Doctors indeed

(From our own correspondent.)

I lived several hundred miles away from my mother and stayed in touch with her by occasional mails and phone calls. At that time I was a certified Advanced Cardiac Life Support instructor and certified as an EMT II.

During these years my mother would keep me informed in regards to her health. At one time she extolled the new health care she had signed into, HMO. In every subsequent communication she would bring me up to date on her getting regular health check ups and the occasional glimpses she would get of her wonderful doctor.

During a four year period following her getting on HMO she had bouts of incoherence. As my brother described, ‘She is getting fuzzy’ which was attributed to her turning 80. At times she became almost incoherent and on one occasion while I was speaking to her on the phone she sounded like she wasn’t all there.

By chance I visited my mother and together we went to a hospital to visit a friend of hers. As we were getting out of the car I noticed a general frailty about her and upon looking more carefully I noted she was slightly cyanotic. Instead of going up into the main hospital I steered her to the emergency room.

I identified myself as a paramedic to the ER staff and that the woman with me appeared to be having a heart problem. I asked that she be put on the 12 lead but the ER staff opted for a 3 lead to initially check things out.

As I stared at the trace on the scope a doctor appeared at my side. We both instantly locked on the P wave being weak or missing and consequently the QRS complex not firing correctly about three quarters of the time. Our mutual diagnosis took all of a few seconds. The doc immediately turned to a nurse to order the 12 lead. He then told me he wanted her to be checked into the hospital over night.

My mother protested as she always did, citing that her doctor had told her ‘Your veins are like garden hoses’. I switched from son to professional mode, informing her that regardless of what she had been told she had a serious condition and we were going to find out what was going on.

The 12 lead instantly confirmed the initial suspicions. The P wave was missing or mostly ineffective and she was getting about 1 out of 4 functional QRS complexes to do the job. As I looked at the read out her regular doctor and a cardiologist came into the room. I confronted the doctor, placing myself between him and my mother to be sure I got his attention.

I held up the print out. “Excuse me, Dr. …, my mother has apparently needed a demand pacemaker for the past four years and during this time she has been under your care and you have failed to diagnose the condition. The less than 10 minutes per year her insurance pays you has apparently taken precedence over the Hippocratic oath.”

The doctor turned on his heel and left the room. The cardiologist ignore the exchange, looked at the 12 lead print out, and asked both my mother and myself if he could schedule her for surgery the following day to implant a pacemaker. I enforced this to my mother informing her she will have the surgery. The cardiologist checked her into the ICU for the night.

24 hours after the surgery my mother was sitting up in bed. Almost her first words to me were ‘I feel like I had been asleep the past four years and just woke up.”

Well, she had. Her brain was receiving just barely enough oxygen to keep from being damaged. However, her condition was classic and any EMT I could have spotted it. The combination of overworked uncaring nurses with too many things to do and an even more uncaring doctor who ran patients through like they were on an assembly line left an obvious life threatening condition that was easily reversible go undiagnosed year after year.

Now, to be fair to the nurses who had seen my mother during that time, her cardiac condition is easy to overlook. Even if the P wave fails and the QRS doesn’t fully trigger, a pulse of sorts will still be felt. If the patient is borderline as my mother was, a quick BP check might only reveal low but acceptable blood pressure. It is entirely up to the doctor to do an assessment of the patient, taking a few moments of time to listen to complaints as well as doing a little detective work and possible preventive intervention. This is not as complex as it sounds. His patient is over 80 and occasionally feels dizzy and light headed. A quick ECG during each regularly scheduled visit is certainly in order, even if overlooking the complaint might be acceptable.

It is easy to blame the HMO, or any other medical insurer for the oversight and lapse, but the doctors are not blameless. They could forego a few thousand dollars a year, still afford the payments on the mansion and fourth car, and still afford the world cruise, though not as often. It is time the entire medical profession does what the lowly first responder, EMT, fire fighter, police officer, and a host of other jobs are required to constantly execute. Self assessment is definitely in order here. Who are they really working for?