The Feb. 4, 2018 episode of NBC TV drama ‘This Is Us’ broke the hearts of viewers around the U.S. Fans watched in despair as the show’s beloved patriarch, Jack Pearson, had a catastrophic heart attack and died alone in a hospital room. Jack had suffered severe smoke inhalation after saving his family, their dog and a few sentimental items from a tragic house fire. His wife would later call it a “widowmaker’s” heart attack, which refers to a blockage of the left anterior descending artery, or widowmaker artery—the largest artery that brings blood to the heart.

Viewers took to social media immediately, lamenting Jack’s death and questioning whether he could have been saved. Patients and colleagues have been asking me the same thing. Unfortunately, the answer is yes—in a modern emergency department, the TV doctors could have saved Jack’s life.

Below are a few factors that today’s doctors understand and that could have changed Jack’s outcome:

1. The doctors should have immediately assessed his airway and provided continuous oxygen through intubation or a facemask.
2. A patient should never be left alone in their room after suffering smoke inhalation.
3. Surface symptoms should not be the main concern when no burns are present. The doctor also should consider poor oxygenation of the heart.

The third point is the real kicker to me as a Burn Center doctor. What took Jack’s life—and what takes the lives of thousands of people in the U.S. each year—was not simply a heart attack. He died because the smoke he inhaled disrupted the delicate balance of oxygen and carbon dioxide in his cardiovascular system. And one thing is clear after the outpouring of shock at his death: We need to better educate our community about the dangers of heart damage from smoke inhalation, as well as measures to prevent it.

How can smoke inhalation cause a heart attack?

The heart is dependent on oxygen. When the flow of oxygen through the bloodstream is compromised, the heart rate slows down and eventually stops. This is called hypoxic arrest, or bradycardic arrest.

Today’s emergency medicine and Burn Center doctors know that smoke inhalation can disrupt oxygen flow due to:

Airway restriction
Smoke and particles in the air after a fire can irritate the throat tissue, causing it to swell and constrict air flow. This is the first symptom emergency department providers should check with suspected smoke inhalation. Poor breathing leads to poor oxygenation, and lack of oxygen can lead to a heart attack.

Carbon monoxide
Carbon monoxide binds to hemoglobin, which is the oxygen delivery molecule of the red blood cells. This prevents the red blood cells from properly delivering oxygen to the heart, which can cause cardiac arrest.

Underlying heart conditions
Cardiac problems such as congestive heart failure or arrhythmia can be exacerbated by the stress of a experiencing a house fire.

Chemicals from the fire
A patient can be poisoned by chemical toxins in the blood before they make it to the emergency department. Patients who do make it to the hospital must be closely monitored because chemicals can take a few days to leech into the airways.

With so many potential causes of cardiac arrest, emergency medical providers must follow a critical protocol to prevent more heart attacks and save more lives.

Emergency steps prevent smoke-related heart attacks

First, the patient must be taken to the nearest emergency department as soon as possible. Once the patient arrives, the emergency care team should immediately assess the patient’s airways. If they can see swelling or constriction—or if it’s even suspected—the patient should be intubated right away and given continuous oxygen. Even if there is no swelling and the patient is breathing fairly well, oxygen should still be given through a face mask.

Next is the most important step. We must diagnose the severity of disproportion to the patient’s blood oxygen and carbon monoxide levels. Without proper oxygen flow, the patient’s heart will stop pumping and they could suffer a heart attack. We always make the diagnosis by taking blood samples to precisely measure a patient’s blood gases: oxygen, carbon dioxide, carbon monoxide and other chemicals. As soon as the lab team delivers this data, we can adjust the patient’s oxygen levels and start measures to normalize their blood gases and prevent cardiac arrest.

It might seem strange that a Burn Center doctor is discussing blood gases and airway constriction. But our Burn Center team cares for burn and smoke inhalation patients all day, every day, and we have extensive expertise in managing both conditions together and separately. Emergency medicine doctors at hospitals across the D.C. area know that they can call the doctors at our Burn Center to consult on the care of patients who suffer smoke inhalation, and they do so frequently. Once the patient is stabilized, we work with them to transfer patients who need specialized care to our Burn Center.

How to reduce your risk of smoke inhalation and heart attack

Several actions Jack should have taken might have reduced the amount of smoke he inhaled on “This Is Us.” The storyline teased Jack’s fate in a previous episode in which the Pearson family’s smoke alarms registered low batteries, but no one changed them. That simple act could have tipped off the family earlier that their house was on fire, and Jack theoretically could have escaped with less toxicity in his bloodstream.

As many angry Twitter respondents pointed out, Jack should not have returned to the burning house once the family was safe outside. He went back to rescue the family dog and save a sack of sentimental family items. While I empathize with the emotional agony of leaving beloved pets or possessions behind, it’s vital that people in our community understand that flames are not the only killer in a fire. Smoke inhalation can be—and often is—fatal.

If you’re ever in a house fire, avoid contact with smoke any longer than is absolutely necessary. Call 9-1-1 immediately to get emergency care for anyone with burns or suspected smoke inhalation. And stay outside once your family is safe. Things can be replaced. Your lives can’t.

The ability to move—and move easily—is something most of us take for granted. But movement is actually a complex process requiring several different parts of the brain to work together with many muscle groups. However, as we age, many individuals develop movement disorders.

“Movement requires continuous communications between the brain and the muscles,” says Lynn Chouhfeh, MD, a neurologist and Parkinson’s disease and movement disorders specialist at the Center for Successful Aging at MedStar Good Samaritan Hospital. “A movement disorder results from a breakdown in these communications and can sometimes lead to difficulty walking, involuntary movements, tremors, or problems with posture and balance. This can be extremely debilitating, severely impacting a person’s quality of life.”

Movement disorders are very common, especially in the elderly population. The most widely known movement disorder is Parkinson’s disease, a chronic, progressive neurological disorder that affects a small area of nerve cells deep within the brain. Approximately one million Americans have Parkinson’s disease, including one out of every 100 people over age 60. And it’s the second most common neurodegenerative disease after Alzheimer’s.

There are also a number of related movement disorders, sometimes called atypical “Parkinsonisms,” as well as other unrelated movement disorders, that affect thousands of people on a daily basis. “The proper treatment of movement disorders in the elderly can be complicated and requires a great deal of coordination and communication between physicians, patients, and caregivers,” says Orion Courtin, MD, MPH, a geriatrician at the Center for Successful Aging. “These conditions can be challenging to diagnose, and each requires a different treatment approach. Seeing an experienced team that includes geriatricians as well as specialists who understand available treatment options for various movement disorders is important.”

That’s what patients and their families will find at the Center for Successful Aging. “We provide elderly patients, particularly those with complex conditions, convenient access to the specialists they might need, all in one place,” Dr. Courtin says. “We offer a comprehensive array of health services to the older adults in our community.”

Lila Shelton, a 90-year-old with Parkinson’s disease, is one patient who has benefited from the expert care available at the Center for Successful Aging. Her daughter and caregiver, Shirley Byron, explains, “Mom was living in Oklahoma and had received a diagnosis of Parkinson’s disease. I moved there to care for her. Her doctor prescribed medication, but it made her nauseated and extremely tired. After talking to the doctor about it repeatedly and not getting any answers, I just stopped giving it to her.”

Byron moved her mom back to Baltimore and started looking for a healthcare provider in the area who specialized in treating the elderly. She learned about the Center for Successful Aging on the Internet. “In the meantime, Mom’s symptoms had gotten worse. She was less steady on her feet and had lost her ability to speak,” she explains. “At the same time, this was taking a toll on me—physically and emotionally.”

After an initial consultation at the Center for Successful Aging, Shelton was referred to Dr. Chouhfeh. “While there is no cure for Parkinson’s disease, there are a lot of ways we can help. The challenge is that every patient is different and responds differently to treatment,” says Dr. Chouhfeh. “When I first saw Lila, I was barely able to understand her. She had dif culty walking and her movements were very slow and stiff.”

To improve Shelton’s symptoms, Dr. Chouhfeh decided to try medication again. “The difference is that I started slowly and gradually increased her dose. She tolerated it well with no side effects. Shortly thereafter, she was able to speak louder, and her other symptoms began to improve.”

The turnaround was almost miraculous,” Byron says. “We can now communicate. Mom is a shy person to begin with and not being able to talk made her withdraw even more. Now she is much better.”

Shelton has continued treatment under the care of Dr. Chouhfeh. She is in physical and speech therapy and is doing well. When asked how she feels about the Center for Successful Aging, she says, “They gave me my voice back ... I am so pleased to be able to talk again.”

The specialists at the Center for Successful Aging also helped Byron find support services to help her care for her mom. “Connecting with the Center for Successful Aging has made a world of difference for both of us,” she says.

“All persons with Parkinson’s do not develop the same symptoms, and any symptoms that do develop may change over time as the disease progresses,” Dr. Chouhfeh notes. “So it is very important for people with the disease and their families to work closely with their doctors and to seek advice from a movement disorders specialist, who can best manage the more complicated aspects of the disease.”

Learn more about the Center for Successful Aging at MedStar Good Samaritan Hospital.

In the district and the U.S. as a whole, the influenza virus is surging, with roughly 200 new cases reported to the D.C. Department of Health each week. Hospital staff must take many steps to prevent infections from spreading: Healthcare providers often wear gloves, gowns and masks; medical instruments and rooms are thoroughly sanitized; we even use high-tech tools such as ultraviolet light to kill potentially dangerous bacteria.

But the first line of defense against what is known as healthcare-associated infections is much more low-tech: hand-washing. Healthcare providers may wash their hands as many as 100 times during a 12-hour shift. This is important because we often need to touch a patient during an examination or procedure. If we don’t rid ourselves of potential germs, we can spread them to each patient we see after—or be infected ourselves.

And it’s not just healthcare providers who are responsible for practicing good hand hygiene. Patients and visitors also play a critical role in preventing the spread of dangerous infections by keeping their hands clean and reminding healthcare providers to do so as well.

When you should wash your hands in a healthcare setting

Most people know they should wash their hands after using the bathroom; before eating or preparing food; after touching their eyes, nose or mouth; or after blowing their nose, coughing or sneezing. These rules still apply when you’re in a healthcare setting—whether as a patient or visitor—but there are a few additional actions that should trigger you to wash your hands.

One of the main hand-washing rules that healthcare providers follow is, “Wash in, wash out.” That means we wash our hands upon entering a patient’s room and again when we leave. This is a good rule for everyone in a healthcare setting to follow. Throughout the hospital, we have cough courtesy stations that hold alcohol hand gels and tissues in waiting areas for visitors and patients to use – all to try to help prevent the spread of flu and other illnesses.

Wash your hands after touching hospital surfaces such as bed rails, tables, doorknobs or remote controls to kill germs that may have settled on them. This may seem obvious, but don’t forget to wash your hands before and after you change bandages. And just because you wear gloves does not mean your hands are clean. Dirty gloves can contaminate your hands, so wash them after you remove gloves.

Did your healthcare provider wash their hands? If not, speak up

We want patients to feel empowered to remind healthcare providers to wash their hands. Don’t be afraid to say, “I didn’t see you wash your hands when you came in. Would you mind doing it again before the exam begins?”

This also goes for visitors or hospital staff members such as housekeeping. If a loved one has been in your room for quite a while, don’t feel bad about asking them to wash their hands again. And don’t forget to keep your own hands clean!

Are you following proper hand-washing procedures?

Even if a person washes their hands regularly, they may not be doing it correctly. That can be as bad as not doing it at all. We recommend two hand-washing methods: using soap and water or using alcohol-based hand sanitizer.

Soap and water 

• Wet your hands and apply the amount of soap recommended by the manufacturer.
• Rub your hands together until the soap foams, and then rub it all over the top of your hands, in between your fingers and under the fingernails. Do this for 15 seconds—the amount of time it takes to sing the “Happy Birthday” song twice.
• Rinse your hands well, and dry them completely.

Alcohol-based hand sanitizer 

• Put the amount of sanitizer recommended by the manufacturer on one hand. The sanitizer dispensers at MedStar Washington Hospital Center will automatically squirt the right amount in your hand.
• Rub your hands together and cover all surfaces until your hands feel dry. It takes about 20 seconds.

Alcohol-based hand sanitizer does not kill the antibiotic-resistant bacteria C. diff (clostridium difficile), which can cause severe abdominal distress. When treating these patients, we’ll wear a gown and gloves and wash our hands with soap and water.

How we are working to further reduce infection transmission

Even without the recent flu outbreak, on any given day, one in 25 U.S. hospital patients has an infection they picked up from being in a hospital. This includes antibiotic-resistant bacteria ,such as C. diff and MRSA (methicillin-resistant Staphylococcus aureus).

For the 2017-2018 influenza season to-date, 824 positive cases have been reported in D.C. as of January 20, 2018, and we’re continually working to reduce the rates of all infection. Because hand-washing plays such a crucial role in infection prevention, we periodically monitor compliance with a “secret shopper.” This person, often a nurse, will observe healthcare providers as they work. When they notice someone not wash their hands properly or in a timely manner, they’ll perform a quick intervention.

Along with hand-washing and manual cleaning and disinfection, we also added a new tool in late 2016 to aid in our battle against potentially deadly infections: an ultraviolet light called UVC.

After an operating room or patient room has been manually cleaned and disinfected, a portable machine emits UVC light for about 30 minutes. The light bounces around the room and reflects into hard-to-reach spaces, killing bacteria by disrupting their DNA. UVC helps us kill bacteria that survived or were missed during manual cleaning.

Our use of UVC is fairly recent, so we don’t yet have hard numbers about its effect, but multiple studies have shown such technology does reduce infection rates. For example, a February 2017 study found that the use of UVC machines cut transmission of four major antibiotic-resistant infections by 30 percent.

We’ll never get rid of all bacteria, nor would we want to. Our bodies are full of good and helpful bacteria. But the CDC reports this season’s flu activity is likely to continue for several more weeks. By following proper hand-washing and disinfecting protocols, we can prevent the spread of dangerous bacteria and infections.

If you want to lose weight in 2018, you are not alone. Research shows that weight loss is the most common New Year's resolution. Yet few people succeed in meeting their weight loss goals.

As we grow older, we all start to notice changes in our ability to remember things. Maybe you’ve gone into the kitchen and forgotten why, or couldn’t recall a familiar name during a conversation.

“Memory lapses can occur at any age, but we get more upset by them as we get older because we fear they’re a sign of dementia,” explains Karen Kansler, RN, nurse wellness coordinator in the Good Health Center at MedStar Good Samaritan Hospital. “Most of the memory problems we experience with age reflect normal changes in the brain.”

The good news is that cognitive decline is not inevitable. Kansler offers these tips to help reduce your risk of age-related memory loss.

Challenge Your Mind

Learning new skills and doing other mentally stimulating activities can help your brain become more adaptable and compensate for age-related changes.

“Challenging your brain is believed to activate processes that help maintain individual brain cells and stimulate communication among them,” Kansler notes. “The more senses you use, the more your brain is engaged. Listen to a new music genre or try a new cuisine. Building and preserving brain connections is an ongoing process, so make lifelong learning a priority.”

Stay Connected

Remaining socially connected helps prevent depression and feelings of isolation. Pursue activities that are meaningful to you. Find ways to be part of your local community, volunteer, and spend time with friends and family. 

“For many people, aging is a time of loss and adjustment,” Kansler says. “Being with others benefits many people emotionally. It can also stimulate the brain, enliven the spirit, and foster companionships. Staying in touch with others is so important.”

Keep Moving

Using your muscles is good for your mind too. “Regular cardiovascular activity helps increase blood flow to your brain. And strength building and balance exercises are essential to preventing falls and helping a person remain independent,” she explains.

“Exercise also helps lower dementia risk factors such as high blood pressure, diabetes, and high cholesterol, and reduces mental stress. Engage in regular exercise that elevates your heart rate and builds muscle such as brisk walking, doing squats or lunges, or lifting hand weights.”

Kansler notes that regardless of your age, eating well and getting enough sleep are good habits everyone should adopt. And if you smoke, stop. Living a healthy lifestyle is good for both your body and your mind.

For daily workout tips, visit this page to learn how exercise can help lower your risk of chronic illnesses.