Doctoring General Medicine Health Care Health Care Reform Reflection

Black Friday in the Cath Lab…

The parking lot is devoid of the usual chaos. The coffee cart is closed. An unusual quiet in the hallway is the norm.

Holiday in the hospital.
There were dark circles underneath the fatigued eyes and a slowness of gait. A colleague “fixed” four heart attacks on Thanksgiving. Sometimes, I make fun of the “squishers,” as plumbing of the heart seems less complex than the electrical system. Squishers are really interventional cardiologists, which means they open complete blockages in the heart’s blood vessels.
A discomfort in the chest starts and crescendos, sweats and breathlessness ensue. An artery suppling blood to the heart muscle is clotted off. Damage to the heart muscle begins immediately, and if not corrected within minutes to hours leads to scar – which never again contracts. A heart attack. Life either ends or is changed forever.
The treatment problem is time. Ninety minutes is the standard to get these blockages open. 90 minutes from walking up to that busy triage desk in the ER to an open artery. Think about the human implications. A staff of 3 and a skilled doctor immediately respond to the beep. Every minute counts. Try this at 0300 after working a full day.
My colleague and staff repeated this task 4 times yesterday, throughout the day and night. Still, there were more arteries to clear today. Heart disease takes no holiday. I ask, “four heart attacks on Thanksgiving, how is this possible, what about statins (cholesterol drugs)?” The face says, what a dumb question and the answer: “this is Kentucky.”
Electrophysiologists get to “fix” arrhythmia on a much more favorable schedule. The rescuer of heart attacks is not so lucky. I briefly observed their work today. More blockages, more coated stents and more bypass surgery to schedule. No holiday for the “fixers” of arteries.
I respect them. The arduousness was visible in their being today.
Two thoughts enter the white matter. First, there is so much work needed in prevention, but, like a spoiled child who keeps getting hand outs, the bail-out that is, acute interventional cardiology, makes thwarting this cascade seem unnecessary. Second, I ponder the unfairness of upcoming cuts in reimbursement for those individuals and hospitals that dedicate their lives to opening a 3mm blood vessel on a beating heart at 3AM in less than 90 min.
Having your life saved by a dedicated institution like Baptist East, an interventional team, and dedicated doctor seems a poor place to save healthcare dollars. I know, bias.
One wonders the thoughts of those whose lives are saved.