As I approached the centre of activity, I gasped and saw that our chief of cardiology was lying in a hospital bed

The following is based on a true story that still gives me the chills. Aspects of the story have been modified to protect parties involved...

I started my medical school rotations in cardiology – the very career I'm in today. During my call night, we received a call that someone important was presenting with angina – a sign of an impending heart attack. I quickly walked to the emergency room. The closer I got, the more frenetic the activity seemed to be stirring within the hospital. I saw important institutional leaders rushing by me in and out of the ER. It seemed to me that this usually calm and high-functioning hospital was in confusion and disarray. As I approached the centre of activity, I gasped and saw that our chief of cardiology was lying in a hospital bed – now in a very personal battle with the disease he had studied and taught about for so many years.

Barely recognisable in a hospital gown wearing an oxygen mask, he looked pale and weak – not the commanding professor who just 24 hours earlier had been teaching me about the different types of coronary stents. Most of the emergency room attendings had dropped whatever they were doing to attend to one of their own. I recognised other cardiology attendings at his side who were clearly not on call but holding his hands and comforting him. An EKG was silently being printed amid the frenzy. This EKG would show why he was having chest pain – if it was coronary obstruction, it would show where and perhaps to what degree.

As the EKG finally printed, someone had the idea to show the results to our chief. Interpreting EKGs can be a complicated task even for experts... why not show the most experienced person in the room? In subsequent morbidity and mortality conferences, this simple and well-intended gesture would be deemed controversial.

Our chief took the EKG with frail hands. He glanced at the squiggly lines and his experienced eyes widened with horror. Dramatically his heart rate increased. He dropped the paper on the bed and slumped in his bed. We all noted his blood pressure starting to fall.

He knew before any of us that he was having a massive heart attack. I could only surmise that he, as a patient, panicked, which caused increasing strain on his struggling heart, tipping him from marginally stable to unstable. We quickly rushed him to the cath lab, but most of his heart muscle had already started to undergo necrosis. The pressures in his heart started to increase and the blood started to pool in his lungs. He died due to complications of his acute heart failure.

Drew Young Shin, clinical assistant professor, Stanford University

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