Monday night, at Lincoln Center waiting for Beethoven’s Ninth to begin. Masses of glass spatially dividing David Geffen Hall from the Metropolitan Opera, are still allowing for the majestic Viennese crystal chandeliers next door to provide the necessary visual interruption between the two symphonic masterpieces, Beethoven’s Eight and Ninth.
For me, the excitement about this particular event is deeply personal: Ode to Joy became part of my classmates’, my friends’ collective memory, about 30 years ago. It represented an escape into multi-culturalism in then still-communist Romania, planting the seeds of desire for exploration of the notion of togetherness as people, and the resilience that accompanies such pursuits. Many times, did I rely on that hidden corner of my consciousness to overcome the uncertainty and self-doubt experienced as a young immigrant female physician faced with the hardship of solitude, augmented by the rigor of American medical residency training. To hear such music today feels as reassuring as family dinners or the sight of a favorite Kierkegaard quote etched into the wood of my childhood bedroom door; it feels closer still when played by the Budapest Festival Orchestra, who were visiting from a beautiful city a few hundred kilometers away from my hometown Timisoara.
Anticipation rising feeding the longing for my brain to be filled with familiar vibes I returned to my seat, high up, second balcony, center. Shared joy translates into more joy, appropriate Facebook intermission updates posted, I was waiting patiently for the lights to go off. Then, from overhead: “Is there a doctor in the house?” My location allowed for a thorough view of the audience: collective paralysis. “Time to go,” I told my husband, and flew into the hallway.
As a critical care doctor, my first instinct was to start running, high-heeled shoes in hand. Adrenaline building I couldn’t help but wonder: How is the patient? Sweaty? Shocky? Unresponsive? With or without a pulse? But I wasn’t in the ICU. So I decide to take it slower and run, shoes on. Wait, where was I going again? Oh, right! Arriving at the back of the stage, I found a musician sitting on a chair. Realizing that the only tool at my disposal was a half-broken wrist blood pressure cuff, I had to rely mostly on my own senses. No AED. No glucometer. Not even a stethoscope.
While the blood pressure machine showed a high reading, it only allowed me to see the systolic number fully. His pulse was strong and regular, at 80 beats/minute. Luckily, the patient was neither sweaty, nor shocky. Nor was he unresponsive; actually he proved to be of most reliable assistance knowing his history and medications. He was even able to describe in perfect English another similar episode in the past, while performing in Germany. Even better, he had an emergency oral non-FDA approved anti-hypertensive in his pocket, which he took, at my advice. No blurry vision, no chest pain, no shortness of breath, to signal impending doom. Still, I asked for a working sphygmomanometer ASAP.
Minutes passed. While waiting for his medication to work I recalled non-pharmacologic ways to lower blood pressure, tools I use with my ICU patients in conjunction with drugs: kinesthetic therapy, calming family presence, music therapy. Holding his hand, his wife by his side, I only needed music. And then, the rest of the orchestra started playing on stage, a few feet away. More minutes passed. An ancient box containing a museum-appropriate blood pressure cuff with a two-foot high double mercury column was making its way toward us. Still, it wasn’t the retro look that made my jaw drop in consternation: when I reached for the stethoscope, I realized both ear tubes were completely missing!
There are a lot of elderly concert-goers, making this national cultural venue a prime place for cardiac-respiratory events! And while I want to believe in the existence of an AED and a functional stethoscope on-site, I can’t help but point out their uselessness without the process to make them immediately available. The solution seems simple: Have supplies (like a working stethoscope, blood pressure cuff , pulse oximeter , and glucometer) on-hand and a plan in place for how to access them. There is almost always a doctor in the house. Physicians will come. Bring us the stethoscope. Bring the AED.
Walking down the stairs of David Geffen Hall at the end of the evening, massive glass panels rising to my right, an elderly woman curiously inquired if I had “saved a life tonight.” Luckily the musician’s life did not need saving. But someone in the future will. A good medical history, the presence of a family member will remain invaluable. As will the comforting human touch born in the place of resilience, where Kierkegaard, family time and Beethoven’s Ninth coexist. For the rest, give me a working blood pressure gauge. Please!
Corina S. Filip is a pulmonary and critical care physician.
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