Part I about why this medical condition is so deadly can be found here.
Welcome back, David!
“I
need to make you aware of a situation.” The Intensive Care Unit Director, Dr.
Thomas Winfield, said as he entered my office. “We have an American contractor
in the ICU who is having a large anterior wall MI.”
I
heard the words “widow maker” in the back of my mind because those were the
words used when I learned an anterior wall myocardial infarction was the worst
kind to have. “What’s his name?”
“Richard
Hall. He showed up at the clinic and collapsed. The ambulance got him to the ER
and they started coding him there. We don’t know how long he was down, but
we’ve coded him four times since he’s been in the ICU.”
It
was here that the ICU director and I were thinking the same thoughts. Will he
be a vegetable when he wakes up? If, he wakes up. We could save the heart, but
lose the mind.
“Have
you called about a special mission?”
He
anticipated my question and before I finished it, he said. “They can’t make it
until after midnight.”
I
shook my head. In the Iraqi desert, all we could do was give him medicine to
bust the clot up and wait for transportation to fly him to Germany, but in the
states we would send this man to the Cardiac Cath Lab where he would get a
state-of-the-art stent.
“I
don’t think he’ll make it twelve hours and if he does ….”
I
nodded. “It’s too early to call it.”
“We’ll
keep coding him.”
Dr.
Winfield and I returned to the ICU and saw Dr. Baur running through the
advanced cardiac life support (ACLS) algorithms. The team was tense, but
composed. When the patient recovered, Dr. Bauer put her card in her pocket.
“Great job everybody.” She gave us a weary look as we approached her.
“What
was he in?” Winfield asked.
“V
tach.” Ventricular Tachycardia is when the bottom two chambers of the heart
start going faster than usual and if prolonged is incompatible with life.
“How
many times have you coded him?” I asked.
“I’m
losing count. He seems to be coding about every twenty minutes.”
“Have
you talked with his friends? Does he have family?”
Dr.
Bauer looked to Dr. Winfield, who said, “I’ve told his coworkers he’s probably
not going to make it. They told me he has a brother who they’re trying to
reach.”
“Dr.
Bauer,” a strained voice from the patient’s bed called out. “He’s coding
again.”
The
ACLS dance began again. I turned to the group waiting outside the ICU. I needed
to have a discussion with them myself. As I approached, the expressions on
their faces said everything. He was more than a co-worker; he was a brother. Thousands
of miles from home, tons of sand and the threats of a combat zone will do that.
“I’m
Dr. Carnahan. Who’s Mr. Hall’s supervisor?”
“I
am,” said a stocky man with a mustache and goatee. He extended his right hand.
“Tim Williams.”
“Mr.
Williams,” I said as I lowered my voice to a respectful hush, “it doesn’t look
good.” He nodded as did the others crowding around him. “We’ve coded him about
five or six times in the short time we’ve had him.”
“Doc,
we appreciate everything you’re doing.”
I
met his eyes. “I just want you to know that the next plane to Germany probably
won’t be able to get here for another twelve hours.” They looked at me, trying
to find the meaning in this kernel of information. “I don’t think he'll make it
that long.”
Then, their
expressions dropped.
Stay tuned... the remainder will post Friday.
*******************************************************************************
Dr. David Carnahan is a Board Certified Internist,
who fell in love with writing while getting his Masters Degree in Epidemiology
at the University of Pennsylvania. He has served in the Air Force for the past
14 years as an academic clinician/educator and now works in the area of
Healthcare Informatics. He has a wonderful wife and two beautiful daughters,
and invites you to read about his life (www.dhcarnahan.blogspot.com),
and weekly installments of his current work in progress, The Perfect Flaw (www.theperfectflaw.com).
Stay tuned... the remainder will post Friday.
*******************************************************************************
Dr. David Carnahan is a Board Certified Internist,
who fell in love with writing while getting his Masters Degree in Epidemiology
at the University of Pennsylvania. He has served in the Air Force for the past
14 years as an academic clinician/educator and now works in the area of
Healthcare Informatics. He has a wonderful wife and two beautiful daughters,
and invites you to read about his life (www.dhcarnahan.blogspot.com),
and weekly installments of his current work in progress, The Perfect Flaw (www.theperfectflaw.com).
Hi, everyone! I can't resist connecting the dots between the post on Monday and this one. You may have noticed the reference to an Anterior Wall Myocardial Infarction (AWMI) and its association to the widow maker. The reason for this is that doctors tend to talk about MIs in anatomical terms. The anatomy of the heart is described in terms of how and where the heart sits in the chest. The part of the heart that sits Anterior (or in front of the chest cavity) is really the same area of the heart as the left ventricle. Another type of MI is the Inferior Wall Myocardial Infarction and you might hear a doctor say, "If God said you had to have a heart attack, this is the one to have." Can you guess which coronary artery is blocked in most cases for an Inferior Wall MI? -- the right coronary artery. The reason the AWMI is usually what we see in a widow maker is because the LAD supplies the blood flow to that part of the heart. So, the description of the type of MI is based on the part of the heart that is affected, but the cause of the MI is really about the blockage of blood flow (based on the arteries we discussed last time) to those areas. Hopefully, this helped clear things up, rather than muddy the waters.
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