As the year draws to a close, a lot of us are thinking about our New Year’s resolutions. This is the time of year in which we begin to analyze our behaviors over the last year and make plans to undertake newer and healthier habits. I’m not usually one for writing down a list of things that I want to undertake in the new year, my personality is much too “que sera sera” for that. But much like most things in life that truly inspire change within us, I was confronted squarely with what the reality of what being reactive rather than proactive looks like. It was the 26th of December, only a 4 day work week (yay!). I am a Cardiac Sonographer that works in a clinical setting. So while most of my patients have very serious heart issues they are usually in stable condition by the time that they come to me to have their ultrasound. Since it was the day after Christmas I really just wanted to do the ultrasounds on the patients on my schedule and go home. The only good part about having to work this day was that everyone else is on vacation and the traffic was really light.
The first two patients on my schedule were pretty run of the mill exams, no surprises, pretty normal stuff. I got through them effortlessly. As I began setting up my room for my third patient I quickly skimmed her chart for indication and diagnosis and notice that she has a little bit of a complicated medical history, but I’m still not expecting any big surprises. I hook her up to the EKG, and and have her turn onto her side so that I can start her test and that’s when I notice her EKG rhythm. It’s funky. And it’s slow. In the 30’s slow. I continue to perform her echo though, hoping that the rhythm would change or speed up but it doesn’t. By the time I am done with her exam her heart rate has remained in the 30’s throughout and the rhythm hasn’t changed at all. I have our nurse practitioner take a look at the EKG, and she says that yes we should send her to the emergency room because she is in complete heart block, which means that the electrical impulse in your heart that causes it to beat isn’t traveling up to the main pumping chambers of the heart.
After further interviewing the patient she revealed that she had been feeling terrible for months and had been experiencing shortness of breath and dizziness for quite a while. She was reluctant to go to the ER because she had basically learned to live with her symptoms which had become normal for her and she was due to go out of country in the next couple of days. She didn’t go though, rather she was admitted to the hospital and scheduled to have a pacemaker implanted the next morning.
Upon closer inspection of her chart, I noticed that at her last office visit with the cardiologist which had been about six months earlier, he had ordered a series of tests which the patient had not done. The tests that he had ordered would have likely detected her deadly arrhythmia much earlier and probably would have kept her out of the ER and prevented the need for an emergency procedure. It might have prevented the foiling of her year end plans to travel. Doctors often order many tests on patients in an attempt to rule things in or out and sometimes it can seem