Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Never forget to advocate for your patient

Anesthesioboist T., MD
Patient
November 24, 2010
118 Shares
Share
Tweet
Share

There are some lessons we learn and keep re-learning in medicine. For me some of these recurring lessons are,

  • Listen to your “gut.”
  • Pay attention to the clues.
  • Listen to your team.
  • Don’t be afraid to call for help.

and

  • Stick to your guns when advocating for your patient.

I encountered a young patient recently, just at the cusp of adolescence and adulthood, who had undergone a procedure related to a sports injury. Other people had been responsible for his care during surgery; I was coming on duty for the night and was part of the team watching over him in the recovery room.

Someone came to me and said, “His T-waves are flipped on the monitor. Do you want to do anything?”

T-waves are a particular portion of the tracing generated on a heart monitor or EKG by the electrical activity of the heart. Normally they look like a small hump. Sometimes the hump is inverted and the wave resembles more of a “u.” This is often a concerning sign with many possible causes, but in children and adolescents in can be normal in certain areas of the EKG.

I went to the patient’s bedside. He was resting comfortably and his vital signs were good. But I had a nagging feeling inside.

Listen to your gut.

“Let’s do a 12-lead,” I said to the recovery room nurse.

A 12-lead is short-hand for a complete EKG. It’s unusual for one to be done on someone this age – who looks for heart problems in healthy, athletic kids? – but I wanted to see for myself what the complete picture looked like.

I took a stethoscope and listened to the patient’s chest. His lungs were clear but he had a loud murmur. I looked on the preop evaluation. The physical exam was noted as normal. He hadn’t had any medical issues at all according to his history. He wasn’t aware of being told of a murmur before.

Pay attention to the clues.

While the EKG was being done I called a hospitalist and a cardiologist for consultation. My kid started feeling nauseated and threw up a little. The cardiologist wasn’t able to call me back because of a snafu with the phone system. The hospitalist was tied up right at that moment but agreed to see my patient shortly. The ICU folks next door were tied up too.

Meanwhile my young patient, whom I shall call Joey, was getting increasingly pale and lethargic. His vitals were still strong, and he complained of no chest pain or tightness. But when the EKG printed out this is what it showed:

I thought this was a significantly concerning EKG. I ordered cardiac enzymes to be drawn and sent to the lab. I tried to page the cardiologist again but was still unable to reach him. I really wanted an echocardiogram to see what that heart muscle was doing and suspected it was abnormally thick. I wanted to give Joey drugs that are normally considered “cardioprotective” but I also wanted to keep his blood pressure up to preserve his heart’s blood supply. Meanwhile, he was beginning to look sicker and sicker.

“Dr. T, everyone you’ve called hasn’t really responded so far,” the recovery room nurse said to me. “He looks a lot worse than he did when we first started. Why not call a rapid response team to the bedside?”

Listen to your team. Don’t be afraid to call for help.

“Sure,” I said. The nurse called the emergency team to the recovery room. I heard the overhead page summoning my reinforcements. Part of me felt like an idiot, and the other part really wanted some input on what to do with this non-child, non-adult with a grossly abnormal EKG but no chest pain and no prior history or abnormality. If there was something wrong with his heart, which I strongly suspected, he needed to have an echocardiogram right away and perhaps some more invasive procedure, preferably at a more advanced center where things could get done faster and there were lots of pairs of hands at the ready.

The hospitalist arrived in a matter of seconds along with the critical care doc, IV access team, respiratory therapist, and a couple of other responders. I showed her the EKG. She was somehow able to get in touch with the cardiologist directly and handed me the phone. I explained the situation.

The cardiologist said, in a tone which I can politely describe as skeptical, “Do you REALLY think this young KID is having a HEART attack?”

Stick to your guns when advocating for your patient.

“I really think, having been with him for the last half hour, that he is having some kind of serious cardiac issue. Something is wrong. His clinical picture is deteriorating before my eyes. I need some input on the next step.”

“You said he had some ST elevations on the EKG? In which leads?”

I started to explain the grand mess that was the EKG, but then the hospitalist took the phone back. “Do you want me to fax it to you so you can see it?”

We faxed the EKG to the cardiologist. He called us back and had us send Joey to the nearest tertiary care center.

Joey’s going to be fine. He has a condition that sometimes predisposes to sudden death – the kind that makes athletes drop dead on the field or on the court – but he can get help for it and do reasonably well. It’s funny – I know just how to handle his condition on the O.R. table, under anesthesia, but the acute diagnostic management definitely pushed me out of my comfort zone.

Throughout this entire incident my beeper was going off non-stop for other things – OB wanted an epidural, there was an O.R. case to start that I had to postpone, I needed to speak to Joey’s parents who were completely blind-sided by it all. But we ultimately kept our focus on Joey and were able to get him the help he needed. I learned so much from his recovery room course – things I had learned before, but which are always good to learn again.

  • Listen to your “gut.”
  • Pay attention to the clues.
  • Listen to your team.
  • Don’t be afraid to call for help.
and
  • Stick to your guns when advocating for your patient.

Anesthesioboist T is an anesthesiologist who blogs at Notes of an Anesthesioboist.

Submit a guest post and be heard.

Prev

Penicillin and the Cocoanut Grove fire in Boston

November 24, 2010 Kevin 2
…
Next

Bedbug rashes, and how to prevent and get rid of bedbugs

November 24, 2010 Kevin 1
…

Tagged as: Hospital-Based Medicine, Patients, Specialist

Post navigation

< Previous Post
Penicillin and the Cocoanut Grove fire in Boston
Next Post >
Bedbug rashes, and how to prevent and get rid of bedbugs

More by Anesthesioboist T., MD

  • a desk with keyboard and ipad with the kevinmd logo

    Why I’m thankful for my son’s surgery team

    Anesthesioboist T., MD
  • a desk with keyboard and ipad with the kevinmd logo

    Why an anesthesiologist would be needed for organ donation

    Anesthesioboist T., MD
  • a desk with keyboard and ipad with the kevinmd logo

    Don’t always blame anesthesia for problems in the OR

    Anesthesioboist T., MD

More in Patient

  • There’s no one to drive your patient home

    Denise Reich
  • Dying is a selfish business

    Nancie Wiseman Attwater
  • A story of a good death

    Carol Ewig
  • We are warriors: doctors and patients

    Michele Luckenbaugh
  • Patient care is not a spectator sport

    Jim Sholler
  • Me is who I am

    Michele Luckenbaugh
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions
    • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

      Montreh Tavakkoli, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Four-Year-Old Gets Hospital Bill; Woolly Mammoth Meatball; How AR-15s Damage Humans
  • How This Doctor Found Purpose After a Devastating Injury
  • House Lawmakers Squabble Over HHS Budget
  • Infant Formula Crisis Exposed FDA and Industry Failings, Lawmakers Say
  • Building Vaccine Trust Among the General Public

Meeting Coverage

  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Less Abuse With Extended-Release Oxycodone, Poison Center Data Suggest
  • Novel Strategies Show Winning Potential in Ovarian Cancer
  • Children Do Well With Fewer Opiates After Surgery
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions
    • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

      Montreh Tavakkoli, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Never forget to advocate for your patient
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...