Saturday, August 16, 2008

Making a Difference

On a daily basis I see many patients in my practice. Some are obviously sicker than others. I do see seasonal patterns such as more URIs in the winter. It can wear on me at times. Sometimes I come home and talk to my wife about how many times I don't feel like I make much of a difference. Some of the things that make me feel this way include Medicare, the payment issues, having to rush patients through just to pay the overhead, etc. I get discouraged and many times wonder if it is even worth it to practice medicine in today's climate. I love being a doctor but practicing medicine today can be frustrating and discouraging. However, on a recent afternoon in our office, things changed at least for a short time.

I realize there is a lot of debate in the blogosphere about giving patient examples and privacy. However, I am going to give you a case example and let me give a disclaimer that I have seen to it that there is not a privacy violation here.

We recently made a difference in the life of someone. We were finishing up the day when an older middle-aged man came stumbling through the door, clutching his chest, stating that he was having chest pain. Our receptionist yelled for a nurse who brought him immediately to a treatment area. No sooner than he lay down on the gurney, he lost conciousness and stopped breathing. We already had O2 on him. We have a crash cart and we immediately hooked him up to see that he was in ventricular fibrillation.

I could go through this step by step, but to make a long story short, we performed ACLS in the office with multiple cardioversions, a few rounds of epinephrine, Lidocaine, called 911 and got an ambulance there. I intubated the guy there in the office and got him stabilized enough to transport to the hospital. He left in ventricular tachycardia with a pulse and BP.

They got to the ER and the cath team was waiting. He had a dominant RCA and had an extensive thrombus. The cardiologist did a thrombectomy and placed a stent. He spent the night on the ventilator and weaned off the pressors and was then alert. This patient lived to see another day and will have a productive life (with lots of secondary prevention).

What was a routine day in the office turned into quite an adventure. I know that we made a difference in at least one life today. For the record, I didn't do it--WE as a staff did it and this patient would most likely be dead if not for them. This was a great day to practice medicine!

No comments:

Post a Comment