Tonight I saw a woman who was lifeflighted in with an acute inferior myocardial infarction (heart attack). She had been given retavase at the outside hospital, (clot buster) and was now chest pain free. She rolled into the chest pain room directly off the lifeflight gurney and there were about six nurses immediately upon her. I figured that the best doctor behavior would be to go in and assess the patient RIGHT NOW, after all, she is having a heart attack I reminded myself! I quickly got the story, saw that the patient was stable, assessed her pain, looked at the labs and EKG from the OSH (Outside Hospital) and had my disposition. Her initial EKG showed classic ST elevations in leads II, III and aVF. It was almost too easy and too obvious. I didn’t provide any care beyond what she already had received, but it was my job to get her to the most definitive care as soon as possibile after she arrived. Her EKG had normalized, and Q waves were beginning to form. She was pain free and glad to be at our hospital. I telephoned the fellow, presented the case quickly, succinctly and without any interuptions, complaints or grief from the cardiologist. It was both my sickest patient and fastest disposition of the night. I wish I was that decisive with all of my patients.

If I were Hermes, I’d have some great analogy or metaphor to share about this patient’s heart attack, how it represents an internal chaos in my own life, or the plight of medical education in its most perverse manifestation…or perhaps how she is lucky to have this type of treatable disease and not an ill defined psychotic illness, pseudosiezures or an abusive husband. I think I’m suffering from blog envy…a few weeks ago, it was Autopsy Report and this week, it’s been Hermes.

Hmm. I’ll have to work on my skills in imagery…