I am writing to share an emotionally stressful week at work. It illustrates the challenges doctors face when treating ill patients. The article will also provide tips for people to look after their “Heart Health”.
I came back after a blissful one month holiday with my son Arun in Brisbane and it appeared that the Gods were angry that I had taken so much time off work. They seemed to punish me by unleashing several acute illnesses in some of my patients. During my first day at work I met ‘A’ (all names withheld to maintain privacy and confidentiality). 20+ years ago at the age of 33 he presented to me with his first heart attack – rather young for a heart attack but his genetics were not good and it explained why he had suffered an illness, usually faced by people in their 50s or older (‘A’ serves as an example of why individuals with close relatives who have heart disease should undergo medical check-ups early, as heart disease can be hereditary, putting them at increased risk of developing the illness at a young age). We gave him medications and implanted a stent (a small hollow metal tube placed in a heart artery to open a blockage) and he stabilized. Then every 2 years for the next 4 years he would present with chest pain involving a different heart artery (most of us have 3 main arteries supplying blood to our heart) – he needed a new stent each time. He then remained well for close to 16 years. He had finally found his soul mate and the wedding was due to take place in 2 weeks. Preparations were in full swing for the wedding. Relatives and friends were preparing to fly in from all over the world when ‘A’ started experiencing chest pains again whenever he walked (chest pain during exertion which resolves with rest is an important clue to the development of blockages in heart arteries). His disease which had lain quiescent for more than 15 years was rearing its ugly head again. Preliminary tests revealed severe heart artery blockage, needing urgent treatment. All wedding plans were put on hold. I advised early coronary angiography – a study where dye is injected directly into heart arteries to evaluate for blockages. ‘A’ and his relatives were understandably under a lot of emotional stress. I too was under a lot of stress. After having been my patient for more than 20 years he was not just a patient but had become a friend. If anything was to go wrong during the procedure (there is a small risk including death during coronary angiography) the happy day that he was planning would turn tragic. Angiography revealed a severe narrowing of his main artery. Left untreated this lesion could result in sudden death. In years past, this would mean emergency bypass surgery (CABG). However CABG would mean that the wedding would have to be put off as A would not be physically fit in the 2 weeks we had for the big day. However with advancements and modern day technology, balloon angioplasty (PTCA – a procedure where tiny balloons are treaded into heart arteries to open up blockages) has been proven to be equally effective to treat A’s disease. The procedure would be risky but if successful would mean that A would be fit to walk down the aisle in 2 weeks. ‘A’ chose PTCA. I was very anxious especially as an elderly lady who refused to undergo CABG for a similar blockage many years ago had died of complications when we did PTCA on her. I requested my colleague, Dr Nazrul to assist me during the procedure and his presence in the cath. lab.(a special sterile hospital room where angiograms are done) increased my confidence. The procedure was a success, and I quietly offered a prayer of thanks once it was over. Throughout it all, ‘A’ remained calm and composed, though I reminded him that the real test would be when he began walking without experiencing chest pain. He was discharged the next day and returned for his follow-up appointment three days later. When he walked into my clinic, his face lit up with a radiant smile. He shared that since leaving the hospital, every step he took had been accompanied by a lingering fear that the pain might return. But with each pain-free stride, his confidence grew. I was equally relieved. Then, ‘A’ asked hesitantly, “May I give you a hug?” I nodded, and as he wrapped his arms around my shoulders (he is about twice my size), he broke down and cried. The weight of his ordeal was overwhelming—had he not recovered, his dream wedding would have to been postponed, and many people would have been disappointed. I reassured him, urging him to leave the past behind and focus on the joyful future ahead with his bride-to-be.
I was recovering from the emotional ordeal of having to treat A when my colleague requested that I help manage a relatively young man with blocked heart arteries as well as kidney failure. He was well when first seen, but early that morning when I walked into his room, he complained of sudden chest pain. An urgent ECG (assessment of the pattern of electrical activity of his heart) revealed a heart attack (one of his heart arteries had suddenly blocked). I started arranging for an emergency angiogram and angioplasty. Very rapidly he started going into heart failure and fluid was flooding his lungs (pulmonary oedema). He became very breathless. I called my anesthetic colleague to come help. Together we took him to the cath. lab. He was so breathless that the anesthetist had to place a tube into his lungs to facilitate the passage of oxygen and help him breathe (Intubation and ventilation). Angiograms revealed a blocked artery and angioplasty was performed. After the procedure he was transferred to our coronary care unit (ccu : a special ward in hospitals where critically ill heart patients are monitored closely) for monitoring. As soon as he was laid on the ccu bed his heart stopped because it gone into ventricular tachycardia (an abnormal rhythm of the heart which can cause it to stop contracting). CPR (cardiopulmonary resuscitation) was immediately done successfully. Examination of his blood revealed severe acidosis (high acid levels in the blood, a common cause of which is kidney failure). Dialysis was started to support his kidneys. He progressively improved and woke up the next morning. He then gradually got better and was discharged home after about a week. He will need lifelong dialysis. Patient with kidney disease have a higher risk of developing blockages in the heart arteries.
I thought I had paid my dues after settling the two cases above and that God would give me a break but it was not to be. There is a superstitious belief among some health care workers, that everything has to occur in 3s. Four days later, after I had returned from my early morning walk, the emergency room called to inform me that a patient who had missed his follow-up appointment had presented with sudden chest pain. His ECG confirmed a heart attack—a compelling example of why patients on heart medications should never stop their treatment without consulting their doctor.I rushed to the hospital and after examining him arranged for emergency angiograms and angioplasty. Angiograms revealed 100% occlusion of the right heart artery. The procedure was complicated by the need to treat low blood pressure. Finally everything stabilized and the moment the stent was implanted, blood flowed down the artery and the patient’s chest pain immediately subsided. After being observed in hospital for another 4 days he was discharged home, with strict advice never to stop his medications.
It was an emotionally draining week, but after over 45 years in medical practice, this roller coaster of emotions has become familiar. I choose to focus on the positives: all three patients have recovered well, and for that, I am deeply grateful to God for His guidance and blessings.
The take home messages from the case histories shared above, is for all is to practice a healthy lifestyle, eat in moderation, exercise regularly, keep away from smoking and especially after you cross the age of 40, to go for annual medical exams to detect and treat illnesses like diabetes early. In spite of all that we have advised and written patients still express surprise that diseases like diabetes and high blood pressure left untreated will cause heart disease. And as illustrated by the 3rd case above, it is very important that those on medications, should never stop their treatment without the advice of their doctors.
Dr. Kannan Pasam is a content creator under the Newswav Creator programme, where you get to express yourself, be a citizen journalist, and at the same time monetize your content & reach millions of users on Newswav. Log in to creator.newswav.com and become a Newswav Creator now!
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