Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Wednesday, June 24, 2015
    Plunged Into Caregiving

    About four months ago my mother asked me to call my father's cardiologist to get clarification on something - "He wants us to do some testing. Is this really necessary?" So I did.

    "Your father has aortic stenosis," the cardiologist said without preamble (he knows I'm an MD), "and it's pretty significant."

    My attitude when we opened the conversation had been doctor-to-doctor. Now suddenly all that vanished and I was repeating, in a very small voice, "Dad has aortic stenosis?"

    The gist of the conversation: yes he did, and furthermore it was getting worse, and the cardiologist wanted to do an angiogram. One angiogram later, Dad had a stent in his right coronary artery but still no clear word on the valve. Cardiologist #1 suggested that we see his pal, Cardiologist #2, an expert in aortic valve problems. By a stroke of luck #2 works at my hospital, Tertiary Care Medical Center.

    This guy is hardcore. He has a large office in the very newest building on the hospital campus. Each room has a chair that looks a bit like a recliner, which doubles as a scale. Yes, they press a button and the chair raises a few inches off the ground and they weigh the patient sitting in the chair. He also has a fleet of nurse practitioners and technicians, high grade office equipment and the ability to perform echocardiograms in the exam rooms. The tech clearly knew what he was doing but still could not get a clear picture of Dad's valve. He pressed a button on the room's intercom, ordered a bag of contrast and this was infused through a vein, right in the exam room, by a nurse who appeared out of nowhere.

    It's wonderful what money can buy. I guarantee you that no internist or primary care doctor has facilities like this.

    After this, we found that the AS was really quite bad indeed. Dad needed a valve replacement as soon as possible. We all agreed that the traditional method (aka "cracking the chest") was not a good idea as Dad is not in the best medical condition. He has a history of several strokes and some dementia. Cardiologist #2 specializes in valve replacement via the femoral artery. How he does this I have no idea, but overall it is less stressful and risky than open chest valve replacement.

    Today we go for the final round of preoperative assessments and tests. He is having more of a workup than average because he's been entered into a study wherein the surgeon places a filter in the aortic arch before doing the valve replacement, which should lessen the risk of additional strokes. Tomorrow, if all goes well, he has the procedure.

    I have been in charge since the workup started: transport to the hospital, spending the night in the hospital with Dad postprocedure and translating developments to the rest of the family. I now really empathize with patients who get confused and lost, and who complain about having to go to the doctor all the time; I am learning exactly how that feels. As you can imagine, I've had to do some canceling and reworking of my office schedule, but I really don't care. All I want is for this to work.

    Wish us luck.

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