Friday, March 16, 2007

Snowy Friday and its Denouement

He called on this snowy afternoon to tell me that he didn't feel well. With a history of cardiomyopathy, hypertension, atrial fibrillation, and atrial flutter, I knew "not feeling well" could mean many things. Bearing in mind that this patient had been sent to the ER by his doc directly from the clinic 12 days ago, I also recalled that he left the hospital AMA before a full cardiological workup could be completed. What to do? I suggested calling 911 and was met with a stony silence on the other end. Against my better judgment, I offered a home visit in 30 minutes.

"But that's so far away. What if I die before you get here?" he asked.

"If you think you may die in the next 30 minutes, you'd better call 911 right now!" I responded.

"No. I'll wait." He hung up.

The roads were almost unbearably icy, the snow blowing hard. With schools letting out early and my office closing up shop on this ugly Friday at 3pm, I was heading out on an urgent visit armed with a blood pressure cuff, a stethoscope, and a whole lot of nothing.

He was sitting on the couch looking like death warmed over. Blood pressure: 90/50. Apical heart-rate: 44/minute. Respirations: 24/minute. Skin: pale, dry and warm. Symptoms: chest pain, shortness of breath, headache, dizziness. His ten birds, locked in cages, squawked relentlessly. I turned off the TV to decrease the extraneous noise. I was beginning to regret agreeing to a urgent home visit. Why didn't I just call 911 from the warmth of the office? Super Nurse strikes again.

"Did you take your meds today?"

"Yes. But I was out of my Lisinopril. My cousin was here. She has high blood pressure too. I told her I was out of one of my blood pressure meds. She said we should split her pill. She broke it in half and we each took a half a pill. She said it was for blood pressure, anyway." His face crumpled with exhaustion.

"What pill was it that you took?" I asked calmly, running his other meds through my mind quickly. I prayed for patience.

"I dunno. Some pill. It was white. Ooooh, my chest hurts now."

"Can we call your cousin to find out what she takes?" I ask hopefully.

"I don't know her number."

I dialed 911. The paramedics arrived in 15 minutes. The portable ECG looked initially OK. The patient: ghastly, ashen, short of breath, moaning.

"Thanks for coming out, guys." The paramedics wheeled him out into the blustery late afternoon.

I scrape the ice and snow from my car. The traffic is crawling. The usual five minute ride to the office takes about fifteen minutes. My desk is piled with unfinished notes, charts, the detritus of a day wherein time to sit and organize is a lost cause abandoned at about 10am. Several colleagues still struggle to finish the day and head home before the roads get any worse. Reports of accidents are coming in on the local radio station. Mary's at the Senior Center waiting for me to pick her up.

I stuff the papers in my bag, close the computer and head out the door. I know what part of my Friday night will consist of: finishing paperwork, making notes for Monday's to-do list, and then blogging about the day as a way to exorcise the stress, and watching the snow drifts grow outside the window.

Monday seems so far away right now. Let's keep it that way, shall we?
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