A Heart Attack in the Mail Slot

        This post today goes out to Ms. Pande and Mr. Demonic, wherever my globe trotting pals might be at the moment.  Pande said she didn’t want me to forget to do some doctor posts, so I’ll dedicate this one to her and her hubby, Mr. Demonic, and their young’uns, the California girl and Pande’s violin.

        I saw a patient recently with a silent M.I.  (Heart attack without symptoms she didn’t know she’d had.)  Here’s how I found it.

       One day some blood work came across my desk. It was from another doc who was seeing one of my patients as a consultant.  It was a patient I had not seen in some time.  I noticed an abnormal test, a high CPK.  This could be a lot of things, but heart attack is on the list. 

        My nurse that day was Lynn O’Carroll, and I had her track down the patient.  Lynn was unable to convince her, and got me to come to the phone.  Given the patient had no symptoms, she was incredulous.

        “Whatda ya mean?  I ain’t had no heart attack.  I’m fine.”

        It took some kinda persuasion, but she did come in.  Her E.K.G. was abnormal, but the findings were subtle; only a few flipped T waves in the lateral leads.   She didn’t want to accept the possible diagnosis.  

        I began to get frustrated.  I mean, this was the same lady who read on the Internet a few years back about someone who developed a cough from an ACE inhibitor and called to yell at me for my choice of the medicine such as that.  (It was a side effect I was well aware of but one she did not tell me had developed in her case.)

        I almost pulled out the office policy manual- you know the rule I have quoted before- “sudden death is against office policy,” but I was able to convince her to see the cardiologist without all that drama.  Sure enough, she had a recent lateral M.I. and some intervention was indicated.  She’ll probably be fine.

        I’m glad my mama had me take that speed reading course, and thankful I read my mail, though I admit some of it is in a hurry.  I wish the patient had been more appreciative, but like my wife says, with some folks if you want gratitude you’d better look it up in the dictionary.

        Hey, don’t feel sorry for me though.  I love this job, and I’ve tried to my best on every encounter without fail.  For the most part I’ve been successful, and very lucky.  I have no regrets, even on the days when there is some verbal abuse.  I figure it comes with the territory.  I’m just glad the lady is O.K. 

        I suppose there is one lesson in this I do want patients to get.  Be sure all your blood work and tests are tracked down before you close the book on it.  Sometimes things can get lost or filed away without the Doc seeing the report.  (That is also against office policy, but I have seen it happen.)  Never assume no news is good news- it might be no news.

        Some of my folks want a copy, and that is O.K. with me as long as they promise to follow another office rule- “Don’t worry till Dr. Bibey says worry.”  (A variation of NTW.)

        If someone has some minor abnormalities, but they are O.K. in the context of the big picture, I don’t worry and try to reassure.

        However, if the abnormality seems minor but Dr. B says worry, I’d commence to doing just that till the thing is resolved.  The trick is learn to worry about the right things.  This patient got confused for a moment, but it worked out.  The Good Lord and mama’s speed reading course were looking out for her.  (Dr. B just happened to be there- it was pre-programmed.)

        Another rule I have is to always worry about the things that could do my patient in before I get another shot at it, so the stakes can be rather high.  (This is why I am not serious about golf, or even music, as much as I love it.)   

        So, if your Doc calls and says they’ve looked at your blood work and they are afraid you’ve had a heart attack, better take ’em seriously until you can prove them wrong.

        Even an old country Doc had better pay attention.  (As you get older, it is even more true, I’m not as quick as those young-uns.)  We don’t make the dignosis this way very often, but it is best to stay alert.  It ain’t every day a heart attack shows up in the mail slot.

Dr. B        

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