The Patient’s Dilemma

Or:

One of the Ten Best Places to Have a Heart Attack

Lisa Hoffman and Charles Atkins

Published 3/17/2005

Charlie writes:

Lately, I’ve been getting an earful from friends and family who have had horrible healthcare experiences. And as I think about it, where Lisa and I have written a lot about her medical odyssey last year, we’ve also held back; some bad things happened—not necessarily malpractice, but countless occurrences that were both dehumanizing and dignity robbing. It’s hard stuff to write about, and so with your indulgence, we’d like to tell a story.

Once upon a time in the mythical town of Southburbia…

Ms. Lisa Jones, a pert octogenarian, was feeling a bit out of sorts, a sharp pain in her belly, a bit of fever. "Something is not right," she fretted, and proceeded to call her doctor.

"Hello?" a friendly voice answered.

"Oh hello," she replied, before realizing the voice was recorded.

"You have reached the offices of Doctors Poke and Croak. If you are a physician calling to make a referral, press one. If you are a patient needing a medication renewal or appointment press two. If you are an insurance representative needing authorization press three. If you are calling with a billing issue press four. If you are a patient calling to speak with the nurse press five. For all other concerns, or urgent matters, please hold and our next available representative will be right with you."

As Lisa listened, the pain grew. She knew something was wrong, and hoped Dr. Theodore Croak—Teddy to his friends--her Ivy League trained gastroenterologist, could set things right. So with hope in her heart, and a stabbing pain in her gut, she listened to Vivaldi that came through the phone. Two minutes later the friendly recording informed her, "Thank you for holding. Your call is very important to us. Unfortunately, all of our representatives are still busy. Please hold."

Struggling with the pain, she gripped the kitchen counter and tried not to dwell on past episodes—her colitis, her palpitations and the time her arthritis medication made a hole in her stomach and nearly killed her. Trying to calm herself, she listened to the Mozart that came after the Vivaldi, but before the Beethoven. Fifteen minutes later, the voice announced, "Thank you for holding. Someone will be right with you."

Lisa’s spirits lifted as the line clicked, she heard breathing on the other end. "Hello?" she said eagerly, finding that the pain worsened when she spoke. "Hello?"

Another click and the line went dead.

Oh, no, she thought. And realizing she couldn’t wait, she dialed 911.

"Hello," a voice answered. But before Lisa could reply, a recording began to give instructions, "If you think you’re having a heart attack, press one. If you think it’s a stroke, press…"

Barely able to stand she hung up and dialed her neighbor, Mildred, who was there in a flash and trundled Lisa off to the emergency room.

Finally, she thought as she hobbled through the electric doors, and across the crowded waiting area, toward the triage desk.

"Why, hello," a clerk said, handing her a clipboard with an eighteen-page form. "Just fill this out and someone will be right with you."

"I’m in a lot of pain," Lisa explained, as the room began to sway.

"Chest pain?" the clerk asked, having been trained to screen for potential heart-attack victims.

"No, it’s in my belly."

"Too bad…if it were chest pain we could get you right in. We’re one of the top ten hospitals in America for heart attacks," she proudly announced, while pointing to a framed certificate that verified this very fact.

"Oh," Lisa said, "taking the clipboard, but as she looked to find an empty chair, a rush of dizziness overtook her, she became lightheaded, and fainted to the floor.

"Oh, dear," the clerk said, as she pressed the panic button on her phone, "code red, waiting area. Code red."

And in a matter of moments, Lisa was scooped onto a gurney and wheeled to a curtained cubicle.

A band of nurses and doctors swarmed around her, "heart attack?" a nurse asked, the emergency room physician.

"Let’s see what the EKG shows," he instructed as they cut through Lisa’s clothes with trauma sheers and proceeded to slap on leads and wires.

As a freckle-faced medical student attempted to start his very first intravenous, by jabbing Lisa’s arms repeatedly with a 23 gauge needle, she awoke.

"Ow! What’s happening? What are you doing?" Lisa complained.

"Oh, good, she’s awake!" A second clerk, who’d been standing with her computer tablet at the ready, fired off questions, as the doctors and nurses, worked feverishly against time knowing that every second counted in a heart attack. Tubes of blood were sent STAT to the lab, the medical student, having been unable to find a usable vein on her right arm had shifted to her left, continuing to wield the intravenous needle like a miniature harpoon.

"But it’s my belly," Lisa shouted, as a second and then third Electrocardiogram were obtained.

"Can’t be too careful," an intense-young resident physician replied, as he stared at the monitor over her bed. "Often, belly pain in women is a warning sign of heart attack."

"Don’t worry, dear," the clerk said, as she fished through Lisa’s purse for her insurance cards. "It’ll be all right," and she took Lisa’s wrist and clamped on her hospital bracelet.

Too tired to fight, and thinking the pain in her arms from the endless jabbing was now worse than her belly pain, Lisa stared at the plastic band. "My name’s not on here. It should say Lisa Jones. It just says cubicle 3A."

"That’s right," the clerk explained. "As part of our efforts to cut down on medical mistakes, we’ve switched to a system of Unique Patient Identifiers--UPIs. Names are horribly inexact, because on any given day we could have dozens of Lisa Joneses. From now on, we’ll refer to you as the lady in 3A, that way there can be no mistakes."

"Oh…when will someone look at my belly?"

"I’m sure they’ll get right to that. But if it is a heart attack" the clerk said hopefully, "we’re one of the top-ten hospitals in America for heart attacks," and satisfied that all of the necessary data had been entered, she flashed Lisa a dazzling smile, "remember, you’re the lady in 3A" and away she went.

As she left, a distinguished silver-haired attending physician entered the room. "What have we got?" he asked, his voice rich with experience and authority.

Lisa started to speak, "I have a horrible pain in my belly, and…"

He glanced at her, and then turned to his resident, "what’s the story, Jim?"

"Well," the resident replied, always a bit anxious under the knowing eye of his superior. "The EKGs are fine and her first enzymes came back normal."

"Very good," the attending said, as he stared at the monitor over her bed. "But she is eighty…I’d say give her a dose of Clot-Be-Gone [referring to the Drano-like wonder drug used to dissolve plaques in the coronary arteries] and send her up to telemetry until all the tests are back."

"My belly," Lisa said, knowing from watching a decade of ER that telemetry meant cardiac care. "It’s not my heart; I don’t have any chest pain. It’s my belly." Although…now that she thought about it, her belly was feeling considerably better, maybe it had just been a case of very bad indigestion.

The attending looked down at Lisa, who’d now been partially covered in a blue-paper gown. "I think we should leave the diagnosing to doctors, don’t you?"

"But…but."

He patted her hand, "you’re going to be fine. This is one of the top-ten hospitals for heart attacks in America." He turned to his resident, "Good work, Jim," and then looking down at the medical student, who still had not started the intravenous line, he winced. "Maybe we should get a nurse to do that," and off he went.

Within an hour, Lisa was wheeled up to the Cardiac step-down unit. Her bracelet was cut off and replaced with a fresh one, "you’re now the lady in 14B," she was instructed by her nurse, as she was presented with a glossy packet entitled, What to do After your Heart Attack.

"But I didn’t have a heart attack," she tried to explain.

"Did you know that denial is the number one sign of a heart attack?" her nurse replied, as the automatic blood pressure cuff squeezed down hard where the medical student had jabbed her.

But by now Lisa was exhausted, and more importantly, her belly felt much better. As they wheeled in her delicious-smelling supper, which unfortunately was left just out of arm’s reach, she realized that it was probably the combination of leftover Moo shu pork followed by a scrumptious box of Jordan Almonds that had triggered the attack.

She kept this realization to herself, as she passed a sleepless night listening to the beeps and dings of the medical equipment. So in the morning, when a small herd of doctors and trainees trampled through her room, she didn’t want to contradict as the resident in charge of her case reported, "This is the lady in 14B, she suffered a silent heart attack, but she got Clot-be-Gone within thirty minutes, and there’s no evidence of any damage. We’ll discharge her this morning."

And as they wheeled their rack of charts toward the man in 15A, she heard one of them remark, "Boy, did she luck out. Good thing for her this is one of top-ten hospitals for heart attack."