As I approached retirement after 35 years of practicing head and neck surgical oncology, my new cardiologist suggested that the daily baby aspirin I had been taking for atrial fibrillation was no longer appropriate. “You should consider a convergent procedure,” he said. “A team of surgeons creates scars on the back of the heart near the left atrium and the pulmonary veins. Then they place a clip across your left atrial appendage, and I do an endocardial ablation a few weeks later. It should help.”
Though physicians are sometimes poor patients, I consider myself a good one, so I agreed. I met with a friend and colleague who would be one of my surgeons. Before long, I was in the OR having a minimally-invasive radiofrequency ablation of my epicardium and placement of the atrial clip.
If I saw the surgeon postoperatively, I don’t remember. But that evening, on the surgical ward, I developed chest pain. Not just mild discomfort but crushing pain, elephant-standing-on-my-chest pain. My wife watched helplessly. Writhing on my bed, I wondered if the clip might be crushing heart muscle. I tried to decide if the pain was radiating to my jaw or arm; I couldn’t tell. But I did know it wasn’t getting better.
Despite being a physician, I was 40 years out of medical school. And I don’t treat hearts. Still, I knew that crushing chest pain is a bad thing. It could mean I was having a heart attack. One can go from chest pain to death in short order. The list of causes of chest pain is not particularly long and has some nasty stuff on it. I hit the call button.
The people who responded were kind, but no one was as worried as I was. I suppose their equanimity should have reassured me, but it didn’t. I asked for IV morphine, but the nurse said my orders included only oral pain meds. The resident was sympathetic and arranged for a cardiac enzyme test. If my attending surgeon-friend was notified of my episode, I was unaware of it.
Around the time my enzyme levels came back as normal, the pain eased. I went home the next day, certain it would return. It never did.
The privilege of being a physician, even a retired one, continues to bring me great joy. Still, being a physician on the receiving end of medical care isn’t going to be easy. I know both too much and too little at the same time.
Bruce Campbell
Brookfield, Wisconsin