The surgeon was devastated and sat with his face in his hands when the family arrived at New Karolinska Hospital on the afternoon of August 18. The operation had gone well, but something terrible had happened.
In the meeting with the doctors, Helena Pettersson and her two daughters Filippa and Clara heard about the medication mix-up. Instead of potassium chloride, which temporarily stops the heart during heart surgery, Johan had been given calcium chloride, which kills the heart muscle. A drug that should not even be in the operating room.
"Stone heart" it says in Johan's journal, total lack of cardiac activity. After the operation, the heart could not be restarted.
In an operating theater next door lay an anesthetized man in his 70s. Even his heart had been given the wrong medicine during a routine procedure.
Both patients were urgently set up for a heart transplant, so-called "urgent call".
Johan Pettersson was taken by helicopter to Lund to get a new heart, constantly connected to Ecmo, which oxygenates the blood outside the body.
DN meets Johan Pettersson's family in the villa just outside Stockholm. Helena Pettersson and the children Filippa, Clara and Eric sit closely together on the large sofa in the living room.
- We are still shocked, we have not understood. But the truth must come out – my husband did not die of complications from a heart transplant, says Helena Pettersson.
It's been a few days since the doctors in Lund said that Johan's body couldn't take it anymore.
Outside the white villa, flags are flying at half mast. All over the kitchen and TV room are vases of flowers.
On the table are photos of Johan who has just celebrated his 55th birthday with his wife Helena.
The family describes Johan Pettersson as a fun-loving person who was always busy, who gave more than he took.
He did a lot of sports, took daily runs. And he loved to ski.
- Dad was always doing something. He did strength training and loved padel. Otherwise he had some project on the plot. It was his way of relaxing, says Eric.
It was almost annoying at times, says Helena Pettersson.
- I said: can't you just sit down and enjoy yourself, she says.
Johan Pettersson was CEO of a company he co-founded.
But he had high blood pressure, and it was when the blood pressure medication was to be renewed that the doctor discovered a heart murmur. He had not felt the same energy, and the operation was expected to give him his breath back.
Johan Pettersson was nervous before the operation.
- He was worried that they would stop the heart, says Helena Pettersson.
At the time of enrollment, the doctors explained that it was a routine procedure to change the heart valve. It was a peephole operation, and something they did Monday through Friday.
The conditions were the very best. In May, Karolinska sent out a press release about the hospital's top results in heart operations, with a 1.1 percent mortality rate within 30 days, according to the Swedeheart quality register. Best in Sweden.
Everything also seemed normal when the two patients were sedated that Tuesday morning.
When the operations started, the surgeon signaled the perfusionist, in charge of the heart-lung machine, to administer the drug. The heart stopped as expected. But when a blood gas test was taken on the patients, it was discovered that the calcium level was very high and that the wrong medicine had been given to the patients.
This took place a few minutes apart in two operating theaters where the heart operations are taking place. The drug was changed immediately, and treatment to purify the blood was instituted. But the patients suffered life-threatening injuries.
After nine days in Lund, the transplant was done and the operation went well.
The family lived all the time at the patient hotel in Lund, and walked between the hospital and the church.
- We prayed that Johan would be allowed to live, says Helena Pettersson.
The family was able to communicate with Johan and there were glimmers of hope. But other organs failed.
- In Lund they were absolutely fantastic. They did everything to keep him alive. He knew we were by his side. For 47 days he was dragged through hell, says Helena Pettersson, her voice breaking.
Karolinska states that the cause of the medication mix-up was a wrong delivery of medication to the operating room and the human factor. The packaging for calcium chloride was similar to the bottle of potassium chloride, which is always in the pantry.
But the hospital's incident analysis, which is part of the Lex Maria investigation, shows that several steps in the care chain have broken down and that there is a lack of structured checks on medicines, for example against checklists. From the time the incorrect medication arrives and is unpacked, until it is taken into the ward, filled into the heart-lung machine and assigned to the patients, there is no control.
- It is on four occasions that no one looks at what is written on the bottles. Will heart surgeries be commonplace in Sweden in 2026? They don't look at the label before putting medicine into my husband's heart. How can that happen? says Helena Pettersson.
The medicine was stored in plastic trays in a cupboard in the corridor, not in the medicine room, which may have affected the mix-up.
Karolinska has reported the confusion to the Inspectorate for Care and Care, Ivo, according to lex Maria, and conducted its own investigation. A police investigation into causing the death of another has been launched.
DN has searched for responsible persons at Karolinska, but a booked interview time is canceled at the last moment, with reference to ongoing investigations and recommendations from the hospital's lawyers.
Instead, the press service has compiled written answers together with chief physician Ylva Pernow. Karolinska admits that the hospital's system and routines were not good enough to secure the entire pharmaceutical chain.
"We have clarified the local routines for receiving delivery, storage and use of blood cardioplegia (potassium chloride) in the operating room with checking against a checklist, clearer labeling and signing by two employees," writes the press service. The perfusionists are on duty.
In the villa where the family is gathered, grief is mixed with anger. Helena Pettersson is determined that there must be a change.
- My husband was in his prime. He was very strong and barely even caught a cold. It must never happen again, says Helena Pettersson.
