The Patient Was…

The patient was a 50 year old chemist, whose life was pretty much tied up in science. His work was all about data, and he believed in science, not superstition. He wanted evidence, not conjecture, in just about everything.

One year, clearly out of his comfort zone, he was persuaded by his wife to spend their vacation in Las Vegas. He protested during both the planning of the trip and while actually traveling there. But his wife persisted, assuring him that they would have a good time and that he could relax and enjoy their unstructured time in the unquestioned gambling capital of the world.

Sure enough, he was soon captivated by the seeming randomness of the gambling opportunities. He knew, of course, that the odds were always at least slightly in favor of the house, so to speak; but the ideas of probability intrigued him, and he carefully observed players at different games in the casinos. However, since he didn’t understand the rules and mechanics of most of the games, he settled on slot machines as an easy and fun way to just give himself over to dumb luck.

After pulling the lever on one of the slots for a while, he began to feel a slight discomfort in his chest. He ignored it for a bit, but it persisted and, in fact, became more distressing. Adjusting his position in front of the slot machine didn’t seem to alter it, and after a short time he began to feel a slightly nauseated.

His wife, playing at a neighboring slot machine, noticed him fidgeting and asked if anything was wrong. He told her that he had a pain in his chest and wasn’t fellikng all that well. She said maybe it was from repeatedly pulling the arm on the machine. He thought a moment, and then said that he was pulling the lever with his right arm and the pain was mostly on the left side of his chest, so her suggestion didn’t seem to fit the facts.

His wife became somewhat alarmed and notified casino security; they whisked him away from the slots and off the casino floor  —  after all, a gambler falling ill is hardly the fun-loving image they wish to project.  An ambulance was summoned, and he was taken to a hospital off the world-famous Las Vegas Strip.

Arriving at Sunrise Hospital  —  there is no Sunset Hospital because the sun legendarily never sets in Las Vegas  —  the patient was placed on a gurney in the Emergency Department. A nurse recorded his vital signs: blood pressure, heart rate, respiratory (breathing) rate, body temperature, all of which were the within normal range. Two young physicians then appeared alongside the gurney.

After they quickly examined him, one of the doctors turned to the other and said, “Two-to-one he didn’t have an MI.” (MI refers to Myocardial Infarction, the medical term for a heart attack; the usual cause is blockage of the blood supply to part of the heart muscle due to a blood clot or other obstruction in the coronary arteries, which are the blood vessels that supply blood to the heart muscle.)  

“Make it three-to-one and you’re on,” the other doctor said.

“What the hell is going on?” the patient yelled, sitting up abruptly. “Are you guys betting on my heart, on my life?”

“Relax,” said one of the doctors. “This is Vegas, we bet on everything.”

“Not on me you don’t,” said the patient, jumping off the gurney. “I’m leaving.”

Nothing the doctors could say convinced the patient to stay in the hospital. They warned him of the dangers if he left, but to no avail. He signed himself out of the hospital against medical advice, went to the airport, and got the first plane he and his wife could book seats on back to New York.

He came directly to my office and related his story. I examined him, and all seemed normal. But his electrocardiogram, a recording of his heart’s electrical activity, showed the unmistakable pattern of a recent heart attack.

I started to discuss my findings by saying how pleased I was that my physical examination of him showed no abnormalities. Before I could go further, he interrupted me.

“I’m not surprised, “he said. “I feel well now. I’m sure I didn’t have a heart attack.”

I couldn’t help myself.

“Want to bet?” I said.