Besides a brisk, southerly wind, the weather on Sunday, Feb. 9, 2020, seemed ideal for a bicycle ride. About 10 cyclists departed Franklin, hoping to burn a few calories along Williamson County's gorgeous rural roads. Within an hour, the lives of friends and strangers would change.
The original Puckett's Grocery is located in Leiper's Fork's scenic village, southwest of Franklin. It's a well-known spot for locals and tourists to gather. On this particular winter day, a group of motorcyclists enjoyed buckets of beer under the 60-degree sun. Others ate barbecue, hearing locals discussing the art of songwriting by the fire pit. A larger group ate inside while listening to a local country band.
I arrived at Puckett’s about 1 p.m. to meet friends. I soon spotted the familiar face of a former boss eating with his family.
Before Bill Frist served Tennessee as a U.S. Senate Majority Leader, he gained notoriety as one of the nation's best heart surgeons. During his first term in Washington, Frist used his medical skills to treat and save others. Once a doctor, always a doctor.
After settling his tab, we spent a few minutes chatting. Besides his venture capital work, we talked about each other's podcast projects. He gleamed with the excitement of a gentleman farmer when we transitioned to the many projects he completed on his nearby property, mainly his latest hobby of restoring a 1951 Chevy pickup. The truck's faulty gas gauge was the true reason for his timely visit.
Turning Left Was the Right Choice
Around the same time, the cyclists rode upon the intersection of Boyd Mill and Hillsboro Roads. The day's outing had already encountered problems. Mike Webb had not one, but two flats early on. Given the challenges of a 20-plus mile per hour wind, along with Webb's untimely repairs, most of the group decided to shorten the route and call it a day. Four others continued.
David Miles, Jamie Putman, Pete Cacchioli, and Scott Shaw, turned left toward "The Fork." The latter three were strong riders and they pledged to help Miles keep pace. "I could tell David was struggling, but I encouraged him to stay and 'press on,'" Putman told me, recalling the day's events. "David told us to ride ahead and that he would meet us at Puckett's."
David, a stocky construction manager, was accustomed to long rides. Nonetheless, a few extra pounds probably added to his midsection from too many holiday gatherings made the ride more daunting; that and the headwind. Peddling might be easier if he could catch up and allow his buddies to ride ahead to break the wind. That was everyone's plan.
The trio quickly navigated the steady hill to rest and allow their buddy to catch up and recuperate.
Pete and Scott stopped at Puckett's. Jamie pulled into the parking lot of the Country Boy restaurant. "The last thing I recall is seeing the 'General Lee' and 'Mayberry' cars parked near where Southall meets Hillsboro Road," David recalls. Jamie spotted his friend from a distance and became concerned as David inched closer.
"Instead of riding in a straight line, David was 'snaking,' meaning he was weaving from one side to the other up the hill. When I saw his eyes, I knew something wasn't right because he wasn't looking at me, but through me. Straddling the centerline, David suddenly fell hard, his head and body hitting the pavement just past Puckett's gas pumps. So hard, it cracked David's helmet. I immediately ran to him."
Alexis Vandernat, a well-known customer of Puckett's, was intertwined in conversation with a musician by the firepit when she heard a crash.
"Something sounded like a loud trash can hitting the pavement," noted Ms. Vandernat. "When I jumped up and looked, people began surrounding the cyclist. I turned and told someone to call 911. They said we should wait a minute, to which I replied, 'He doesn't have a minute!' I Immediately dialed 911."
A cardiac nurse eating at Country Boy reacted immediately, rushing to assist. Another man, thought to be a veterinarian or someone with EMT training, also offered to help.
A Collective Calmness Appears
Tracy Frist stood with her husband filling a gas can when she saw Miles drop. Nudging her husband, he quickly walked over to assess the situation. Perhaps a cramp or rock caused the fall. With Putman at his side, Miles wasn't moving. The former heart surgeon knelt to diagnose the rider. Miles's heart wasn’t beating, and he was in full cardiac arrest. Without immediate medical intervention, he would soon die.
"I was talking to David, trying to revive him when a man who looked familiar walked up," noted Putman, describing the moment Frist appeared. "A 'collective calmness' came about when he told us he was a former heart surgeon and for everyone to back up. He didn't raise his voice or lose his cool, but confidently took charge."
Transplanting hearts in a controlled setting is difficult. Treating someone who's just experienced a massive heart attack in the middle of the road with no medical equipment is even more daunting. Training and experience guided the former surgeon's next moves.
"He had no effective heartbeat and no palpable blood pressure, and was almost certainly in ventricular fibrillation," said Frist. "As a heart surgeon, I can say that someone in complete cardiac arrest in the field and requiring prolonged CPR with mouth-to-mouth resuscitation efforts rarely survives, especially when a defibrillator isn't handy. Immediate action on everyone's part saved his life."
The clock was ticking, but Miles’ heart wasn't. Frist told his nephew to try and locate a defibrillator. Not a single store had one.
Realizing the importance of adequate blood flow and consistent oxygen levels, Frist forcefully thumped and then began pumping Miles' chest, stopping only to focus on transferring his own breath into the lifeless cyclist. The nurse attempted to locate a pulse in the patient's neck while Putman tried the same around his groin area. Neither found a pulse.
At least one, if not multiple 911 calls alerted first responders. No ambulance was nearby. Frist continued forceful chest compressions and intermittent mouth-to-mouth breathing, mentioning afterward that he thought he had broken Miles' sternum. That was the least of either men’s worries.
Suddenly, a man, possibly one of the first of two Sheriff’s Deputies to arrive, had a defibrillator. Frist now had the life-saving device he needed.
An Automated External Defibrillator is designed for ease of use. Pads (known as electrodes) are connected to the patient, allowing the device to access the electrical output of the heart. The intent is to shock the heart back into rhythm. If one is warranted, the internal battery prepares the unit. It’s imperative no one is touching the patient when the shock is delivered.
"I've never seen a defibrillator used," said Putman. "David's a stout boy, and when Dr. Frist hit him the first time, his entire body came off the pavement. It's much different than seeing it on TV."
Once wasn't enough. Chest compressions and breathing were immediately restarted. The first shock is between 120-200 joules. If a second shock is required, the unit automatically increases the amount, usually to 200J, then 300J, before maxing out at 360J. A minute later, a second electrical joint lifted the cyclist from his horizontal position. Someone found a pulse.
"His heart began beating after the second shock," Frist said, exhausted from his life saving efforts."
Luck And A Second Chance
A relief fell upon the group when Miles responded, his eyes moving. Five minutes later, the ambulance arrived. Miles was stabilized and lifted into the rear door. Becky Webb, Mike's wife, arrived and jumped in to accompany their friend.
After finishing my conversation with Bill, I stayed inside to catch up with an old friend. I had lost track of time, but apparently, 15 minutes had elapsed when I walked back outside. An ambulance sat parked in the street. Traffic was backed up in both directions.
"What the hell just happened?" I asked Alexis, still standing at the fire pit.
"A man fell off his bike and apparently suffered a heart attack. That man over there," pointing at Frist, "saved his life. I've never seen anything like it."
My former boss stood about thirty yards behind the ambulance, looking down at his phone. I walked straight toward him. "Bill, what happened?”
"That man," pointing to the ambulance, "suffered a massive heart attack, and I had to revive him. You know, most people don't like to use mouth-to-mouth resuscitation techniques, but that's the only real way to immediately push air into the lungs," he casually said, as if advising a group of medical residents.
Today wasn't the only time I had witnessed Bill Frist exercise a “collective calmness.” If needed, he wouldn't hesitate for a second to save any life, and we would be damned lucky to have him around. I'm confident David Miles feels the same.
Living to Ride Another Day
After the ambulance left, we realized no one knew the injured cyclist's name. A rumor circulated that he had died, yet no one knew for sure. Before leaving, Bill asked me to relay any news if I heard anything.
The following day I called the Williamson County Sheriff's department to inquire about the rider's fate. Did the rider survive? Privacy laws make learning such information challenging.
I spoke with the public affairs officer, who, at the time, wasn't aware of the incident. I relayed Sunday’s event and informed her that Sen. Frist had saved the man's life and that I would appreciate any information if and when it was available.
Weeks later my phone rang. It was David Miles. He was told that I had inquired about his condition. More importantly, he wanted to thank Bill Frist and everyone involved in saving his life.
Miles was transported to St. Thomas Hospital and admitted into their cardiac intensive care unit. After a series of tests, Dr. Mark Robbins placed a stent in Miles' artery on Monday. He was released on Tuesday, just in time to celebrate Valentine's Day with his now fiance, Karen Paris. The following week he was back at work and in the gym days later. After having minor repairs made to his bike, Miles rode 25-miles on March 26.
What stood out when I began writing this story was where everyone's individual account of the day ended. Everyone expressed their own unique perspective. Yet, without fail, everyone made a startling similar comment:
"If Bill Frist had not been nearby, David Miles would not be alive today." Included in that sentiment is David Miles.
"Lot's of things happened that day," Miles later recounted. "And if any one of those events were altered, I wouldn't be alive. I am truly thankful for everyone who helped, and I am blessed to live and to ride another day."
I had to ask Miles one last question. Are you doing anything different after the incident? "I'm definitely going to church more and saying a few extra prayers. Something like this makes us realize how fortunate we are."
If anyone knows the identity of the nurse who assisted, please contact us so we can pass the information along to David. He’s also looking forward to personally thanking Sen. Frist. Please make time to learn CPR and other emergency procedures that could save someone else's or even your life. Thanks to the generosity of others, Puckett’s restaurant now has a defibrillator.