Heart Trouble -HCDT
Chest pain. Everyone, even a thick headed insurance company med cost manager, knows chest pain could be a heart attack. So, I’m gonna start out by telling you about no chest pain first. The bug-a-boo of heart trouble is the subtlety of the clues. If that wasn’t worrisome enough, at times there are no symptoms at all. I went to a recent conference on the subject, and there were two big shot Tobacco Triangle U. cardiologists frettin’ over this issue as bad as a lowly country doc.
One Sunday afternoon a few years back, I decided to go up the golf shop and see if anyone wanted to walk nine. I ran into an old friend, Snookers. I won’t tell him his full name for now. For one, it would be a HIPAA violation, as his name is rather unique and would be identifying. He gave me full permission to use it, but I have some other motivations to protect him for now. You see, Snook was instrumental in unraveling a medical mystery a few years ago, and I promised I’d keep his role under wraps until the book comes out. So for now, he has to go by Snook.
Snook and I go back all the way to childhood. In some ways, we had little in common. My yearbook byline read like thousands of other well scrubbed southern kids. Band 1,2,3,4. Honor Society 1,2,3,4. You know the routine.
Snook didn’t even have his picture in the yearbook, ’cause he was out gambling on the golf course the day they took the photos. If any of his accomplishments had been documented, I guess it would have simply stated, smoked cigarettes, gambled, and of course, golf 1,2,3,4.
We played on the team together. Snook was the star. I was the sixth man. One time I shot 39 on the back nine for the team to hold onto the Conference title by a shot, but my most valuable contribution was to coach Snook to a C minus in History so he could keep his eligibility. We won the State that year, though I only got in one match. Snook shot 64 the last day. No one came within a half dozen shots of him.
So, fast forward some quarter century. Me and Snook are still buddies. When I walked into the golf shop, he was giving the pro some pointers on putting.
“Hey, Snook. Wanna hoof nine?”
“Sure Doc.” Snook put out his cigarette, and retrieved his clubs. “Play for a burger?”
“No problem Snook. Four a side?”
“Come on Doc, Three is all you get. I’ve been watching your scores on the sheet. You’re doing good here lately. Four? No way, partner.”
“O.K. Snook. Three it is.” I’d contributed many a cheeseburger to Snook’s monthly meal plan, and had no reason to suspect any different outcome today. We set out with no anticipation of anything other than a walk in the park.
It was one of those gorgeous spring days that leaves you hard pressed to believe God could frown on golf, at least if you didn’t use those blasted carts.
As usual, Snook jumped out to an early lead, but seemed a bit off his feed. Still, I was closed out by number eight. Eight is our number one handicap hole, and requires a solid drive of at least 240 yards to reach the top ot the hill, then a mid iron over water to a sloped green. The hole is a tough one, and has shattered many a dream of a good front nine. We both hit good drives that carried the hill.
When we crested the hill, I got my first clue something was wrong. First of all, Snook only outdrove me twenty yards. It was usually more like thirty. More worrisome was the fact he stopped walking, and it wasn’t to light a cigarette, but to catch his breath.
“You O.K. man?”
“Yeah Doc. I’m fine.”
He didn’t look fine. “Honest to God, Snook, you’re gonna have to give up those cigarettes.”
“I’ve cut way back, Doc.” Right. We’d been through this routine before.
“When did you start having to stop on eight to catch your breath like that?”
“Just in the last month.” He paused to catch his breath. “I’m just outta shape Bibey, that’s all. I didn’t work out much this winter.”
“I dunno ’bout that Snook.” I checked his pulse, and it was regular. There were a few beads of sweat around his temples. We waited a minute and they cleared up. “Any chest pain, coughing up any blood?” I went through all the standard questions.
“Naw, Doc. Hey, I’m fine.”
“Let me walk in and get you a cart.”
“Hell no, Bibey. I ain’t no invalid.”
We played in, and Snook collected his cheeseburger. I followed him out to the parking lot. We sat on the tail gate of his truck and I watched him change his shoes. He still seemed a little short of breath. I thought through his family history. His mom was elderly, but spry. His Dad had run off when Snook was twelve. I still remembered that trauma, and didn’t want to bring it up. His sister was healthy. He did not have any brothers. “Anybody in your family with heart trouble Snook?”
“Naw, Doc. Booze and womens our only problem.” He seemed more like himself.
“You getting short of breath every time you walk up number eight?”
“Pretty much, yeah.”
“Does it get better when you rest a spell?”
“Sure. Don’t it for you?”
“Look, Snook. I don’t want to alarm you, but this could be your heart, man. You want to go over to the ER?”
“HAIL no.” As opposed to Snook, I am no gambler, and I did my best to convince him, but he was resolute. No hospital today.
“Well, at least let me line up some tests.”
It took some powerful persuasion, but Snook did go for his treadmill. As you might guess, he flunked it and wound up with bypass surgery.
The moral of the story. First of all, “Doctor, know thy patient.” I don’t think the finest cardiologist at Tobacco Triangle U. coulda won Snook over unless he happened to be a scratch golfer, and there for the opportunity.
Second, and for purposes of our more general discussion of how country doctors think, know the heart. Once a patient had some odd symptoms in her chest, and kept telling me, “But it can’t be my heart.”
I got frustrated and said, “Ma’am. I don’t care if every time you sip cider through a straw your nose twitches and your left ear wiggles, it could be your heart.” I regretted it as soon as I said it, ’cause no one wants a smart ^** for a doc.
I was exaggerating, but not by much. Remember the Groopman hypothesis. For acute illness, think of what might kill you first, and then work your way down the list. If we are paranoid and turn out wrong, we can visit on the front porch of the nursing home someday and laugh at the war stories.
Well, old long-winded Bibey has gone on too long again. I’m gonna tell you more about heart in the next segment. After that, we’ll talk some about how country doctors think about chronic illness over a few posts. So far no one has gonged me back to bluegrass music, but we’ll get back to that in short order.