Like many veteran marathoners, Bob Pohl always had an eye on the clock.
"I used to tell my wife that if I drop in a race to stop my watch because I don't want to go to the hereafter with a bad time," he said. "The joke was funnier before."
The 55-year-old Marriottsville runner did collapse during a race. He was about 200 feet from the finish line of the Baltimore half-marathon on Oct. 15 when a blockage in a main artery stopped his blood from flowing — and his heart from beating.
Now seconds seriously mattered.
The minutes lost in receiving aid typically make it rare for someone to survive sudden cardiac arrest outside a hospital. But close on Pohl's heels this day were a Baltimore police officer, a Columbia chiropractor, some Howard County paramedic trainees, a Union Memorial Hospital doctor and other medical professionals who swiftly provided CPR, a shock to his chest and a trip to the emergency room.
The speed was part planning and part luck, Pohl learned. Though he didn't open his eyes for days, he is now home recuperating and reflecting for the first time publicly on the time he still has.
"He went from dead to alive in a matter of minutes," said Dr. Cynthia Webb, chief of Union Memorial's emergency room who has been coordinating medical care at the Baltimore Running Festival for three years along with the event organizer, Corrigan Sports Enterprises.
She normally sees cases of cramps, blisters and hyperthermia — not heart attacks. A 2009 American College of Cardiology study found there is less than one death from cardiac arrest per 100,000 people, far better odds than dying in a car accident or from some diseases.
But when there is cardiac arrest, fewer than a third of the victims typically get CPR or defibrillation in the first crucial minutes, and only about 8 percent survive. The condition has claimed the lives of two other runners in the festival's marathons and half-marathons since 2001.
"He was really lucky, not that it happened but where it happened," Webb said. "He could have been alone running in his neighborhood or home watching TV. It couldn't have been in a better place."
Even on the 26.2-mile course, where there are six other medical tents and medical personnel riding bikes among the 25,000 competitors and tens of thousands of spectators, there could be a three- to four-mile gap where help is not available.
As Pohl neared the finish line outside Camden Yards around noon, he dropped to his knees and then fell to the ground. Some other runners stopped to help, including Baltimore Police Lt. Col. Ross Buzzuro. One runner checked for a pulse and another held Pohl's head, said Allen Manison, a chiropractor with special training in emergency and sports medicine, who jumped a fence onto the course.
"It was so impressive those runners stopped their race to help," said Manison. He normally tends to the muscles and bones of the elite athletes but immediately recognized Pohl's heart rhythm was irregular. His position, on his back with his arms bent in toward his chest, also was a possible sign of brain damage. Manison called for help.
Howard County paramedic trainees came with a gurney. Within minutes they were inside the tent, with Webb and a team from Union Memorial, Franklin Square and Harbor hospitals and Baltimore City Emergency Medical Services. They took over resuscitation, provided defibrillation and placed a breathing tube down Pohl's throat.
Meanwhile, Webb flipped over the paper that was pinned to Pohl's shirt and displayed his race number, and found his emergency contact. She dialed his wife, Karen, and told her it was serious.
Emergency personnel didn't wait for her to reach the medical tent. Her husband was already in an ambulance en route to the closest hospital with a cardiac specialty, the University of Maryland Medical Center.
Karen Pohl and race officials set out to find her 27-year-old son, Mike, who was also racing and had disappeared into the crowds after running ahead of his father a half-mile from the finish. The father had wanted to keep a slower pace as part of his training for his 15th Marine Corps Marathon.
She found her son pacing beyond the finish line. He'd seen a commotion and thought his father was stuck behind it. A police officer took them to the hospital.
"We weren't promised he'd make it," she said of the agonizing first few minutes at the hospital. "It was amazing circumstances. He had such a swarm of angels over him."
The Maryland doctors suspected a heart attack and moved immediately to cool Pohl's body to delay the chemical reaction that causes injury to organs when the blood supply is cut off. Without therapeutic hyperthermia, "you can get the heart back but the brain never recovers," said Dr. Michael D. Witting, an emergency department physician.
More investigation was needed to determine that part of Pohl's heart was not functioning and there was likely a blockage in one of his arteries. They took him to the cardiac catheterization lab, where three stents were used to reopen the vessel, which had been fully blocked by plaque that ruptured during the race.
After the procedure, Dr. Erika Feller, a cardiologist who is medical director of Maryland's heart transplant program, stepped in. She said Pohl's fitness meant he wasn't an obvious heart attack candidate, but genetics played a strong role. The building plaque, left untreated, meant he'd likely have had a heart attack whether he had run the race or not.
Now, he'll require cholesterol and blood pressure medicines for the rest of his life.
Still, Feller marvels at the team in the field and in the hospital that "did their job. One missing link and it wouldn't have worked out the way it did."
She eventually expects Pohl to run again. And that's a relief for someone who is used to running four to six times a week.
For now, he says he'll enjoy time with friends and family, including twin grandchildren Ryan and Abby, born to his daughter Jennifer just weeks before the race. He and his wife also plan to learn CPR and encourage others to learn about their family history and to get more regular checkups.
"In the hospital when I woke up, I thought, 'Why me?'" said Pohl. "But I have learned genetics trumps diet and exercise."
Lee Corrigan, president of Corrigan Sports, said he often thinks about runners like Pohl, who have trained for months but have a dangerous and unknown problem. He said the racing community hasn't settled on how to prepare.
"There is no standard formula," he said, adding that the Baltimore festival has a larger team than most with 250 medical professionals on the course.
"We can do the best we can and be prepared, but there are no guarantees," Corrigan said. "We are very relieved and happy today. We're proud of the effort and happy with the outcome of this story."
Corrigan said Pohl will get a race medal, perhaps at an event scheduled Thursday to reunite Pohl and those who saved him. Corrigan said Pohl technically completed the half-marathon when he was carried on a stretcher over the finish line to awaiting medical aid.
His official time was 2 hours, 16 minutes and 17 seconds, though his family never did stop his watch.
An earlier version misstated the title of chiropractor Allen Manison. The Sun regrets the error.