its explanation: Cunninghamโs 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 bodyโs natural blood pumping, using the ECMO machine to act as a temporary heart and lung, with the cannulas draining the side of Cunninghamโs heart, the blood passing through a pump which pushed it into an artificial lung, which moved it back through the heartโs 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.
โAnd then he squeezed my hand, and I was like โYes, yes,โ โ Khalpey said, his voice turning into a whisper as he leaned back in his chair, closing his eyes and pumping his fist. โCan you ... believe this? This is amazing.โ
Cunningham was not out of the woods, nowhere even close, but he was stable, and in that moment, they all needed a win.
โI had to give his mom some semblance of one step had been done, just one thing which would allow her to breathe a little,โ 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: Cunninghamโs 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, theyโve got a little extra help on their side.
โI told his mom, โI have to do this, do you trust me?โ Heโd be the third person to have this done in the world,โ he said. โAnd she said, โDo it.โโ
Khalpey grabs a plastic model heart on his desk and shows what he did next.
โI 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.โ
To that point, Cunningham had displayed little-to-zero heart function.
After that, it went from zero to 45 percent.
Whatโs it like, to save a man like that?
โHumbling,โ Khalpey said. โAnd a privilege. โฆ You canโt really compare it to anything. The acuity of that โฆ itโs better than getting a goal. Itโs better than winning a cup, whether itโs 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.โ
And now?
โThe long-term prognosis is that his heart function is working really well,โ Khalpey said. โWill he be able to move around on the ice?โ
That question remains unanswered. Itโs not the only one. How could this even happen to a healthy, 26-year-old professional athlete in the first place?
โThatโs the million-dollar question,โ Khalpey said. โWeโre still trying to find out. It could be multiple causes.โ
Khalpey lists a few: A predisposition to abnormal pathways, or abnormal electrolytes, if Cunninghamโs potassium was too high.
โAnd sudden death is another thing,โ Khalpey said. โBut he doesnโt have the pathology for that.โ
Sudden death is a hockey term.
Until, suddenly, itโs not.
Humbled by support
Laying in a hospital bed, weak from a monthโs worth of trauma but strong enough to talk, Cunningham talks about the future like itโs an open landscape.
โWhen I woke up, I had to readjust a lot of things in my life,โ he said. โAll Iโve ever known was how to be a hockey player, and itโs all I ever really wanted to do. Now that I know that Iโll most likely never play again, Iโm not sure what the next door is for me.โ
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. Heโs 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.
โIt just shows the hockey world is such a small world,โ he said.
He is humbled by the support heโs 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.
โTo be honest, every single doctor and nurse Iโve dealt with so far has been very personable as well as very professional, and it makes a big difference,โ he said. โIt makes you feel a lot better about yourself, especially going through tough times.โ
And these are indeed tough times.
โThe biggest thing is, itโs scary,โ he said. โThey still donโt know what caused it. Iโm a young 26-year-old, Iโm healthy, Iโm in good shape, and Iโve never had any heart complications before. The scariest thing is every night before I go to bed, I donโt know if Iโm going to wake up in the morning.โ
Heโs not the only one who has trouble sleeping.
โI go to bed every night trying to figure out what went wrong. If I went wrong?โ Cunninghamโs mom said. โI have no idea what went wrong. You canโt fix what you donโt know. I have two other sons, and Iโm worried sick now. You put your kids in sports because you think itโs healthy, and itโs good for them and itโs going to do well, and it kinda backfired in a way on me. Itโs the hardest thing to understand, something thereโs no answer to.โ
For now, theyโll continue to seek answers. Until then, thereโs always hope.
โNow that Iโve seen him come back and be as strong as heโs been, I know that heโll be in the NHL, maybe not as a hockey player,โ Heather said. โBut he will find a way to get there. I know that. Thatโs one thing I can say without a tear, without a shake in my voice. Craiger will make it some way, somehow.โ
