I really don’t understand why people don’t seek medical attention when it’s so obviously needed. I mean, I understand that money is tight for most Americans and co-pays are expensive (if they have insurance at all) but your health is everything. I can see foregoing the doctor’s office if you have a rash, the flu, or a painful knee trying to save the cash in these tough times, but if you can’t breathe…. no, I cannot understand that.
A woman presented in the ED with shortness of breath for the last week; worsening each day and decreasing her ability to perform daily activities. Upon presentation, the 12 lead EKG showed mild elevation of the ST segment (suggesting a heart attack) and the patient was placed on BIPAP (an oxygen mask that also delivers pressure to help open the lungs). The ER doctor had consulted a cardiologist who took the patient to the cath lab within the half hour.
The patient wasn’t able to lay flat for the procedure due to her difficulty breathing. Her lungs were filled with fluid and the diuretic was not working. The physician from the ED was called to the cath lab to intubate this patient. After she was intubated, her blood pressure began to plummet. She was started on multiple medications to increase her blood pressure as the procedure was underway. One of the main blood vessels in the heart was 99% occluded and after over an hour of attempts, they were unable to get it open. By that time, the bloodwork had returned from the lab showing myocardial injury (heart attack), anemia (low blood count), and renal failure. During the catheterization, the physician checked the heart function and it was at 5% (normal is 60-80%) meaning that the heart was not effectively pumping blood to the vital organs (such as the kidneys) and the blood then backs up in the lungs causing difficulty breathing.
The outcome for this patient was not good. She made it up to the ICU, but not for long; not even long enough for her family to get up the 2 flights to see her.
It really is sad that people are not seeking necissary medical care, even when they do have available insurance. In this case, the patient did have insurance, but did not seek care for some other reason unknown to us.
While I understand that as a nurse that must be very frustrating… I also wonder what, realistically, getting in earlier might have done. After multiple expensive tests, for which this patient was uninsured I’d gather from the story, they might discover the precursors of a heart attack. They might not have. What might have been done for her in those circumstances to avoid future cardiac arrest? They might have discovered the signs of early onset liver failure, but there’s not much that can be done for that either. While medical intervention might have given this woman some more time, how much? At what cost? I know that seems horribly cruel, but I feel like we’ve become a nation divided on health care. We have insured people who run to the doctor for maladies that don’t require a physican (I sprained my ankle, I have a cold, my back aches) and those without insurance who wait until things are emergent. Either way, they cost the system entirely too much. The reality is that in many cases, and most docs I talk to agree, intervention wouldn’t accomplish much either way..
Looking back on my post, I realize I didn’t elaborate much on the medical details (I tend to skim over those as I realize that most of my readers are of non-medical background). But, the reality of what happened to this woman is that she had a heart attack previously (probably more than a week prior to this event) and because of that heart attack, her heart muscle was dying causing her heart to pump less effectively. When the heart pumps less effectively, fluid backs up in the lungs causing shortness of breath and oxygenated blood fails to perfuse the organs causing kidney and liver failure. If she would have come in earlier, the blockage really could have been opened, taking the burdon off of her over-worked lungs and preventing death of heart muscle and preventing further damage to the liver and kidneys.
She wasn’t actually in cardiac arrest when she came in… she was in respiratory failure (due to heart failure).
Actually, this woman did have insurance and it was probably more of a “but I dont want to go to the doctor… I’m sure I’ll be fine” type of conversation (of which I’m purely speculating).
I agree with you in some of what you are saying about health care costing too much, but I do think my life is worth going to the hospital if I can’t breathe (and I’m only 70 years old). At the hospital we routinely change pacemaker generators (batteries) on 100 year old patients who look like they’re circling the drain because the family can’t bear to make the decision to “just let the pacemaker die” and therefore just let their loved one die… lots of ridiculous costs.
This is such a big issue. If you go to the ER in a non-emergency, then yours insurance wants to rake you across the coals. And don’t get me started about when they ask you for your co-pay, before a doctor has even laid eyes on you.
We have to figure out a way to give people the medical care they need without being fearful of the cost associated with it. People are dieing and having horrible qualities of life because of oversight.
Hi Amy,
Found your blog a couple of weeks ago. Enjoy reading your posts.
I understand your concerns relating to “health is everything”. Sometimes people have a silent, or atypical MI. And then as they incrementally deteriorate, they don’t realize they are ” that sick”. I think a combination of denial and perhaps hypoxia, affect the mind. If nobody noticed this woman’s deterioration for a week, I wonder if loneliness and depression- and therefore apathy took over her decision making process as well.
Given you don’t know this lady- this may be her life long way of dealing with problems anyway. Or perhaps she knew inside she was deteriorating and knew that if she went to hospital that she can be disallowed from going home if it is found that she can’t care for herself adequately.
Here in Iowa we have a huge elderly population and having gotten to know elderly people well- know that that is a huge fear always on their mind, that they won’t go back home.
Why do people do what they do? I am less surprised than I used to be about these kinds of things. I see the young do this as well… My nephew is dying of melanoma this week, because he would not listen to me ( a nurse), his wife, his mother, for three years about going to the doctor to have a mole looked at. Then after he was diagnosed with melanoma he went into denial and refused treatment. This week he was told he was about to die. H only saw DR when he decided it hurt too much. Now he’s hoping for a miracle. He has 5 children under the age of 6. We all are very angry at him for the way he has dealt with this- if not for himself, for his family. So I do understand your reaction when people are not proactive. Sometimes I’m understanding of it, other times sad or angry.
It’s hard on you RN’s emotionally too when you get a patient like this. It’s tough and bewildering at times.