As Stephanie Kuleba's doctors attempted to save the popular 18-year-old, a woman from the plastic surgeon's Boca Raton office called 911 for help.
Malignant hyperthermia, a hereditary condition said to have killed Kuleba, baffled the dispatcher as the caller offered crucial descriptions of the high school senior's condition.
The caller couldn't explain the condition, and at one point turned to the doctors, saying, "They want to know what malignant hyperthermia is."
The metabolic condition is triggered by certain inhaled anesthetics. Those who have it often are unaware until a reaction during surgery. Family history and probing questions from the anesthesiologist are the only routine ways to find out if a patient may have the genetic traits that make then vulnerable.
Still, anesthesiologists might come across the condition only once, if that, during their careers. A patient's heart rate increases, body temperature rises and muscles become rigid. Ninety percent of people diagnosed with the condition survive.
Both the caller and the dispatcher sounded calm on the 1-minute, 24-second phone call a week ago. In the background, Dr. Steven Schuster and his anesthesiologist cared for Kuleba, intubating her to open her airway and shocking her heart.
The caller was circumspect as she outlined the need for help: "911. Emergency. Patient having surgery. Possible malignant hyperthermia. This is an emergency."
She told the dispatcher that Kuleba had been sedated. The West Boca Raton High School student with a 4.1 grade point average was undergoing corrective breast surgery. When Kuleba displayed symptoms consistent with malignant hyperthermia, the doctors called the hotline of the Malignant Hyperthermia Association. They consulted with an expert from the Mayo Clinic in Minnesota and administered the antidote drug dantrolene, according to the association's president.
It is unclear whether doctors called 911 first.
"And what happened while she was in surgery?" the dispatcher asked.
"We think it's malignant hyperthermia," the caller said.
"And what does that mean exactly?" the dispatcher asked.
The dispatcher also did not seem to know what an endotracheal tube is, asking, "She has a what tube in her?"
"She has an endotracheal tube in her," she said. Then, with emphasis, "She's tubed and they're shocking her."
The Kulebas' attorney has questioned how the teen, captain of her cheerleading team, was cared for and whether her death could have been prevented.
Attorney Roberto Stanziale has said it took 30 to 40 minutes for rescue workers to get Kuleba to Delray Medical Center, where she died Saturday morning, less than 24 hours after the surgery. Schuster, the plastic surgeon, rode in the ambulance with Kuleba while Kuleba's mother, Joanne, was driven by the surgeon's staff.
The name of the anesthesiologist has not been released, though Schuster's attorney said it was a board-certified medical doctor. Attorney Keith Puya declined to comment on the specifics of the surgery because he is still reviewing the case and the autopsy is pending.
"When there's a case like this, it's sometimes better to wait until you have all the facts," he said. "In this particular case, [Schuster] feels the care and treatment he rendered was appropriate."
Puya added that Schuster is devastated and sends his condolences to the family, who have declined to speak to the media.
Patty Pensa can be reached at firstname.lastname@example.org or 561-243-6609.