It was several hours into our night shift when I noticed a particular room was repeatedly using the call light. It wasn't my assigned room, so I asked the assigned medic and nurse what was going on. I'll call the medic Gertrude. The RN stated she was too busy and hadn't been in to see the patient. Gertrude rolled her eyes and said the patient thought he was having a heart attack, but that he was just fine. I offered to answer the call light and went in to assess the patient.
The patient was a retired service-member. If my memory serves me correctly, we were told there were about 80,000 retirees in the Colorado Springs area. In addition to our active-duty personnel and their families, we also cared for retirees and their spouses at our hospital. This patient fit the profile of many statistical risk factors for heart attack including age, race, and fitness level.
This patient was African-American (a risk category), in his 60s (the older a person is, the more risk of heart attack), and he was not in great physical condition. In fact he had the body shape known as an 'apple'. This body shape is one in which a person gains extra weight in the middle. I asked the gentlemen what he was calling for. He advised me that he thought he was having a heart attack. I asked him what it felt like and he began to describe a heart attack: tightness, pressure, shortness of breath, weight on his chest, etc. I could see he seemed a little short of breath. He was also a little sweaty. Either this guy had read the book on heart-attack descriptions or he knew what he was talking about. I asked if he had ever had a heart attack before and he told me he had. I asked him how it felt and he told me it felt 'just like this'. I reassured the man that I would make sure he was taken care of and then placed a non-rebreather mask on him and turned the oxygen up to 15 liters per minute.
A non-rebreather mask has a bag attached which acts as a reservoir to store oxygen until a person inhales, and it then gives them near 100% oxygen. I knew that if he was having a heart attack some extra oxygen would buy a little time and maybe a little heart muscle. In any case it wouldn't hurt him to have some extra oxygen for the time being. I went out to the desk and reported my findings.
I told Gertrude and the RN that I thought this guy was having a heart attack and that he had one in the past and that it felt like this one does. While the nurse called the doctor, Gertrude and I obtained a 12-lead EKG and a set of vitals on the patient. In short order a doctor arrived, blood labs were drawn and the patient was transferred to our Special Care Unit, or ICU. That was the closest thing we had to and ICU, and it would have to do for now.
Cardiac medications were run through the IV line as they tried to get the patient stable enough for transport to a larger hospital. The doctor didn't feel like the patient would survive the trip in his current state. The doctor stayed the night in the SCU, watching over the patient. After a long night, the patient was finally transferred at around 6am.
I know he survived the transport and I'm pretty sure we would have heard if he died during that hospital admission. So I really think the guy made it. I don't know if he required heart surgery or got a pacemaker or anything else about him. Sadly we don't often know how a patient fairs down the road. No matter what department we are in, in a hospital we usually just see a patient long enough to get them well enough to be discharged from our care. It's pretty rare that we see these patient's again unless they are sick again and are admitted for more medical care.
That night I learned that there are many types of patients and hospital workers. Their personalities do not always match up in an ideal way. As providers of medical care it is our responsibility to listen to our patient's concerns and act on them, the patient knows their body better than the rest of us. Only the patient can really describe pain or discomfort, and only the patient knows for sure when it feels better.