Can You Hear Me Now? (Part 3)

A reader asked me if my patient from "Can You Hear Me Now (Part 2)" ever recovered. Here’s what I got from the cardiologist (who called our patient a "miracle") the next day:

Melvin’s right coronary artery (RCA, or the main blood pipe that feeds the muscle of the right side of the heart) had been building up plaque for some time and was about 75% blocked. What gave him chest pain and brought him to us was a recent clot that blocked 99% of his left anterior descending artery (LAD). This kind of blockage, when it’s close to the beginning point of the LAD, is called, "The widowmaker" as it often kills the patient right away (and makes a widow of the wife).

The left side of the heart is the larger and harder working side. The clot in main branch of Melvin’s LAD kept blood from getting to the muscle of the heart. The blood flow from the right side (which can sometimes travel around to the left via the circumflex artery) was insufficient due to the old buildup of plaque in his RCA.

In the OR, the cardiologist had put a stent in Melvin’s LAD, pushing the clot out of the way and allowing blood to flow to the left side of his heart. Even so, the muscle was so damaged and, in some places dead, that he needed a mechanical device inserted into his aorta called a "balloon pump" to help his heart get enough blood out to the rest of his body.

Melvin made it to the cardiac operating room and he got some good treatment from some good people but his heart was too damaged by all the blockages. Twelve hours after surgery, he died in the intensive care unit. He stayed dead this time.

Looking back, could I have done anything different? No. I feel good about everything I did. The team I was working with was spot-on as well. Perhaps Melvin could have taken better care of himself but that’s moot now. So, what good did I do?

Melvin’s wife saw the whole thing. She was upset but present. She saw all of us doing everything we could to keep Melvin from dying, including talking to him. She rode the roller coaster of dire prognoses and moments of hope ("He’s grabbing my hand!") but she wore a face of resolve and acceptance as we wheeled Melvin to the OR.

I’ve posted recently about one we didn’t save, yet I felt we gave him every chance. I feel the same about Melvin. I’m sorry that he’s dead. I’m sorry that his wife was made a widow. I gave him every opportunity in my power to live. Often, despite my best efforts, Death wins. I’m here to make that victory a difficult one and, when needed, to lose gracefully.

–maddog

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  • Student Paramed

    Damn. That sucks.

    Thanks Maddog.