When does Medicine in America rock?
When things like this happensâ€¦
The call came during one of the earlier cases to see this patient who had complete AV block. As her BP was normal, the report described her as“stable.” (Note: cardiac output requires an adequate heart rate, so just because one’s BP is stable, does not necessarily confer stability.)
It is 5 o’clock–as it so often is in these cases–when I see her.
She has just got back from the bathroom. She is pale, distressed, breathing like a locomotive, and after I move my eyes from the dangerous “short-long” pauses on the bedside monitor, I notice her neck veins distended and intermittently bulging. (There is a name for said neck vein abnormalities which I cannot recall now, but will surely know a few weeks before board exams in five years time.)
We need to move now. Like right now. Electro-physiologists rarely have to move as fast as the “squishers.” Over the years, I have grown accustomed to the controlled atmosphere of the EP lab, in which excitement is invariably a bad thing.
This afternoon, there will be even more excitement as my home court, the Cath lab, has both call teams rolling. They are not available.
It has been many years since I did a pacemaker in our operating room. So many, that my preference card was yellow. But call a case an emergency and American medicine swings into motion. And, in emergencies, insurance cards, patient deductibles and mindless forms take the back seat to caring for the patient. Nice.
Nurses from the floor wheel the patient directly to the OR room. They are greeted by an army of professionals, including The CRNA (nurse anesthetist), the c-arm rad tech and at least three other nurses prepping the patient. In no time, the pacemaker is in, and the crisis averted.
The next morning, as I enter the room, the patient is strolling about with a much more human like color. She immediately asks me when she can go home, and when she may return to work. To her, it was as if nothing happened.
Although, a bit stressful for a middle-aged doctor, emergencies seem to bring out the refreshing purity of medicine. Once in a while, that’s a good thing.