Chapter 3

Several days later, I was back at work at the clinic. Things were humming along. The folks I worked with knew their stuff, and attended to business. I was charting on my most recent patient, when Melissa touched my elbow.

“Mark, can you take a quick look at the guy in room 4? He doesn’t look so hot. Once I heard his story, I got an EKG. It doesn’t look right to me!”

The EKG was pretty dramatic, with his ST segment elevated around 3-4 millimeters, particularly on the inferior leads. No ectopy (yet), but his T waves were inverted from where I expected to see them. (translation to English from Medical: Not Good!)

I opened his chart, reading “55 year old male, recently ex smoker, complaining of left elbow pain and tooth ache for a day or two”. I looked at his vitals, and reviewed his allergies and medications.

When I got to his family history, I got a bit more excited, and not in a good way. Mom dead of heart disease at age 45, dad dead of massive MI at age 50, brothers have both had multiple coronary arteries stented, sister alive and healthy. His name was Andy Boudreaux.

I entered the room, EKG in hand, and began my interview. “Mr. Boudreaux, what can I do for you today?”

“Well, Doc,” he began, “I guess I’ve got this bad tooth. Really started paining me just yesterday. And, somehow, but I don’t remember, I must have banged up my elbow here, because it’s hurting as well. For some reason, my tooth really got to hurting as I was climbing my stairs this morning, and I figured that the time for waiting was over, so here I am!”

I asked, “Your stomach treating you OK? You breathing like normal?”

“Funny you should ask! I’m kind of queasy, and my breathing gets kind of short when my tooth starts to hurting really bad!”

I listened to his heart and lungs, and poked and prodded. Looking in his mouth, and tapping with a tongue blade, no tooth was tender, none looked decayed.

I poked my head out of the room, saw my MA.

“Melissa, I’m gonna need a bus for my friend here. Right quick like, please!”

Melissa was already dialing 911. “Coming right up!”

I turned to the other MA. “Suzie, may I please have some aspirin, 81 milligram x 4 tabs, please, for my buddy in four? And, let’s give him 4 liters of oxygen, on the double, please!”

“I’m on it!” was her reply, over her shoulder as she entered the med room.

I re entered the room. “Mr. Boudreaux, this here EKG looks like you are trying to have a heart attack, and, from this tracing, it looks like you could be in for a serious one. I want to send you to ER right now, by ambulance.”

“What? How can that be? I’m the healthy one in my family! I’ve never had any heart trouble, ever! This doesn’t make any sense!”

“Uh, sir? It certainly looks like you are, now, as we speak, having heart trouble. That tooth ache? Remember when I told you that I couldn’t see any reason for you to have tooth pain, that your teeth are not tender, and they do not appear to have a single cavity nor any infection? Remember that?”

Dubiously, he answered, “Yeah, I remember. So what?”

“So, one way a heart attack shows itself, not commonly, but it does happen, is for the heart attack patient to complain of tooth pain. Another is for the heart attack patient to have left arm pain. Sort of like that aching you have in your left elbow, without any exertion or injury.”

“So, you think I’m having a heart attack, right?”

“Yep. Are your parents alive?”

“No, my father died ... of a big heart attack ... and my mother died ... of heart problems...”

I prompted him, “And, your brothers and sisters? They have any history?”

“My sister is fine, no problems. My brother Theodore had a heart thing, where then put in stints or something...”

I suggested, “Stents? Like to open the artery in his heart?”

“Yeah, stent, that’s it. And, my other brother, Leonard, he had one of them, too!”

“Mr. Boudreaux, you have symptoms of a heart attack, you have a very strong family history of heart disease, I think that it is foolish to not get it checked out. The best place to have this checked out is the hospital, and that is why” I looked over my shoulder at the voices of my staff giving EMS preliminary report, “these nice paramedics are here, now. Please go with them.”

He looked at me. “Mister, you look as if you know what you are doing.”

I chuckled. “I oughta. I was a medic for a dozen years, and an ER nurse for 20 years after that. I’ve been a Nurse Practitioner for 6-7 years, by now.”

“And, you’re not fooling around, are you? This could be as serious as you’re telling me, right?”

I looked him in the eye. “Mr. Boudreaux, I shit you not: if my concerns are on the mark, you could die from this. Or, you could have such extensive heart damage that the act of turning over in the bed could leave you gasping for breath. Please, do not trifle with this!”

He returned my gaze, unflinching. “Mister, you’ve convinced me. I’ll let these young fellas take me to ER. So, before I go, tell me your name again, please?”

“Mark McFee, sir.”

Thank you Dr. McFee, thank you!”

“Mr. Boudreaux, I’m not a physician, I’m a Nurse Practitioner. My friends call me Mark.”

“Well, Mark, you just may have done a really friendly good deed for me, and I thank you!”

“You’re welcome! Good luck!”

I sat down to complete my charting, and dialed up The Best Trauma Center In Da City, so I could give report.

I had almost forgotten about him, when, two weeks later, Andy Boudreaux announced himself at the registration window. “I want to talk to the finest clinical expert in the Midwest! A fine man, a good friend, and a stalwart savior of the ill and diseased!”

My staff, smiling, looked up. Melissa asked, “Sir? Are you certain you have the right office? This worn out old has been, here next to me, might have been pretty good in his prime, but, sadly, that was a long time ago!”

Mr. Boudreaux was having none of it. “Yes ma’am, that ‘s the guy! Mr. McFee, Clinician extraordinaire, generally all around fine fellow, and hero of the ongoing battle to fight disease and save lives! Yep, that’s the very fellow I am looking for!”

Other patients were starting to peek out of their exam rooms, trying to see what the booming voice was going on about. Mr. Boudreaux was on his game, and waxing eloquent. I rose, smiling, in an attempt to return the atmosphere to one more suited to an institution of healing. “Mr. Boudreaux, thank you for your kind words. What can I do for you?”