From all appearances, Ruby Graupera-Cassimiro was dead.
Her heart stopped beating for 45 minutes, and the doctors performing her cesarean section summoned her family to say goodbye.
What happened next still seems scarcely possible: The blip of her heart beat began to show on a monitor.
Graupera-Cassimiro was alive — and by all appearances, she survived the Sept. 23 experience without lasting damage.
"She went for almost an hour without a pulse and the resuscitation lasted almost three hours," said Dr. Jordan Kanurr, the anesthesiologist during the cesarean section who also led the resuscitation effort. "I've never seen anything like this. Neither have any of other anesthesiologists and other doctors I work with."
The 40-year-old mother, whose daughter was born healthy, says she is just savoring every new day.
"I am just a normal girl. To me this is humbling," she told The Associated Press on Monday. "The doctors call it a miracle and they do not have an explanation."
It began as a routine C-section, something hospitals do every day.
But Graupera-Cassimiro suffered a rare, amniotic fluid embolism, which happens when fluid that surrounds the baby in the uterus enters the mother's bloodstream, clogging the heart and creating a vacuum that stops circulation.
Kanurr said the medical team realized something was wrong when Graupera-Cassimiro lost consciousness shortly after the birth. Resuscitation efforts began immediately and continued until doctors felt there was no hope left.
That's when they called in the family. A short time later, Kanurr said he was getting ready to turn off all supportive care. "Just before I did that, she began to have a rhythm," he said. "To keep it simple I believe this is truly a miracle."
Doctors called her survival a double miracle because she had no brain damage despite going for so long without a pulse.
Graupera-Cassimiro remembers nothing that happened after her daughter was born. But her 21-year-old niece Crystal Santos said family members gathered to say goodbye.
"They said they were going to have to call a time of death, that it had been almost 45 minutes and that they normally don't go that long on a code," Santos said. "My grandmother was crying and begging for God to take her instead."
Moments later, a blip was heard on the heart monitor.
"There were at least 15 people in that room working on her and they all started crying. They told us they had never seen anything like that," Santos said.
Doctors nevertheless warned the family that there was a high likelihood of brain damage.
"But my mom (Graupera-Cassimiro's sister) didn't believe them she told them that God doesn't do things halfway and wouldn't bring her back like that," Santos said.
Hours later, Graupera-Cassimiro woke up in the intensive care unit and began pulling at the tubes in her nose and mouth.
"I kept hearing people talking about whether I was having involuntary movements. I noticed all my family was there. I thought I was just waking up after going to sleep," she said.
Family members showed her a picture taken of her with her newborn daughter, Taily, moments after the 12:36 p.m. delivery.
"I don't remember taking that picture and I wasn't looking at the baby in the picture, which isn't normal," she said. "The last memory I have is saying that my nose felt stuffy."
Although several weeks have passed, she said she still feels like she was watching herself in a video and that the entire experience seems unreal.
She said the ordeal was most difficult for her husband, mother, sister and other family members who went through the emotional roller coaster of thinking she was dead, feeling overjoyed that she was alive, fearing that she would be brain damaged and then realizing that she was fine.
After the near-death experience, time with her husband, 7-year-old son and infant daughter is even more precious, she said.
"Now we are just savoring the moments," she said. "Every day is a gift."