chekhov's peloton

Ask a Cardiologist: Should Carrie Have Called 911?

Photo: HBO Max

Ever since And Just Like That … ruthlessly killed off Mr. Big via Chekhov’s Peloton, everyone from me to Jonah Hill has been screaming the same question into the void: Why the fuck didn’t Carrie call 911??? And then I couldn’t help but wonder: Could Carrie have saved Big’s life if she immediately called an ambulance, instead of staring at him for a very long time before low-key drowning him in the shower? The world is owed a real answer, and I’m the best detective for the case due to an important combination of factors: my love of pointless internet research and my friend who is a cardiologist.

But first, the specifics: Exactly how long was Big chilling on the floor near the shower, his heart failing, while Carrie listened to some impressive teenage piano music? His heart attack begins in earnest at 38:40 in the episode, just after he gets in a good ride with his instructor Allegra and texts Carrie, “Let’s go tonight,” a reference to the Hamptons trip they postponed so Carrie could attend Charlotte’s daughter’s concert. Despite being fully clothed, Big turns on the shower, then drops his phone straight into it. Suddenly, his face contorts in pain and he falls to the floor, grabbing his left shoulder. He reaches for his phone but is too unstable to grab it. Meanwhile, across town at the Manhattan School of Music, Charlotte’s prodigious daughter finishes her piano recital. At 39:20, Carrie checks her phone and sees Big’s text, tells Stanford she has to go home, then has a bit of trouble hailing a cab. (We don’t see her actually grab one, just her biting her lip, looking irritated.)

Big and Carrie live at 1010 Fifth Avenue, which is a 16-minute drive from the Manhattan School of Music on a no-traffic night. This is a Thursday in Manhattan, so it could go either way, but I’ll give this one to Carrie. Let’s build in the extra time that we didn’t see pass between the recital ending and Carrie walking outside, plus the time for her to hail said cab, then to take the elevator up to her apartment, which is the 15th-floor penthouse. We can call it, with extreme generosity to Carrie, a half-hour between Big starting to have the heart attack and Carrie arriving home.

Carrie opens the door at 40:00, pauses to drop her keys and some papers in the hall, walks into the bathroom, sees Big slumped on the floor with his eyes closed, and stops in her tracks. “John?” she says. HE OPENS HIS EYES AND LOOKS AT HER. For at least ten seconds, they stare at each other open-mouthed and I guess romantically. Time continues to pass. He is still awake. She is still standing there. At 41:17, she finally comes to her senses and races toward him, ostensibly to help him. But instead, she puts him on his side half-under the shower and just sort of drags him around by the torso, yelling his name and kissing him. HIS EYES ARE STILL OPEN. HE BLINKS AND MOVES HIS ARM TO HUG HER.

At 41:51, Carrie pronounces Big dead, despite the fact that they are an eight-minute drive from Lenox Hill Hospital, where Beyoncé gave birth.

Even to a non-medical-expert average citizen like myself, the whole thing seems to have been preventable since the advent of the telephone. So I called up my friend Daniel Luger, a cardiologist at Chicago’s Rush University Medical Center, to get some conclusive answers about exactly who is responsible for Big’s death — Carrie, Big, Peloton, or Satan himself?

How familiar are you with Sex and the City?
Not particularly. I have watched several episodes with my wife; I know the characters. I would freak out if I saw Jessica Sarah Parker on the street.

Jessica Sarah Parker?

Okay. Do you know the character Big, and are you familiar with his heart history?
I know him, but I am not aware of his cardiovascular history.

So Big has to get an angioplasty in season six because they found a blockage. He recovers. When we revisit him in the first episode of the sequel series, he’s taking nitroglycerin pills. What are those for?
Nitroglycerin dilates the coronary arteries and improves blood flow to the heart muscle. It’s used in patients who have chronic chest pain.

So it’s not preventative in terms of heart attacks?
Not routinely. It’s just to treat symptoms. If you have stable coronary disease, meaning you’re not in serious danger but have recurrent chest pain, you can take it to palliate the symptoms. If you have had a heart attack, you can keep a nitroglycerin at home, and if you have severe chest pain, you can take one. It’s not used to prevent a heart attack. It just helps open up the coronary arteries for symptoms — or in the case of acute heart attack, you can give it to help open the arteries a little bit.

So Carrie goes to this concert across town, and as she’s leaving, Big is puffing a cigar and talking about going on his Peloton later. And she’s like, “Oh, a cigar and a Peloton in one night?” Sort of pooh-poohing that. Do you think that’s a bad combo?
I would say it’s a great idea to do Peloton. But I would certainly avoid any tobacco products, particularly with a history of coronary artery disease.

Okay, so he gets on the Peloton for a 30-minute ride and he’s having a great time. But right after he finishes, he suddenly starts to have a heart attack. And he can’t call 911 because his phone falls into the shower. How realistic does that seem as a post-Peloton situation?
There is a phenomenon where, after your exercise, you could have pooling of blood in the legs. That’s usually with running: Your blood pressure and blood flow to the heart can drop. Is this in the morning?

No, at night.
So, if you have a known history of coronary disease, you can have a heart attack at any point. It’s not unrealistic that he would exercise and then have a heart attack. Exercise slightly increases your risk of having a cardiac event, but we encourage all patients with coronary disease to exercise, because the risks of having an event are low and the benefits are much higher.

Peloton has defended itself by blaming Big for his “extravagant lifestyle” of “cocktails, cigars, and big steaks.” Is that fair, to blame him entirely?
That’s totally fair. I am on the side of Peloton here. Exercise itself does not cause an event. What caused him to have an event is that he had poorly controlled cholesterol, poorly controlled blood pressure, he was clearly using tobacco, and he has a history of coronary disease. All of his risk factors for coronary disease should have been aggressively modified in order to prevent an event.

Okay. So I calculated that he was having a heart attack for roughly 30 minutes before Carrie found him. Is it possible to have a heart attack for that long and still be conscious?
Absolutely. Very much so.

So she gets home, she walks into the bathroom, sees him on the floor, they stare at each other, and she runs toward him and just sort of hugs him until he dies in her arms maybe a minute later. People are aghast that she didn’t call 911. If he was still conscious, and she called 911 right away, is there a chance he would have survived? For reference, they are an eight-minute drive from Lenox Hill.
Absolutely. This is her fault. Without trying to point a finger at her, this is absolutely the fault of — what’s her name?

Sarah Jessica Parker.
What did I call her before?

Jessica Sarah Parker.
Right. So there are a lot of different ways that you can die from a heart attack, but usually the way that a heart attack kills somebody is the blockage of an artery leading to instability of the electrical conduction system in the heart muscle. If you drop dead suddenly, you probably had electrical complications from a blocked artery. If he was in the hospital or if EMS was at his side when that happened, they could absolutely shock him out of that rhythm. That’s a very treatable problem in the hospital setting. People don’t die from heart attacks anymore because we’re so good at quickly opening up the arteries, treating the sequelae of coronary disease or pump failure — we’re good at reversing all of that stuff.

Even after he went unconscious and “died” in her arms, how long would she have had to call EMS and still revive him?
Time is about the brain when it comes to cardiac arrest. Your brain can survive for somewhere up to three minutes without oxygen. What she needed to do was, when he went unconscious and lost a pulse, she needed to immediately start CPR. Feel for a pulse, call for help, and start chest compressions. Because you can absolutely stimulate blood flow to the brain and the rest of the vital organs with CPR, and once EMS came, they could have resuscitated him immediately with medications and defibrillation. So did she just sit there?

She held him and screamed.
She needed to do CPR. This is a PSA: If you see somebody lose consciousness, the first thing you do is feel for a pulse. If there’s no pulse, you call EMS and start chest compressions without delay. You can definitely save people’s lives that way. He didn’t need to die. This is a goddamn travesty.

Should Carrie Have Called 911? We Asked a Cardiologist.