The call from the ambulance dispatcher came around 1 p.m. A patient in her 50s was on the way in. She’d been in cardiac arrest for 40 minutes.
Code blue.
Dr. Kevin Frevele ’21 (pictured above, far left), an emergency department pharmacist at Samaritan Hospital, turned to Rafael Diaz Melendez (third from left), a P4 pharmacy student on rotation: did he want to help resuscitate the patient? Diaz Melendez had earlier told Dr. Frevele that he wanted the chance to perform CPR, and Dr. Frevele encouraged him to take the opportunity if it arose. But the question caused Diaz Melendez’s own heart to race.
“I wanted to have the experience,” Diaz Melendez said, “but at the same time, it’s scary.”
He said yes. The next several minutes would end up re-shaping his view of his profession, his patients and his future.
Diaz Melendez had found his way to the emergency department by special request. He had asked the preceptor for his hospital rotation, Clinical Pharmacist Kristen Bulmer (above, far right), if he could spend some time there to get experience in urgent care. She agreed, and Dr. Frevele said he would supervise Diaz Melendez.
On that day in July, the cardiac patient had been getting mechanical chest compressions through a LUCAS device during transport. The decision was made to switch to manual compressions when she arrived at the Troy hospital. Manual compressions are often an all-hands-on-deck response, with each staff member stepping in as another gets tired, so there’s no interruption. Pharmacists are not always expected to participate, but in an emergency setting, their willingness to do so is appreciated, Dr. Frevele said. Diaz Melendez would be fourth in line.
“It was tense,” Diaz Melendez said of the atmosphere in the emergency department. He remembered thinking, “please god, I hope this works,” while recognizing the outcome would leave an imprint on him, either way.
When it was Diaz Melendez’s turn, he learned that doing CPR in an actual emergency feels different than when it’s practiced. After three to four minutes, his muscles burned.
“I didn’t know how tiring it could be,” he said. He persevered, reminding himself that the next compression could be the last one the patient needed. “I keep on going until I can’t do it anymore,” he explained of the moment. “I’m sweating.”
When Diaz Melendez at last stopped, he thought he heard the doctor speak. But because he wanted to hear those words so badly, he wasn’t sure they were real.
“We got a pulse,” the doctor had said.
A deep momentary calm followed this news that the patient had been revived, as automatic defibrillation ceased and the mood shifted. What did it feel like to Diaz Melendez? He could not find the words.
“Exciting falls short,” he said. “It was very significant.”
Prior to the experience, Diaz Melendez thought he would pursue a residency after graduation in May 2025, perhaps in pain management or palliative care. While those specialties remain options, he is now also eyeing a career in critical care, especially emergent care.
Aside from the extraordinary experience of helping to save a life, Diaz Melendez said the interaction reminded him of the values he learned from his pharmacist grandmother in Puerto Rico. She worried about the people who came to her pharmacy and would call their doctors to ensure they were on the right medication. She advocated for them when they could not afford the medicine they needed.
Each patient was important to her.
“It’s easy to get used to seeing ‘name, number, medication,’ “ Diaz Melendez said of the records-oriented tasks he is often assigned. “Having such a direct interaction reminds you that you’re working with an actual patient, not just a name and date of birth.
“That’s true of everyone whose chart I’m looking at.”