At the Crossroads

At the Crossroads offers a change of pace from our usual clinical fare. Here we can read about the life endeavors of our patients. It may help us remember that this patient in front of us on the cath table is not #5 for the day in this room with Dr. Whatever, but rather a fellow human being with an interesting story or two to share. Patient histories encompass years that most of us have not seen or been a part of. The experiences our patients have endured throughout their lives sometimes can give us perspective and remind us of the gravity of our position in the cath lab. We’re at their crossroads in life, so to speak. We are there to extend aid in whatever manner we can to help our patients continue their lives. Send your patient stories to At the Crossroads column editor Bruce Coyne, at bnkc99@msn.com. Christmas Time Last year, the week of Christmas or the week before (I'm not sure because things have become a blur with exact dates), it was later in the afternoon and the lab was wrapping up another day. The phone rang and the next thing I knew I was setting up for an acute coming in. I remember looking at the patient for the first time and thinking, "Man, another young one." She was in her early 50’s. I remember talking to her while I was draping her out, telling her that she was young and she should be fine. The physician arrived and we shot the coronaries. There was a moderate lesion right at the circumflex and 1st OM bifurcation. I remember she had an unusual takeoff off the left main to circumflex and it took several tries to get the interventional wire down the right vessel. After we get the wire started down, I injected a bit of contrast to see the vessel. I put another small amount down and asked the cardiologist if he was down the proper lumen. He looks at me: "I think so." He pulls the wire back and attempts to redirect. Another small injection of Isovue and I look at the MD and mumble, I think you’re subintimal. The patient began to complain of some chest pain. The doctor looks at me and says, I think you’re right and I can’t get into the true lumen. The vessel has a large dissection but appears stable. While we were getting ready to take her to surgery she said that she couldn’t die. Her daughter was a senior in high school and she wanted to watch her graduate and have kids. We did our best to reassure her that everything would be fine. We called the ICU the next day to check on her. She was on a balloon pump and not doing well. There is some bleeding. Later that day the surgeon took her back to surgery and did not find anything to cause the bleeding, but for some reason, before they close her up all of her grafts clotted off. After redoing her CABG. She was back in ICU and still on a balloon pump. We checked on her daily to see how she is doing. They had two RNs assigned to her. We asked how her family was doing. They said they were taking it hard. On Christmas Eve, I went down to check on her. The prognosis was not good. A lot of things are going on: HIT (heparin-induced thrombocytopenia), she was starting to go into renal failure, and she was still on a ventilator. I remember telling the ICU nurses, I know you have no control of the situation, but try to keep her alive till after Christmas. The RNs looked at me kind of crazy, but I said, do it for her daughter, so that she can enjoy Christmas for what it is and not as the time her mother passed away. The ICU did everything they could, but later on Christmas Eve, the patient passed away. I remember, as I was transporting another patient back to recovery, seeing her 17-year-old daughter in the hall crying and saying, Mom is supposed to be here. She's supposed to teach me how to cook our family Christmas dinner this year. By the time I finished report and hurried back into the hall the family had left and I could not find them. I remember it was one of the few times I got emotional over a patient and their family. That is one of the few patients I will never forget.

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