01 May 2009

Not my specialty

The medical office building at our facility is located right next to the ER.  The entrance to their clinic is maybe thirty yards from the ER's main entrance.   A lot of the docs use the ER waiting room as the route into the hospital proper; it's shorter and drier and the state of the waiting room gives them a sense of how many calls they are likely to get on any given day.  So it was with no surprise that I saw one of our general surgeons standing in the waiting room as I slipped out to run to the cafeteria for lunch.

She quickly buttonholed me, "Shadow, I need your help with something."

This surgeon is one of our best -- smart, witty, always willing to come in and do the right thing.  But she takes no bullshit either.  We have a very good relationship, and so I stopped to see what it was she needed.

"I was in clinic this afternoon," she explained, "and I started feeling a little off.  Sweaty and tired.  I mostly ignored it, because I've got some cases this afternoon and I wanted to get through clinic on time, but then I started to feel worse.  I threw up once, and was feeling a lot of indigestion.  So I went into the back room and did this ECG on myself."

She handed me a piece of paper, and I glanced at it.

"What do you think?  Is this real?"

Inferior MI
(Click to embiggen)

"Yeah," I said, scanning the cardiogram.  "This is real.  Are you still having pain?"

"Well, I don't feel good, but I don't have any pain.  I took an aspirin and found some nitro, which really helped with the indigestion.  But now that you mention it, I'm feeling a little lightheaded."

"That's probably the nitro talking," I said, taking in her rather pale complexion.  "Let's get you in back."

"But my cases..." she trailed off.

"Will have to be canceled." I said firmly, as I grabbed a wheelchair and flagged down the triage nurse.

"Whatever you say.  I'm out of my depth here.  You know, this really isn't my specialty." And with that resigned grumble, she slumped down in the wheelchair and gave herself over to our tender mercies.

She was actually profoundly hypotensive (nitro and inferior MI's are often an unhappy combination).  But that perked up with a bit of fluids.  Although she was young, early fifties, she had some bad genetics working against her, with a strong family history and wicked high triglycerides.  She didn't like the cardiologist on call (with reason, I must admit) and so we called one of her partners in her multispecialty group who came right down.  She was whisked off to the cath lab where her RCA was stented (door to balloon 45 minutes, thankyouverymuch) and as far as I know has made an uneventful recovery.

No great teaching point here, other than perhaps that women have different symptoms of heart disease than the classic ones.  I just thought it was striking that this was the first and probably only time in my career I have seen someone self-diagnose their MI with an ECG prior to coming in!

8 comments:

l33t MD* said...

Very cool. :-o

onesillyme said...

I'm just a medical social worker, but I'd really love to see the descriptor "classic" symptoms replaced with "typical male" symptoms. Needing to stop to remember that women and men may present differently equals delayed care for females.

rlbates said...

Best wishes to your colleague.

Rogue Medic said...

onesillyme,

I like the idea of using the term Typical Male symptoms. I will try to remember that and to use it.

Was this just an inferior MI, or was it RVI, too. The combination of NTG and RVI is not expected to help her to feel better, at least not without a bunch of fluid running in fast.

I hope she recovers quickly and without complications.

Toni Brayer MD said...

Great post and I wish her the best. Had a similar case at my hospital with one of our OB docs running the EKG on himself, making the diagnosis and getting to ER and Cath lab in time. It's so great when denial is NOT present.

Gene said...
This comment has been removed by the author.
Gene said...

Best wishes for you colleague.

I thought I had it, but your description of the ER/Med Bldg layout finished it for me. My first wife died in the cardiac unit in that hospital and my second worked in the MOB basement for the hospital. And I've made a visit or two to the ER there...

I've eaten a lot of meals in that cafeteria; overall, not bad food most days.

William said...

There's a Dr. Stephen Sinatra who has written books about the fact that women have different heart attack symptoms than men.

He also got me started taking Co10Q, Alphalipoic Acid and Acetyl-L-Carnetine.

But don't arbitrarily dismiss him as a nut because of that second sentence.