Friday, September 24, 2010

Heart and Head Problems

This post needs a little bit of background that I would normally not give. While I work in a more urban setting now, this took place when I was working in a much more rural area. Its also mid morning.

Dispatch says we are going to the local doctors office. Not the first time I had been there so I knew they meant the building in the center of town, not the hospital on the edge of town with a few doctors offices. Dispatch also says its cardiac related. Could this mean I actually get a code?

Now one thing I still do not understand about this building is that despite the fact that it has doctors offices on the second floor, the elevators will not fit our cot without it having the head raised and the frame dropped at the top end. We wheel into the doctors waiting room and are quickly directed to an exam room with out AED and gear.

I see an older lady in her seventies with a beautiful LifePack12 from the doctors office nearby. But she herself seems to be in only mild distress, not sweating, normal breathing, no visible pain on her face.

Well, guess this means no code, but maybe I can give nitro?

EMT GFP: "So what is going on today?"

Lady: "I came in for my appointment."

Doctor: "She was complaining of chest pain and has a history of heart problems, so we gave her three nitro. She is still in pain so we called 911."

Darn! No nitro today, but the doctors seemed decidedly worried so we got a quick set of vitals and got back into the ambulance as I started asking questions.

EMT GFP: "Have you had a heart attack before?"

Lady: "Yes, last year."

EMT GFP: "Does this feel like the last time you had a heart attack?"

Lady: "Yes."

EMT GFP: "When did the chest pain start?"

Lady: "Last night around 2 AM."

Blink. Blink. You are having chest pain that is identical to your last heart attack and you are just NOW getting to the hospital? Its nearly 10 AM?! Mind you, I did my best not to show my utter confusion and astonishment.

EMT GFP: "So why didn't you call 911 when your chest pain started?"

Lady: "I knew I had a doctors appointment so I just waited for that since I don't live close."

She didn't code on the way to the hospital and I am pretty sure she did not die that day, though I am not sure about her long term outcome. I am still amazed at the denial of her situation or her lack of education on heart attacks. Sure, for you 20-30 minutes might be a "long distance" but in an ambulance that is not far at all when going lights and sirens and we really don't mind being woken up at all hours to help you out. We will take a hit on our sleep if it means you will live to see another day. I hope that maybe this time she well get the education/wake up call that she need to understand 911 is there to help her!

So please people, if you are having cardiac chest pain, whether you have had it before or not, please call 911!

Monday, September 20, 2010

And Fructose 6 Phosphate is converted by PFK 1 to...

I love science, don't get me wrong, but there is something about having to memorize metabolic pathways that I just haven't mastered yet. Ugh. That was a brutal exam. And its sad that I am excited to get back to endocrinology (because endo really doesn't excite me all that much other than I know it fairly well being the ooooh, fourth time I will be doing it now).

However, it has made me realize (yet again) I have some serious study habit issue I need to resolve. This is my last chance into medical school, I had better not waste it. I may be pretty absent for a bit till I get this studying thing down, but I promise the next post will be an EMS one!

Sunday, September 19, 2010

The Masses

I started at this school during the summer in hopes I would get into the program that I am in now. The library was quiet, the campus was fairly depopulated and I only had to worry about lunch when there were camps going.

The classes started.

All the med students came back. I was there taking classes with them. And the library was packed. I thought that many people in one place was nuts.

Then the rest of the campus started classes.

Undergrads started/came back. Grad students appeared. The library became packed (though still the best library ever because it lets you take in food and drink).

I miss the summer not because of summer, but because it was quiet on campus!