Published in The Townsend Letter, May 2010, Reprinted by Permission, All Rights Reserved
By John Parks Trowbridge M. D., FACAM
“This can’t be happening” is often the first thought. Gripping, gnawing chest pains give way to a heavier, crushing feeling that generates fear. The idea of “indigestion” soon gives way to “impending doom.” In this setting, 9-1-1 is sometimes a reluctant last resort, after antacids and resting produce only a pitiful response.
The arrival of paramedics brings reassurances from technicians who methodically start oxygen, apply EKG leads, and prepare for transport. Nurses and doctors in the emergency room go about their duties calmly and with dispatch – starting ivs, administering medications that relieve the urgent worry. Transfer to the Coronary Care Unit is swift and easy, and monitors beep with the soothing monotony of a metronome.
From A to Z, everything about the medical team responses engenders trust and dependence in the patient: “These folks really know what they’re doing. Thank God I got here in time.” Trusting eyes gaze into the cardiologist’s face, searching for any clues that the situation is worse than it might appear. Again, reassurance: “You’re here, you’re safe – we need to do some tests to figure out how best to fix you now.”
Slippery slope? Conveyor belt? One-way road to a “dead” end? Many terms have been applied to the “work up” and “treatments” offered in modern cardiology and cardiovascular surgery. In point of fact, major studies 30 years ago showed that one in six bypass operations are life-saving, when high-grade blockage is worsening in the left main artery or early in the left anterior descending (LAD) artery (the “widow-maker” or “artery of sudden death”).[1]
Then what of the other five in every six patients? Therein lies the rub.