Walking in My Shoes, Part 2
7/25/2014 12:37 PM
By Beth Adams, DO
Note: Did you miss Part 1 of this post? For more of the morning and for background to the below post, click here.
… as the morning unfolds, the patients who sticks in my mind is the youngest of the day, a 9-day-old baby with a very thick heart.
Anna (not her real name) was supposed to be a normal, healthy baby, after a normal, healthy pregnancy. But she’s not. Before going home from the hospital, one of her doctors heard a heart murmur, and her problem was discovered. No one teaches doctors how to give bad news—at least, no one did when I was training. You sort of figure it out as you go along, by watching what works, what doesn’t work, and trying to read people as you go along.
In general, one of the things I love about being a congenital cardiologist is that we almost always have reasonable solutions for our pediatric patients. I can usually look at a family and tell them that their child will most likely grow up and have a reasonably normal life. But not always. Not in Anna’s case. Anna has a bad problem, and while we can talk about options, none of them are really all that good. She’s been dealt a bad hand, and it’s up to us to make the best of it. The Annas are the ones who keep me awake at night.
The rest of the morning is uneventful, although I end up a bit behind schedule but with an extra 10 minutes to grab lunch as I run across the parking lot to the adult clinic. I’ll catch up on charting and reading echos, not to mention phone calls, later.
The afternoon begins, and has much the same theme as the morning. The differences: Adult patients, for one, and no medical student. About half of my patients are new to the practice and about half are patients coming in to follow-up. As with the morning, they have a variety of problems ranging from straightforward to complex, and no two are alike. The afternoon is flowing well until I walk into Amos’ room (again, not his real name.)
Amos is a young Amish man I’m seeing for the first time, and unfortunately, he and his family are a bit nebulous about what exactly his diagnosis is. They talk about two heart operations, moving one valve to where another should be, and then his cardiac arrest a year later, leading to placement of a defibrillator. The good news is that there is a break in the echo schedule, and I use it to my advantage.
“Tom, I need you to put your detective hat on,” I tell my sonographer. “This sounds like it may be aortic stenosis with a Ross operation, but see what you can find out, OK?” And off he goes, one of my best techs who I know is up to the challenge. As it turns out, my suspicions are correct about the diagnosis, but Amos still has a worrisome problem that needs more evaluation. The good news is that Amos is my last patient of the day, and two and a half hours later I am sending him out the door with a detailed plan for additional testing next week.
I glance at my watch and discover that it’s 1730… which means I have just enough time to run back over to the hospital for our monthly division business meeting—but at least there will be food, which takes care of the dinner problem. The meeting is short for a change, only about an hour, and I pack up to head home just before 1900, knowing that completing the day’s paperwork will be my evening activity.
As I head for the front door my pager starts to chirp, and sure enough, it’s the number for the emergency department. “Looks like the charts will have to wait a bit longer,” I think, as I turn around and head back inside.
I can tell that 0515 is going to come early tomorrow.
Beth Adams, DO, is currently both a CHD patient and congenital cardiologist at Penn State Hershey Medical Center, where she cares for adults and children with CHD. She graduated from Ursinus College and then went on to medical school at the University of New England, in southern Maine. Beth remembers ACHA in its infancy, and is delighted at how it has grown and evolved over the years. When not at work, Beth enjoys reading, kayaking, gardening, and spending time with her nephew.