The ones we don't save

One of the most rewarding parts of my job is saving lives.  I can open a blocked coronary artery in the setting of a heart attack.  Or I can help prevent that heart attack by guiding my patients to good lifestyle choices, and when necessary, prescribing medication.

Everyone knows I'm passionate about lifestyle and the power of food and movement.  I will admit, though, as an interventional cardiologist, I enjoy procedures, and I take call at a few local hospitals to care for those in the throes of a major heart attack.

Far more often than not, my team and I work together, open an artery, and save a life.  The gracious patient who no longer has chest pain thanks me and my team, and goes home in a day or two.

It's the patients who don't have that outcome that haunt me, especially when they are young.  I was called emergently for a man in his 30's.  When I arrived, he was sweating profusely, clearly in pain.  His blood pressure was low, so I knew we needed to start working immediately.

I got some brief information from him -- he'd had pain for several days.  He smoked.  He had a strong family history of heart disease.  He hadn't been to a doctor in a long time.

I had one of the best scrub techs at my side, as we worked hard first to get access into his artery and vein.  I worked as quickly as I could, advanced a catheter to his left main, injected it to see that the left anterior descending, the widow-maker artery, was completely blocked at its origin.

His blood pressure was dropping, and we gave medication to support that blood pressure.  I knew I needed to open that artery.  I managed to get a wire into that artery, inflate balloons within the artery, saw blood start to trickle through.  But there was so much clot that had organized in that artery.

Then his heart stopped.  We did cpr, we shocked him, we provided every intervention at our disposal that we could to save his life.

He didn't survive.

I think about this patient often.  I remember telling his wife who sobbed, absolutely shocked and devastated.

I also think, this didn't need to happen.  What if he had come in a few days earlier when his pain started?  What if he hadn't smoked?  What if he had been to a doctor, who may have been able to treat high blood pressure or high cholesterol?  What if someone had gotten through to him to convince him to eat better, to exercise?

I think about what I could have done differently as well.  He was so sick on arrival, I just don't know that I could have done anything differently that would have saved him.

What's my point?  Heart disease can be deadly.  Even if you have no symptoms, but you have risks -- high blood pressure, cholesterol, family history -- manage those risk factors.  Eat right, exercise, if you have high blood pressure get it under control, if you have diabetes, get it under control.  Quit smoking if you're a smoker.  See your doctor and listen to your doctor.