February 4 was “pretty much a typical morning” for Alex McMillan, 20, an economics major at Syracuse University. An alto sax player, McMillan would be at the noon basketball game against Virginia as part of the Sour Sitrus Society.

He remembers eating a pulled pork sandwich and drinking bottle of water at the Carrier Dome.

Next he knew, he awoke in a hospital bed. IV lines were poking from each arm. Electrodes were taped to his chest. Medical machines surrounded him. He was in the cardiac intensive care unit at Upstate University Hospital.

The Orange were celebrating a 66-62 come-from-behind victory.

But it was McMillan who made the more dramatic comeback at the Dome that day.

Not even four minutes after tipoff, without warning, McMillan‘s heart just stopped. His body slumped onto a band mate. He and the person on McMillan‘s other side laid him on a riser. They called for help.

Emergency physicians from Upstate University Hospital staff the first aid station at the  Dome. Depending on the size of the crowd, a dozen or more paramedics and emergency medical technicians are on duty for SU basketball games and other mass gathering events at the Dome.

A pair of EMTs were about 20 feet from where McMillan collapsed. “They started CPR right away,” explains Christopher Tanski, MD, the emergency doctor on duty that day. Their compressions kept blood circulating through McMillan‘s body, keeping his vital organs nourished.

Meanwhile, Tanski made his way down the stairs from the first aid station. He directed other EMTs to bring the stretcher down an elevator.

 One look at McMillan, and the emergency doctor knew the situation was serious. Young people rarely suffer sudden cardiac arrest. A handful of things can cause a heart in a healthy, young person to suddenly stop beating – but Tanski was too busy to ponder them.

 “Once the heart is stopped, it doesn‘t really matter why,” he explained. “You just need to get it started again.”

 Briefly Tanski considered moving McMillan to a more private location, but he knew he could not afford the seconds that could take. Instead, he and the EMTs cared for McMillan behind the Syracuse baseline. The game continued, punctuated by roars from the 27,553 in attendance.

McMillan‘s heart was in a dangerous quivering rhythm known as ventricular fibrillation. An electrical shock, delivered by an automated external defibrillator, prompted it to begin beating somewhat normally again. His pulse returned. He began moving around. One of the paramedics started an IV, and McMillan was moved to the stretcher and wheeled to the ambulance.

He was half asleep, half awake and really confused by the time the ambulance got him to the adult emergency department at Upstate, where its director, Jeremy Joslin, MD, happened to be working that afternoon.

Joslin quickly connected McMillan to a monitor to watch his heart‘s electrical activity, and he kept close watch on his blood pressure, which required some supportive medication. Hearts in healthy young people typically don‘t stop beating except in cases of trauma, or if the heart grows abnormally large, or in the case of an electrical malfunction. Joslin summoned cardiologists and set about determining what caused McMillan‘s heart problem.

 A groggy McMillan kept asking the same question, not remembering the answer: Did SU win? Did they beat Virginia?

 Tanski stopped at the emergency department after the game to check McMillan‘s condition. Both emergency doctors marvel at the young man‘s good fortune.

 “If you put me in his shoes and I got to pick where I had this event, if it couldn‘t be inside a hospital, I‘d want it to be in the Dome,” Joslin said.

 “The Dome is known for having good survival rates,” said Tanski, adding that the outcome surely would have been different if McMillan had been driving, or alone in his dorm room, when his heart stopped.

McMillan is from Ashland, in suburban Boston. His parents were away on Feb. 4, visiting a college with his younger brother. Somehow, the social worker in the emergency department – whom Joslin says regularly works miracles – tracked them down quickly.

While he remained hospitalized, McMillan underwent a series of tests to determine what caused his heart to stop beating.  Structurally, his heart was normal. The problem appeared to be electrical. He recalled that he was still hooked to a heart monitor on Feb. 7 when SU traveled to South Carolina to play Clemson. As the clock ticked down to the 82-81 “buzzer beater” win, McMillan watched the lines of his heart rate spike.

In a cardiac catheterization procedure the next day, cardiac electrophysiologist Tamas Szombathy, MD, determined that McMillan needed an implantable cardiac defibrillator, a small battery-powered device designed to shock him back to life if his heart ever stops beating again.

 “I can definitely feel it in my chest,” McMillan says of the defibrillator. A month after its insertion, he says the bruising and swelling have subsided, but he still has the restriction against lifting his arm above his head to prevent the defibrillator system from being displaced.

What caused his heart to stop beating? “They think it‘s a genetic thing,” McMillan said. He had blood drawn and met with a genetic counselor at Upstate. If other members of his family are found to have the same genetic mutation, and receive pre-emptive care, more than just McMillan‘s life will have been saved that Feb. 4 day in the Dome.

 McMillan missed several days of classes while he was in the hospital, but by the end of the month he was caught up with his studies. He was not allowed to play his saxophone again yet, but he did feel up to attending another Dome game on Feb. 22.

 That was the Duke game. The Orange won with an epic 3-point basket sunk in the final second of the game. People started once again referring to the team as the “Cardiac Cuse.”

 McMillan felt his heart racing. He was thrilled to be part of the court-storming, after-game celebration.

 In more reflective moments, he‘s grateful he was at the Dome game 18 days prior, where, after his heart stopped, he was brought back to life.