My ER story: From ER doctor to ER patient … almost
by Kevin Pezzi, MD
This is a continuation of the story that I began on another page in the midst of a long discussion about frivolous malpractice suits. If you missed that intro, you should read the two paragraphs in it prefacing the rest of this story, which follows below. (Clicking the link in the above sentence will open that page in a new window and take you to the pertinent paragraphs.)
The arrhythmia developed suddenly after driving a few miles, heading for my Mom's home 200 miles away to spend Christmas with her and my brothers. My cardiac output plummeted so much that I began to pass out, so I pulled into the driveway of an old farmer snowblowing with his John Deere tractor. As I grayed out, I—not thinking too clearly at this point—staggered out of my car with my Jeep still half in the road. An oncoming car speeding by missed me by inches.
I exited the car because I intuitively thought that standing up might help control the arrhythmia. As it turned out, and I later verified by living with this arrhythmia for years, this simple maneuver did indeed help somewhat by reducing the venous return and hence the cardiac preload. I was still profoundly short of breath after a few minutes, but improved enough to think that I could drive without passing out. Changing my plans, I turned around and headed for the ER in Traverse City. I stopped by a pharmacy in Interlochen on my way, tenuously clinging to consciousness and life. I told the woman at the pharmacy counter that I was a doctor and needed Inderal® (propranolol) stat. She began asking me routine questions about insurance and whatnot when I truncated her queries by saying that I was on the verge of dying and needed the medicine NOW. A pharmacist, overhearing this conversation, told her to give me the pills, which I quickly gulped down. I asked how much I owned them, and he said it was free. I thanked them and resumed my trip to the ER.
Before the medicine could be absorbed and exert a therapeutic effect, I began to doubt whether I could make it to the emergency room—at least, make it there alive. As I neared an Urgent Care center on US-31, I decided to go in. I explained my uninsured predicament to a pretty young nurse who sat in a chair next to me in the waiting room, taking my pulse and holding my hand in comfort. Initially, I assumed this Urgent Care center was owned by the Munson Healthcare System, a conglomerate that owns many hospitals and clinics in this area. I began to doubt that supposition when the clerk relayed a message from the cowardly Urgent Care doctor, who threatened to call the police and have me arrested for trespassing if I didn't leave at once. I was the only person in the waiting room besides the nurse, so I knew they weren't busy, and while I appreciated what the nurse was doing, I never demanded anything. I was just sitting in a chair, sweating a bit, and wondering if I would be alive in five minutes.
From the needless threat, I immediately knew that the Urgent Care doc wasn't worried about the small amount of space I was taking up, but the fact that I might code at any minute and therefore become someone he was obligated to treat. Before I became an emergency room doctor, I worked in an Urgent Care and treated patients with cardiac arrhythmias and even heart attacks without melting down, but I've learned that most Urgent Care docs are terrified of handling such serious cases, even when they know they are just temporizing and can immediately call for the patient to be transferred to an ER. So, basically, this Urgent Care doc was a spineless wimp who lacked confidence in his medical ability—probably with good reason—and cared more about saving his ass than saving a patient. I was also struck by an irony: Throughout my career as an ER doctor, I bent over backwards to give free "professional courtesy" care to everyone I could think of, including doctors, nurses, paramedics, EMTs, other healthcare personnel and their family members, police officers, firefighters, and many others who struck me as being decent people who might appreciate a break. Now I had a twit of a doctor threatening to sic the police on me. I'd given free care to so many people, and the first time I needed help, I was threatened by a colleague. With doctors like this, it is no wonder why some people despise the medical profession. One of my grandfathers, for instance . . . but that's another story.
I was so stunned by the trespassing threat that I can't recall if I thanked the nurse as I quickly left, but she earned my eternal gratitude. One of my life goals is to become rich enough so that I can buy her (and the Interlochen pharmacist) a very nice present, such as a new car or even a home. If I have the time, I might even build the home myself (the adjacent picture shows one of the many sheds I've designed and built; more are pictured on this page).
I returned to my car and resumed my trip to Munson, still not certain if I could make it there. If money weren't a concern, I would have called 911 and requested an ambulance long ago. But money was a concern. "I might die if I don't get treatment" and "I might go broke and wish I were dead if I DO get treatment" thoughts reverberated through my head instead of the Christmas jingles that I would otherwise be singing at this time of the year. After driving for a minute, I knew that I needed more propranolol, so I stopped by a Rite-Aid pharmacy to buy a bottle of it for $8 (propranolol is inexpensive now that the Inderal® patent has expired).
I arrived at Munson's ER a few hours after my ordeal began. I asked the charge nurse to call the cardiologist on-call—the doc who would eventually see me if I were admitted—and ask if he would see me in his office if I agreed to pay him. An office visit would be much less expensive than what the hospital would charge, but this proved to be a moot point when the cardiologist refused. So it was back to Plan B: Take more propranolol and hope that it kicked in before I dropped dead, or became a soon-to-be-penniless patient in the ER if I passed out and couldn't say "no" to being treated.
I called my brother who lived in the area and explained my situation. I hoped that he would come to see me, not that he could have done anything, but merely for companionship. If one of my brothers was in danger of imminent death, I know that I'd want to be there. But that's just me.
After our call ended and I knew I was going to go through this by myself, I felt alone. Really alone. Christmas was coming, the goose was getting fat, and here I was sitting in an ER waiting room hour after hour by myself after being given the cold shoulder by two doctors and my family. I'd also called my Mom earlier, but she never seemed to grasp the potential severity of the situation even though I explained that I'd almost died and could still pass out and die any minute now. I was new to this area and didn't have any local friends, so I sat alone and waited. Come on, propranolol, start working!
Hours later, it controlled the arrhythmia to the point that I felt safe enough to leave the ER. With the benefit of hindsight, I later realized that an ER visit and hospital admission would have drained my bank account but done nothing to get at the root of the problem, which turned out to be a strange mix of a medication side-effect and another co-factor that no ER doctor (other than myself) or cardiologist would ever figure out. I suspect that many other people with chronic arrhythmias could benefit from the same therapy that I instituted for myself (propranolol was not the answer; it was just a means to control it until I discovered something much better). Since it's Christmastime again and I am still alive years later, you can have that advice for free if you want it. Unlike that nasty Urgent Care doc and the selfish cardiologist, I want you to be around for the New Year and many years to come in the future. Merry Christmas!