The Phone Call

I made a big mistake. I said, "I'm the patient."

IT BEGAN WHEN I TRIED to call my cardiologist at 9:15 a.m. I just wanted to ask a simple question, "Should I stop taking the new (for me) anti-arrhythmic medication you prescribed for me ten days ago?"

Three years ago, a routine EKG during my annual physical examination revealed atrial fibrillation/flutter. I consulted Dr. Hart whom I had known professionally since his arrival in Sacramento. As a primary care internist, I referred him many patients. We worked together in their mutual treatment. I have high regard for him both as a physician and a friend.

Six months later, cardioversion converted the arrhythmia to normal sinus rhythm. All went well until last Christmas, when I began to experience episodes of palpitation and distress, which were finally diagnosed as periods of asystole. Dr. Hart tried controlling the symptoms with a variety of anti-arrhythmic medications.

Two weeks after he gave me a new medication, I began to have more frequent spells which seemed to last longer than ever before. I took my medications at 6 a.m. By 9 a.m., I felt much worse. Then I decided to make my call.

I thought I would have no problems because Dr. Hart had assured me, time and time again, that I could call at any time and he would call back as soon as he could. I never tested his statement. I hadn't had to. In the three years of his caring for me, nothing urgent occurred.

I expected that I, a former colleague, could leave a message to someone live, who would convey my message to the doctor. I wanted to be certain that I would get a callback before my evening dose of medication. That's all I wanted. I didn't realize what the consequences of my actions might be.

I dialed the number, listened to the menu and dialed #1 for the "doctor" channel. A live, pleasant voice answered. I said, "I'm Dr. Richard Johnson of Colusa, I want to speak to Dr. Hart."

"What's your patient's name?"

I made a big mistake. I said, "I'm the patient." I could have lied and said, "It's a new patient," but I didn't.

Immediately the tone and pitch of the voice changed. It lost its warmth. It became strict and dogmatic, "Patients can't talk to the doctor. They have to talk to the doctor's nurse."

"O.K. Let me talk to her."

"I can't. She's busy." And then, in a less judicial tone, the voice added, "You can leave a message in her voice mail."

"When will she call back?"

"I don't know, but she always calls back by the end of the day."

The receptionist was following job instructions. Getting angry would change nothing. I kept my cool and thanked her for her help

During this brief interchange, the asystoles, which had prompted the call, had increased both in frequency and duration. I didn't have to find an artery to palpate to find my pulse. I could feel my heart beat throughout my entire body. I started counting. When I got to 11, I couldn't feel a pulse. I kept counting. Finally at 14, it became regular. I kept counting. At 43, it stopped and stayed stopped at 44, 45 and 46. Then it started and I stopped counting. Something was going on that I didn't like. I needed help.

I had to take action, some type of action. I called Dr. Primus, my primary care physician. When I finally persuaded the receptionist my call was urgent, he came to the phone. He heard my lament and gave an order: "Go to the emergency room, here in Colusa, right now! I will call Dr. Hart and let him know what's going on."

I tried to argue but to no avail. My anger increased. I did not want to go to the E.R. That would be an expensive waste of time and effort. I was not sick. I did not need emergency care. I just wanted an answer to my question. I had had enough studies, enough monitoring and enough medication. The diagnosis had been made. Only 10 days before, because of similar, but less pronounced findings, Dr. Hart had stopped one of my medications and added a new one.

By then, Claire, my wife, became involved. She had no empathy for my remarks that "If I'm going to die, I can die just as well here at home sitting in the same chair where my father died, as I can lying on a gurney in the E.R." She found no pleasure whatsoever in my gallows humor.

Twenty minutes later I was in the E.R. lying on a gurney attached to a cardiac monitor. A cannula in my nose gave me supplemental oxygen, which I didn't need. I did not get an I.V. because the Emergency Room physician fortuitously arrived before the I.V. therapist.

Dr. Hurdme came to my side, introduced himself, shook my hand, pulled up a stool, sat down and asked me to give him the history of my present illness. As I began pouring out a dramatic account of my symptoms, my reactions and my perceptions, he did something unusual: he listened. Although he had the records of my previous visits to the E.R., he did not attempt to read them while I gave my history. He listened intently, rarely interrupting except for clarification. Finally, after a brief but adequate physical examination and the drawing of blood samples, he conferred with Dr. Primus and Dr. Hart.

Lying on the gurney waiting for results, I became aware of the sounds my monitor made. I heard the beep that accompanied each heartbeat and the raucous horn-like sound that documented each pause longer than a heartbeat. The longer I listened, the more secure I felt. The regularity of my heart, despite the frequency and duration of the interruptions, reassured me that my heart was still there, actively doing its job. Even though it paused, it always came back. And, if it didn't? That thought didn't bother me. Deep down inside, I knew that I had finally accepted the consequences of my mortality.

Dr. Hurdme returned from his phone consultation with Dr. Hart and Dr. Primus. They had decided that the digoxin, which I had been taking for three years, probably was responsible for the bradycardia and the asystoles. They suggested stopping digoxin, reminding me that eliminating it from the body would take at least two weeks.

I felt elated. Finally I had the answer to my simple question. I took the oxygen cannula out of my nose, pulled the electrodes off my chest, grabbed my shirt and started to get off the gurney. A nurse stopped me with the admonition that I had to be taken by wheelchair to my car.

After I got home, I forgot about my heart. I did not try to count my pulse. Later, I walked a couple of miles. In the evening, just prior to going to bed, I checked my heart and found it beating regularly, at 54 beats per minute. The next morning, after eight hours of good sleep, I checked my pulse. It pulsated regularly at 54 beats per minute. At 6 a.m., I took my medication, all of it, except the digoxin.

drrlj@colusanet.com