Tuesday, May 15, 2012
Most of us can remember why we started this career. And most of the time it was help people, to make a difference in someone's life. We have all learned that making a difference doesn't happen everyday. Occasionally we run that call that we know we have all trained for and that training pays off. I once had the pleasure of meeting a wonderful lady. Our meeting was unfortunate for her. This woman was a nurse of 50 years, still practicing 2-3 nights a week in the local prison. The night of our meeting she was attempting to go to bed when she began having a pressure in her chest. She thought it was just gas from a soda she had earlier in the evening. In just over an hour the pain and pressure increased dramatically, radiating to her neck, shoulder, arm, and back and then she got nauseated and sick. She decided she was just going to try and tough it out until her son-in-law heard her vomiting and checked on her and immediately called 911.
Upon my arrival BLS had just gotten an initially set of vitals. All it took was one look and my gut shouted "not good". Placed a 4 lead on this woman and immediately did not like what I saw and proceeded with a 12 lead. Within 5 min of being on scene I knew this woman, who had very little past medical history, was having a heart attack. My BLS crew helped her onto a stair chair and out of the house and down the stairs to stretcher while I called Medical Command at the local hospital and spoke to a Dr. who had received the 12 lead I sent and agreed this pt needed a cath lab and to proceed to the heart hospital, a mere 30 miles away, but that takes the better part of an hour, even with lights and sirens.
I fell back on my education and got my thoughts in gear. Zofran given IM before we moved pt to prevent any more vomiting, ASA given orally as pt was being moved into stairchair, IV placed on first try as soon as pt was in the ambulance, and then I began the NTG SL sprays and morphine administration. While my pt remained in a lot of discomfort throughout the transport, I did my best to make her as comfortable as possible. The receiving facility knew we were coming and had received 2 EKGs prior to my arrival, one directly form me and another faxed from the local hospital I bypassed. They also received a phone update from me while enroute. I was greeted by 3 doctors, 2 nurses, and an ER Tech all prepared to help my patient.
During the ride I got to know my patient a little better. She told me of her nursing career of 50+ years, and how she enjoys keeping herself busy by working at the prison infirmary 2-3 nights a week. She was concerned about not making it to her next scheduled shift the next night. She also told me she was expecting her first great grandchild, a girl, very soon, that the baby shower was next weekend, and she didn't want to miss it. It wasn't until we were about 3/4 of the way there that she looked me straight in the eye and asked "Is it possible I am having a heart attack?" It was at that moment that I realized 1) I hadn't made it clear to her that she was and 2) I had kept my cool so well that she was unaware of just how serious her condition was. I looked right back in the eye and said "Yes ma'am. You are having a heart attack, but I guarantee I am doing everything I can to help decrease your pain and that I am taking you to the most appropriate place for you to be to fix it."
Normally a patient in this condition would go immediately to the cath lab, but due to another patient already on the table there, the ER team did their best to make my patient as comfortable as possible until they were able to get her in. The patient had to have thanked myself and the ambulance crew a dozen times during the handoff process.
I have the capability to follow up on patients that I take to this particular facility, so the next day I followed up and found she had a 100% blockage in her RCA.
It's patients and calls like this that remind me why I continue to do this job even when we run the frequent flyers, the drug seekers, and all the other calls we consider "BS". This woman will most likely walk out of the hospital and return to her busy life, her nursing job, and that great grandbaby that is coming so soon...