The Patient Was…

The patient was an eighty-year-old woman whom I first met as she fell to the floor in full cardiac arrest.

We were both attending a formal dinner and concert at one of New York’s iconic hotels. She was there in support of the host organization, which gave scholarships to promising, young musical artists. I was there in support of my stepmother, a talented musician in her own right, who played and taught piano, and sang in the chorus of the Metropolitan Opera. (Parenthetically, my father, a dentist by profession, had a wonderful baritone singing voice, and the duets they sang in our living room were truly beautiful.)The dinner-concert was the main fund-raising activity of the sponsoring organization.

Mid-way through the dinner, that preceded the concert, my stepmother suddenly got up from her chair at a table adjoining mine and hurried over to me. Just as she blurted out, “A woman at my table is very ill,” my wife, sitting next to me, said, “Henry, a lady at the next table just died.”

Looking where my wife was pointing, I just glimpsed a figure falling from her chair to the floor. Jumping up from my chair, I ran over to where a tiny, elderly woman, dressed in a formal evening gown, lay sprawled on her back. She was unconscious, pulseless, and not breathing.

The first thing I did in attempting to revive her, even before starting standard CPR (cardiopulmonary resuscitation), is something that engenders controversy among medical personnel. I delivered a sharp blow to the center of her chest with the side of my hand, a sort of karate chop. A few seconds later, seeing no response, I repeated it. A faint but palpable pulse returned.

Now, it is known that direct trauma to the chest can, in rare instances, cause cardiac arrest; hence, the concern about striking the chest of someone whose heart has already stopped. But it has also been shown that, in equally rare circumstances, a sharp blow to the chest can restart a heart that has ceased beating. Since the procedure only takes a few seconds, the downside seems negligible, and the upside is a restored heartbeat. What’s to lose?

By this time, a small crowd had formed around the patient and me on the floor. Everyone looking on was elderly, as the membership of the organization sponsoring the event was composed of mostly older people who were lovers of music and could afford to sponsor young artists. One man, who turned out to be a retired physician, held out his hand with some tiny tablets and said, “Is nitroglycerine okay?” (Nitroglycerine is a medication used to treat angina, chest pain due to inadequate oxygen supply to the heart muscle.) When I said it wasn’t needed for the patient, he replied, “No, I mean for me. I’m having chest pain watching this.” Before I could reply angrily to what was an inappropriate interruption, the man’s wife dragged him away.

By now, hotel security had arrived and were soon followed by emergency medical personnel who were responding to a 911 call that had been placed. The patient, now fully awake, still on the floor with my tuxedo jacket under her head, was very calm through it all. I introduced myself to her, told her I was a cardiologist, and that the ambulance had arrived and would take her to the hospital.

She said, “I’m not going.”

“What?” I replied.

“I’m not going,” she repeated.

I was concerned that she didn’t understand what had happened, and the gravity of the situation. We were still literally on the floor of the banquet hall, people were milling about excitedly, the police had arrived, and the emergency medical personnel were anxious to get moving. I asked if there were some place we could have some privacy and where the patient could be moved off the floor and be more comfortable. The emergency medical technicians transported the patient as hotel security led us to a lounge just off the ballroom. Once there, I tried to explain the seriousness of the situation to the patient, but I didn’t want to be too specific for fear of frightening her. 

“You know you had a serious fall,” I said, “and it was a caused by a serious problem.  You really need to go to the hospital.”

“No,” she said, as before. “I’m not going.”

After a few more attempts with euphemisms, I thought I needed to be direct and specific. “Do you know that your heart stopped?” I said. “You had a cardiac arrest. That means you actually died, and we had to bring you back.”

“I’m still not going to the hospital,” she replied.

“Why won’t you go,” I said, now exasperated.

“I paid for dinner and a concert,” she said, “and I’m not leaving until I’ve had both.”

The security people, the policeman who had joined us, the emergency technicians and I all just looked at each other. And then we, and the patient, all started to laugh.

She finally agreed to go to home, with a friend, and a promise to call 911 if anything untoward occurred. It was the only solution that she accepted.

She became my regular patient after that —  the evening had been a true “cardiac event”

—   and she lived another seven years with no further heart problems.