Gosh, atrial fibrillation can be hard to treat.
He lay in the ER bed with a light sweat, and an obvious discomfort from the rapid heart rate and high blood pressure. He is my age. The belly protrudes from a too small XL tee shirt, there is week old facial hair, and he looks up at me from under the bill of one of those foamy baseball hats with an NFL logo. It is his fourth, or fifth, or sixth admission for atrial fibrillation. Many good doctors have tried previously, but now an electrophysiologist gets the call, like an “expert” can magically modify behaviour.
Middle age can hit hard. There was a good job, but now this is gone. A divorce, and 12 daily beers poke at an already inflamed heart. Of course, he has no insurance, and thus, there has been no follow-up since the last discharge weeks ago. A measure of the blood thinner, the INR (should be 2.0-3.0), is greater than 10 –just a hair less than the mice in my house which I have not seen since laying out the dish of green coumarin pellets. No job or insurance precludes buying all his medicine, and the heart races.
Minutes before in the doctors lounge at lunch, for some unclear reason, the TV was unusually loud. President Obama was thumping the podium on the importance of passing healthcare reform, like doing so will spontaneously heal many.
“Doc, I am turning my life around. I am done with the beer, and committed to helping myself.”
Ok, we will try again.
The moral of this story: any chance of success in treating AF requires a cooperative patient, and insurance to pay for the basics. I may have the tools, and knowledge to help, but like a broken chain on an expensive bicycle, without mutual cooperation from the patient, moving forward is impossible.