Teenagers Michael and Tristen Wheatley were home alone on the afternoon of Sept. 28 when they got into a quarrel that nearly destroyed both their lives.

Michael thinks they were discussing anthropology.

"It's just bizarre, it's not even for a reason we would fight over," he said.

It began as regular rough-housing. Tristen charged at Michael. Michael raised his fist. A reflexive move. It landed in the middle of his brother's chest.

Tristen went down.

"It was so fast," Michael said. "He made a weird noise, just like a gasp. … I realized his eyelids were just open and staring, there was a little drool collecting and it immediately hit me that he was dead."

What happened next was a family nightmare: an extremely rare but sometimes deadly injury, caused by a blow delivered to a specific place on Tristen's chest. By that evening, 16-year-old Michael Wheatley found himself alone in an interrogation room at Anchorage Police Department headquarters, not knowing whether his 17-year-old brother would live or die. And he was the prime suspect in an aggravated assault case. His brother was in a hospital bed.

"I was just sitting there with my thoughts," Michael said.

Back from the brink

For the boys' parents, Chris and Tiffany, the afternoon went from normal fall afternoon to a dire emergency in a heartbeat.

"You've got one son being loaded into the ambulance to be taken to the hospital with no idea what's going on, and another one the cops have that they won't let us see," Chris Wheatley said.

In the moments after Tristen collapsed, Michael first called his mom and didn't get an answer, then called 911.

"I started doing CPR because I felt he had no heartbeat, but I thought it was pointless," he said.

When first responders arrived, paramedics initially thought the boy might have suffered a drug overdose, but Michael told them that couldn't be the case. His brother doesn't do drugs and attends early college classes at the Alaska Middle College School in Eagle River.

Paramedics shocked Tristen four times with a defibrillator. As he was being placed in the ambulance, they began to see signs of life. On the way to Alaska Regional Hospital in Anchorage, Tristen continued to improve and had to be sedated as he tried to fight to breathe on his own.

He spent the weekend in a haze of medication as doctors evaluated his condition. But by Tuesday, he was ready to go home.

"It's a miracle I guess — or the opposite of a miracle, I don't know," Tristen said.

Lightning fast

Tiffany Wheatley said doctors told the the family Tristen had suffered an injury called commotio cordis, a Latin term that means "agitation of the heart." It's an extremely rare and dangerous condition that occurs when someone suffers a direct blow to the chest at a precise time during the heart's electrical rhythm.

Keri Gardner is the chief medical officer at Alaska Regional Hospital and an ER doctor. Gardner said the condition is "akin to being struck by lightning."

"If you get a hard enough force at just the right spot on the ventricle, and it does it at just the right time — which is the recovery phase — the heart will stop," she said.

The injury is incredibly rare. According to Dr. Gardner, the National Commotio Cordis Registry has recorded just 224 cases since 1995. However, it's also highly fatal. According to a 1991 article in the American Journal of Diseases of Children, it's a leading cause of death among youth baseball players.

Dr. Gardner said the injury is most common among teenage boys and is seen most often in sports like hockey or baseball where an athlete can sustain a sharp, direct blow to the heart.

"It's almost always boys and it's almost always athletes," she said.

Recognizing the injury and treating it immediately is key to survival, she said. Starting CPR — as Michael did — and administering an electrical shock as soon as possible can often reverse the stoppage and restore the heart's function, she said.

"In this case, early defibrillation saves lives," she said.

Coaches and parents should be aware of the condition, she said, and know how to prevent it. That can include things like teaching players to turn their chest away from flying balls or pucks to instead absorb the blow with a shoulder. The injury is easily recognizable due to its onset almost immediately after a blow to the chest.

"This is not a delayed event," she said.

Out of the fog

After questioning Michael and searching the family's home, police officers eventually released the teen to his parents without charges. Tiffany Wheatley said the first two days in the hospital were difficult due to Tristen's insistence on watching the Judge Kavanaugh hearings — nonstop — on cable news. He'd been given the assignment by his political science teacher and didn't want to fall behind his classmates.

"All he cared about was school," she recalled. "He kept telling his nurses about midterms."

Tristen was released Tuesday night in time for midterm exams — which he said he aced. He said he's glad he doesn't remember the incident.

"It's a weird event," he said. "You go around the school and tell kids you had a heart attack, kind of get some shocked faces."

Fortunate son

The family attended an Oct. 24 awards ceremony honoring 10 CVFRD members for their work to save Tristen's life — work that included crucial help from Michael on an extraordinary afternoon in Chugiak. For their work helping Tristen, Benningfield awarded the CVFRD's Lifesaving Award to first responders Craig Hayes, Brian Dunleavy, Darin Swain, Tim Robbins, Chris Wilkins, Clifton Dalton, Molly Swanson, Aly Ward and John Della Croce.

"They don't always turn out like this," said Benningfield, who was also involved in the call.

In Tristen's case, everything that needed to go right, did.

"From dispatch recognizing on the phone and helping Michael, to us getting there and doing what we did, and us transporting him to the hospital, all of those things fell into place that day," Benningfield said.

Tristen is expected to have no lasting effects from his injury, and thanked paramedics and doctors for their prompt response. His mom did, too, and said she's struggled to find a way to properly thank everyone involved in bringing her son back from the brink.

"There's not really a lot of ways to say thank you for a life," she said.