LEXINGTON -- Paul McElwain was at the Lexington Tennis Club on Monday night when a doubles match quickly turned into a life-or-death emergency.
"It had been a close match," he said. "We were like 3 to 2 in the tie-breaker."
But as they were switching sides, McElwain, 61, said he suddenly felt dizzy and flushed.
He said he bent over and put his hands on his knees.
"That's the last thing I remember," he said. "I woke up in the cardiac cath lab."
He had been playing the best possible opponent: a cardiologist.
From the corner of his eye, Dr. Hal Skinner, a Paducah native, saw McElwain fall.
Skinner graduated from Heath High School in 1980, studied pre-med at Murray State University and graduated from the University of Louisville Medical School. He did his cardiology residency at the University of Kentucky in Lexington, where he now lives and has his own practice. Skinner's parents are Carolyn Skinner of Paducah and the late William "Bill" Skinner.
"I first thought he stumbled or something," Skinner said. But he quickly realized it was something worse.
"I rolled him over and he wasn't breathing," Skinner said. There was no pulse, so he began CPR and asked bystanders to go get a nearby automated external defibrillator and call 911.
McElwain was in sudden cardiac arrest.
"Thank the Lord it was a confluence of circumstances," Skinner said. "It couldn't have been a more perfect scenario to prevent a tragedy."
Unlike a heart attack, which is caused by a blockage of blood flow to the heart, cardiac arrest occurs when the heart's electrical system malfunctions, and the heart stops beating.
Skinner used the defibrillator to deliver the shock that "resets the heart back to normal." McElwain's heart restarted, but he was unresponsive and not breathing.
Once the ambulance crew arrived, Skinner said, McElwain had to be shocked three more times.
Skinner called Baptist Health Lexington and told staffers to get the cardiac catheterization lab ready.
He met the ambulance at the hospital and rushed his tennis opponent into the lab. He was doing a heart catheterization within half an hour of McElwain's collapse.
His cardiac arrest was determined to be caused by ventricular fibrillation. The heart's lower chambers weren't pumping blood at all. They were "just quivering" at a rate of more than 300 times a minute, Skinner said.
McElwain, who works in risk management at Baptist Health, had a defibrillator implanted Wednesday and went home Thursday afternoon.
He'll be on medicine to prevent future problems, but if it does happen again, the device will either deliver a shock to his heart or pace it back into rhythm.
McElwain, who previously had two heart attacks, said he has "an incredible feeling of fortune that that happened in the setting that it did."
Often, the outcome is much worse.
Dr. Sandeep Duggal, who implanted the defibrillator, said most people who go into sudden cardiac arrest outside a hospital don't survive.
Once the heart stops pumping blood and oxygen to the brain, people can last only five minutes without brain damage.
Symptoms can include a racing heartbeat and a feeling of dizziness, but some people experience no symptoms at all before they lose consciousness.
McElwain, Skinner and Duggal said the case highlights the importance of knowing CPR and having automated external defibrillators, or AEDs, in public places.
"Everybody should be trained" to do chest compressions, Duggal said. "You don't have to do mouth to mouth."
"That keeps blood flowing to the brain," Skinner said.
He credited the AED with saving McElwain's life.
Skinner said he takes note of AEDs wherever he goes, and he knew the tennis club had one.
"Without that ... there's no guarantee that he would've been OK," Skinner said.
McElwain said he had to forfeit the match against Skinner, but he plans to hit the courts again.
"I'll be out there in six to eight weeks," he said.