It was a typical busy day. Not only busy, but there was a lack of nursing staff. All hospital beds were occupied, which means keeping all the patients in the emergency room. In other words, there was only one doctor and one nurse for eight patients. But everybody was dedicated to going beyond their duties. This is what we call frontline healthcare heroes.
Around 1500, a man suffering from chronic toe pain and wounds came to the emergency room. I asked him, “What can I do for you today?” He said, “I think my foot is getting worse. Neither my podiatrist nor my infectious diseases doctor has time to see me. That is why I have decided to come to the emergency room.”
While examining his foot, I said to him, “Yes, we are open 24 hours/7days a week/365 days. It is very convenient but a little expensive, though.”
The wound didn’t look very good, and the infection has spread to surrounding tissues, and radiology findings suggested the possible early onset of osteomyelitis. He also had diabetes. I asked if he had any medical history or had any other symptoms. He laughed and told me, “No, this is good enough for me.” His COVID 19 test was negative. The venous ultrasound was also negative for any blood clot. I admitted him after consulting with a podiatry and ID specialist. But there was no bed in the hospital, so he had to stay in the emergency room until space was available inside the hospital.
He called the nurse every three minutes. His room was just across the hall from my desk. First, he would call the nurse. If she did not respond, then he had called me. His needs were very small such as a phone charger, water, blanket, or adjust the bed. We judged him, “Being alone and needing attention.” No, we were not wronged either.
Later on, the hospitalist and his senior resident evaluated the patient. He did not have any other complaints except for his non-healing wound. His inflammatory markers did not indicate that he had sepsis. Empirical antibiotic therapy was in progress. Everything looked perfect, and it was over three minutes, but he had not called us yet. The nurse went right away to see him. She screamed from the room, “He is not breathing. There is no pulse.”
Well, my adrenaline kicked right away. I instructed the nurse,” Press the code blue button and bring the crash cart.” while she did that, I already jumped on the bed and started chest compression.
The rest of the code team arrived, and the technician took over from me and started to do compression. He was intubated. The nurse had done the EKG, and nobody believed it, “the massive heart attack was in progress.” we immediately sent the patient to Cath Lab, where the cardiologist saved the life.
No chest pain, no shortness of breath, or typical heart attack symptoms, but his only pain was toe pain. He didn’t even have finger pain which could have alerted us. We did our aftermath brainstorming but could not find any specific reason.
Everybody started to wonder what could have happened if he had not come to the emergency room. What could have happened if he stayed at home?
Later on, the cardiologist stopped at the ED to update us. His words were exactly, “No, it was not his time to go yet. The wound was just an excuse. The reality was it was not his time. If he stayed at home, there would be no chance of survival because his coronary artery was 99% blocked.”
I don’t think his angels were ready to give him a ride.