This heart
This heart is heavy this morning.
I've been on my new rota on A&E for a week. It's night 5 of 7, and these are pretty relentless. That's not to say that I'm not entirely in love with the job; despite all the dross - and I suspect that this blog will become full of stories of the inane - I do like the hustle, the autonomy and the idea that I'm actually fixing something.
I'm looking at a new card in the incoming box. 29 year old asian with chest pain. I'm inclined to think this is going to be a pneumonia, but I look at the ECG anyway. I'm not sure why this is; but for a moment my eye is drawn lazily to the 'nil acute' scrawled across the top. Then to the floird ST elevation in one lead.
I walk over to the patient, who looks tired, but OK, and take a history. It's a pretty classical description of ACS, the central chest pain, the hand splayed over the neck and the shoulder, the nausea, shortness of breath, the dizziness. He's been woken from sleep.
I believe him and do a Troponin, mildly worried.
The trop comes back 12 minutes later, and I rub my eyes incredulously. >2.0 ng/ml. "Massive cardiac damage."
I'm not sure how to tell him he is having a heart attack.
A half hour later, he is already half way through his streptokinase, and I'm warmed that I have contributed to saving his life. But there's a cold shadow to the words scribbled hastily on his ECG in a moment of oversight a good two hours before I ever knew of his existence.
A little part of me feels like Segun; can we ever slip for a moment again? And like my patient, I'm shuddering.
I've been on my new rota on A&E for a week. It's night 5 of 7, and these are pretty relentless. That's not to say that I'm not entirely in love with the job; despite all the dross - and I suspect that this blog will become full of stories of the inane - I do like the hustle, the autonomy and the idea that I'm actually fixing something.
I'm looking at a new card in the incoming box. 29 year old asian with chest pain. I'm inclined to think this is going to be a pneumonia, but I look at the ECG anyway. I'm not sure why this is; but for a moment my eye is drawn lazily to the 'nil acute' scrawled across the top. Then to the floird ST elevation in one lead.
I walk over to the patient, who looks tired, but OK, and take a history. It's a pretty classical description of ACS, the central chest pain, the hand splayed over the neck and the shoulder, the nausea, shortness of breath, the dizziness. He's been woken from sleep.
I believe him and do a Troponin, mildly worried.
The trop comes back 12 minutes later, and I rub my eyes incredulously. >2.0 ng/ml. "Massive cardiac damage."
I'm not sure how to tell him he is having a heart attack.
A half hour later, he is already half way through his streptokinase, and I'm warmed that I have contributed to saving his life. But there's a cold shadow to the words scribbled hastily on his ECG in a moment of oversight a good two hours before I ever knew of his existence.
A little part of me feels like Segun; can we ever slip for a moment again? And like my patient, I'm shuddering.
posted by Bas at 11:17 PM
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