Soul Curry

A Second Lease of Life

At the age of 39, John Punnose, former CEO of Madras Medical Mission, and currently Managing Partner, Oyster Healthcare had sudden death episodes, while working in Kuwait. He shares how this incident changed his outlook towards life

I was the Advisor of Healthcare for Kapico Holding Co Kuwait and the Chief Executive Officer for Royale Hayat Hospital, when I had the first 'sudden death' episode on one fateful day in August 2008. I was only 39 then. I was found by my colleagues in an unconscious state in my office, with the body slumped on the table. There was no evidence of pulse or any signs of life. It is believed that my staff saw me in this state within a minute of my attack and called for immediate help. It was the grace of the mighty God that at that very moment, a group of my clinical team including the intensive care nurse and Code Blue in-charge nurse was attending a meeting next door in the conference room.

The Treatment

I was resuscitated after using repeated external defibrillator shocks and immediately rushed for further intervention to Mubarak Al Kabeer (Ministry of Health) referral hospital which was fortunately located in an adjacent campus.

I was first taken to the Mubarak Hospital and on seeing my fast deteriorating condition shifted to the Central Heart Hospital of MOH Kuwait. During the first two days, I had repeated attacks of ventricular fibrillation (heart rate of excess of 200 beats/minute), following which I had to be defibrillated and the heart got back to normal pacing, this repeated attacks is apparently called an 'electric storm'.

After a battery of tests, which included a CT to rule out brain damage or nerve rupture, angiography to check on my coronaries for any blocks and a electrophysiology test to evaluate my heart muscle condition and 24 hour monitoring, I was put on a host of drugs including a miracle drug called Cardarone (Amidarone) which helped the arrhythmia to cease.

After steadying my heart condition and almost 10 days of close monitoring in the intensive care, I was implanted with a life saving device called AICD (implantable cardioverter-defibrillator) in place of my old pacemaker. This device implanted on the left side of my body will perform the function of a lifeguard for rest of my life, constantly monitor the heart rhythm and automatically administer shocks if required, for various life threatening arrhythmias, according to the device's programming.

Was on Pacemaker

Before this accident, I had a pacemaker implant in the year 2001 at the age of 33 for suspected sick sinus syndrome (irregular heart rate), but had no significant concerns during these past eight years. My doctors seeing my good state of health and life, used to laugh that I had a pacemaker because I was the CEO and not that I required it.

I was at the best of health during this period. In fact, had just returned back from a two-week holiday in the US with family and earlier made a visit to Bangkok for a board meeting with the owners of the Bangkok Medi Clinic (partly owned my Kapico group). I underwent regular health checks and had a very balanced lifestyle, although I must add, I had an extremely challenging professional life as a hospital administrator and healthcare professional. I was in Kolkata as the CEO of AMRI Hospitals, when I was first diagnosed for the suspected sick sinus syndrome in the year 2001. Later I held positions of operational head at Indraprastha Apollo Hospitals, New Delhi (2001-2003), CEO (Operations & Management) of Apollo Hospital's Managed hospitals and consulting division (2003-05), CEO of Madras Medical Mission (2005-07) and finally CEO of Royale Hayat Hospital Kuwait.

The Diagnosis

I am now been diagnosed having an extremely rare form of cardiomyopathy called Arrhythmogenic Right Ventricular Dysplasia (ARVD), the second most common cause of sudden death of young adults worldwide. Studies have shown that ARVD is present in up to 20 per cent of individuals who experience sudden cardiac death (SCD) and is even more common among young athletes in their 20's and 30's, who die suddenly. Studies carried out so far by various groups across the world have shown significant variability in expression of ARVD phenotype in different populations. ARVD in India shows relatively early age at onset when compared with other Asian populations with more than half the patients showing the disease below the age of 30 years.

The pathological hallmark of the condition is the replacement of right ventricular myocardium with fibro fatty tissue and characterised by right ventricular dysfunction and ventricular arrhythmias (VT/VF), a state where the heart beats at extremely fast pace leading to syncope and/ or sudden death. The condition has also been reported to have genetic etiology, with about seven genes already identified to carry mutations.

Family's Reaction

It was an extremely traumatic period for my family especially my wife and two daughters. Fortunately family, friends and well wishers rallied around them and supported them. It was touching to see the entire community including the promoters and staff of the Royale Hayat hospital coming forward to help and support.

My children were entertained and looked after by friends. My wife made several friends, whom she had never met before; who prayed for us during this time, irrespective of caste, creed or nationality. We often talked about an Egyptian lady whose husband also was in the same hospital undergoing treatment. She would pray for us and bring food for my wife and children.

Lessons Learnt

I am grateful to God for his abundant blessings. I repeatedly remind myself that if the sudden death episodes had occurred at any other place outside the hospital, or when help was not around, I may not have survived. My life has now taken a new meaning.

We as a family decided to return back to India and settle down in Chennai. I have since taken sabbatical from active professional life and spend more time with the family and in my social venture Oyster Healthcare. The incident was an awakening that every day is a Gift of God, we can't take it for granted. We must enjoy life with our family and friends. In our quest for glory and fame, we tend to forget being human- to love, to serve, to give, to share, to enjoy and to smile. The time I have spent in the last few months, with my family and friends and especially renewing some old acquaintances, have been the most enjoyable and the most precious.

I must also admit that the second lease of life has enabled me to straighten up the basic essentials of this world like putting the finances in order and planning for the future things we normally ignore!

Looking Back

It is extremely painful, when I think back on the incidence, but I know God had a different purpose for my life. Today, we as a family are more God fearing and conscience of the needs of the people around. We are supporting several social causes through Oyster, especially supporting education of children from the lower socio economic group, supporting the development of the non for profit healthcare sector through advisory and consulting services and creating awareness about sudden cardiac death among the youth through media campaigns.