The following is based on a true story that still gives me the chills when I think about it. Aspects of the story have been sufficiently modified to protect parties involved.
I started my medical school rotations in cardiology…the very career that adopted me today. I was fortunate to be a student in a high-volume and high-performing institution. When someone presented to the emergency room with chest pain from coronary blockage, you could measure the minutes to the life-saving catheterization with an egg timer.
During my call night, we received a call that someone important was presenting with angina – a sign of an impending heart attack. I quickly walked to the emergency room. The closer I got, the more frenetic the activity seemed to be stirring within the hospital. I saw important institutional leaders rushing by me in and out of the ER. It seemed to me that this usually calm and high-functioning hospital was in confusion and disarray. As I approached the center of activity, I gasped and saw that our Chief of Cardiology* was lying in a hospital bed – now in a very personal battle with the disease he had studied and taught about for so many years.
Barely recognizable in a hospital gown wearing an oxygen mask, he looked pale and weak – not the commanding professor that just 24 hours earlier was teaching me about the different types of coronary stents. Most of the emergency room attending had dropped whatever they were doing to attend to one of their own. I recognized other cardiology attending at his side who were clearly not on call but holding his hands and comforting him. An EKG was silently being printed amidst the frenzy – this EKG would show why he was having chest pain – if it was coronary obstruction, it would show where and perhaps to what degree.
As the EKG finally printed, someone had the idea to show the results to our chief. Interpreting EKG’s can be a complicating task even for experts…why not show the most experienced person in the room – who in this case happens to be the patient? In subsequent morbidity and mortality conferences, this simple and well-intended gesture would be deemed controversial.
I remember seeing our chief take the EKG with frail hands. He glanced at the squiggly lines spinning their story and his experienced eyes widened with horror. Dramatically his heart rate increased. He dropped the paper on the bed and slumped in his bed. We all noted his blood pressure starting to fall.
He knew before any of us that he was having a massive heart attack. I could only surmise that he, as a patient, panicked which caused increasing strain on his struggling heart tipping him from marginally stable to unstable. We quickly rushed him to the cath lab but most of his heart muscle had already started to undergo necrosis. The pressures in his heart started to increase and the blood started to pool in his lungs. He died due to complications of his acute heart failure.
Our chief was correct in his interpretation – there was no error in self-diagnosis. However, I’ve come to learn there is an important role that a treating physician has in delivering care. The art of medicine is to go beyond understanding the disease – but to understand your patient in context of his/her illness. For some, it’s helping the patient overcome denial or important mental blocks. Other patients may intellectualize their disease. For others yet, the tact may be to emphasize the positives. All of this becomes infinitely difficult when trying to treat or diagnose yourself.
For our cardiology chief, I can’t help but to wonder if the outcome would have been different if instead of showing him the frightening EKG print out, a close colleague were to quietly and calmly say “As you may have suspected, the EKG is consistent with a heart attack but you are in the right place and we have already arranged to have this process reversed. With hope, you’ll be eating our crummy cafeteria food by morning.”