Doctor’s Theater 1

Otherwise, it was a rainy night with the monsoon at its peak, only an hour after I had fallen asleep. My phone rang. It was an unknown number. “Hello beta, my son has severe chest pain, and an electrocardiogram done in a nearby hospital shows a heart attack,” a jittery voice spoke from the other side of the phone.

It was my patient, Mrs. Sharda, whom I had treated for a heart attack with coronary angioplasty a year ago. She continued with the same restless voice, “The doctor here is saying he has low blood pressure and his condition is very critical, so they have asked us to shift him to you.” “I know very well that my son will come out unscathed under your care.” Midnight emergencies are routine in the life of an Interventional Cardiologist. I frequently get patients with massive heart attacks and low blood pressure. (It is called cariogenic shock in medical terminology.) However, this time I was a bit nervous. Maybe it was the burden of expectations or the blind trust of that lady. As per protocol, I activated our emergency angioplasty care team, and within nine minutes of receiving the call, I was behind the wheel of my car. Thanks to the “commando training,” I have been inducted into my alma mater. I have been trained to be ready to act within minutes of an emergency. By the time I reached my hospital, the patient had already reached the emergency room. 

Mr. Ramesh was a 36-year-old IT professional. I had interacted with him multiple times when he came for his mother’s treatment. Drenched in sweat and rocking in bed with excruciating pain, this time he looked extremely pale. As soon as he saw me, he held my hand and started crying, “Please save me.” I have two kids and elderly parents. I’m the only breadwinner in my family. I know the divine powers you are blessed with, and I trust you. “If you save me, you will save six lives.” I tried to calm him down as I started examining him. His pulse was thready and running fast (which means his blood pressure was very low and his heart wasn’t performing adequately). His ECG showed a massive heart attack, which if not dealt with immediately would lead to sure mortality. I would like to confess one thing here: however experienced and seasoned a doctor you may be, such clinical scenarios cause a great deal of anxiety and stress. A young man in a life-threatening situation will make even the toughest cardiologists’ hearts pound hard with restlessness. However, the commando training works here as well. Even when the land beneath our feet is sinking in flood waters, we doctors are taught to be rock solid. 

A heart attack occurs when an artery supplying blood to the heart muscles becomes clogged, and the clog must be opened as soon as possible to save the heart muscles from irreversible damage. As per protocol, I walked to my cabin to talk to his family and explain the clinical status, criticality, further treatment plan, and risks incurred. I had tears in my eyes when I saw Ramesh’s anxious wife and their 5-year-old daughter, who was trying to be courageous and overly mature for her age, walking in my cabin. Before I could even discuss the treatment options, his wife confidently said, “Sir, I have complete faith in you and your treatment, and I know you’ll save my husband.” Please go ahead with whatever treatment you feel is right for him. “I was just praying that my husband should survive till he reaches you, and now that he has reached here, I know he is safe.” Such trust, although a compliment to a doctor’s honest services, also puts a lot of pressure on him to perform. 

Mr. Ramesh was immediately shifted to the cath lab, a kind of operation theater where coronary angiography and angioplasty procedures are performed. I’d like to thank the emergency and cath-lab teams for being quick enough to shift him to the lab in less than 40 minutes of his arrival to the emergency ward. As I was changing into my scrubs, I could feel the burden of six lives at stake. I tried to concentrate on the clinical scenario and ignore everything else. I returned to my work quickly and tried to be as efficient as possible. His coronary angiography revealed occlusion of the Widow-Maker Artery (this is the largest artery of the heart, and occlusion of this artery has the highest mortality rates). It was probably 2 a.m., and I was cautiously negotiating my way through the chocked coronary artery. There were multiple challenges: low blood pressure, a restless patient, the most critical artery in the heart, the tortuous course of the artery, and occlusion at the branching segment. I had been very engrossed in the procedure and tried not to get distracted by Ramesh’s restlessness. As coronary angiography and angioplasty procedures are painless, we try not to sedate patients so they are fully conscious.

 After two hours of teamwork, we could successfully open the artery and restore the blood supply. As soon as his artery opened up, his pain significantly reduced, and vital parameters like heart rate and blood pressure improved. I could see the fear of death disappearing from his face, and he looked relaxed. As I removed my gloves and walked to the end of the procedure table, he said, “Sir, thanks for everything.” Can you do me a favor? “I want someone to convey to my mother that I’m fine, or else she’ll get a heart attack.” I took out my phone and dialed his mother’s number. “Hello, beta, thank you for saving my son.” “May God bless you with a long life.” I interrupted her: “Aunty, please talk to Ramesh and calm him down.” I handed the phone to Ramesh. In the next few minutes, I could just see him weeping and sobbing while talking to his mother. 

As he was being shifted to the intensive care unit, I walked out of the cath lab. I could see Ramesh’s wife and daughter helplessly praying in a corner, tears streaming down their cheeks. As soon as they heard my steps, they rushed towards me. I told them that Ramesh had responded well to treatment. Soon, Ramesh was brought out of the cath lab. He had multiple monitors connected to his body and vials hanging from the bed on which he was being transported to the ICU. His family was relieved to see him in such good health. I was on my way back home after making sure everything else was in order. It was 4.30 a.m. by the time I got into my car. I was tired but satisfied that we could save him. 

On my way back, as I was driving through deserted roads, I was just pondering about how emotions can control your conscience. Had I been in the same state of mind if I had not known Ramesh so well? The next two days were uneventful. Being young and otherwise free of any other co-morbidities, Ramesh made a fast recovery and was discharged on day 3. It has been more than a year now, and he is living a productive life. Every time he follows up for a checkup, he just has one question that is still unanswered: “Why did I get the heart attack?” “I don’t smoke or indulge in any addictions; I’m hardworking and strict about my diet and exercise.” Well, I guess only God has the answer to that question. and I’d leave it at that.

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