Best Practices in Healthcare Management Begin With Self

Miki Goodwin, PhD, RN, PHN, NEA-BC; Kim Richards, RN, NC-BC

Disclosures

Nurs Econ. 2017;35(3):152-155. 

In This Article

Case Study 1: Heart Health

This story gives a personal account of how a 57-year-old chief nursing officer who, despite doctoral education, resources, and access at her fingertips, nearly lost her life to mismanaged cardiovascular care.

I made an appointment with a cardiologist at the hospital where I worked because I thought I might need an angiogram. He acted surprised and told me I looked great, and that there were many reasons for chest pain other than the heart. I had worsening chest pain, both my parents had died of cardiovascular disease, and I had a chronic autoimmune disease, often associated with cardiovascular burden (Gianturco et al., 2015). He said it was far too invasive to do an angiogram at this stage and instead asked me to smile. Thinking it was a new cardiac test I had not yet heard of, I smiled, whereupon he exclaimed that he had never "seen a Brit with such good teeth!" (my accent revealed my British heritage).

Finally, the cardiologist ordered an electrocardiogram (EKG) and booked me in for a stress test. I had an inconclusive stress test in the past, and was frustrated but agreed I should not have an invasive procedure unless necessary. Westerman and Wenger (2016) provide evidence microvascular coronary dysfunction is more common in women and may not manifest under a traditional stress test, whether or not there is coronary artery involvement. Similarly, Keteepe-Arachi and Sharma (2016) found women may not reach full exertion and symptoms during a stress test simply due to a lower exercise capacity, thus missing a potential diagnosis. That was indeed the case – I passed the stress test with flying colors.

Both the EKG and stress test were normal, which I only knew because the cardiologists' technician called to tell me the results, and then she threw in the idea that the doctor suggested I eat a low-fat diet (my weight was 126 pounds, I exercised regularly, rarely drank alcohol, and had never smoked). In addition, I was acutely aware of recent research which suggests eating a low-carbohydrate diet may in fact reduce cardiovascular risk factors more so than following a low-fat diet (Mansoor, Vinknes, Veierod, & Retterstol, 2016).

The pain in my chest, down the left arm, up the jaw, and across the left shoulder kept getting worse, until walking 50 feet from the garage to the kitchen caused me to stop in pain. On occasion I was even awoken by the pain. Once, walking to the cafeteria at work I thought it was all over – there was that crushing, elephant-on-the-chest feeling commonly described as a heart attack. Somehow, I remained standing, extremely still, breathing deeply, and determined to make it back to my office. But the cardiologist had told me it wasn't my heart, so, convincing myself there were other reasons for chest pain, I continued to work and stopped as often as I needed to, avoiding grocery stores and not walking any more distance than I absolutely needed to until this left "rib" pain went away.

Thankfully my nursing colleagues were not intimidated and encouraged me to return to the cardiologist, which I did. But I did not even see the doctor. The technician performed an EKG, pulled off the strip and disappeared. A few moments later she returned saying the cardiologist had looked at the EKG strip and it was fine. I could go. A few more days passed – a trip to a wedding in Europe was cancelled – my husband could not imagine getting me on a plane in this condition. He was right.

Eventually, in desperation, a nurse practitioner colleague called her own female cardiologist and I was seen in her office that day. Declining help, I drove myself 30 minutes to the new cardiologist, stopped three times from the parking lot to the office due to pain and finally presented exhausted, with a blood pressure of 220/110 mm Hg. Suddenly, everything took an urgent turn. The cardiologist asked me to call my family, a bed on the telemetry unit was being arranged (no, I could not go home and feed the dogs first), and I was to be driven to the hospital. I was to sidestep the emergency room to be admitted directly and an angiogram was arranged – stat. The cardiologist stayed with me until my ride arrived, comforting, telling me that soon we would know for sure what was going on, and wondering why I had waited so long to get help.

That night, an exceptional interventionist somehow inserted two stents into a 99.89% blocked left anterior descending artery, avoiding by-pass surgery. A month later, due to continued (although significantly reduced) pain, two more stents were placed into the right coronary artery. At the same time, a diagnosis of pericarditis was made for continued (although different) pain, although remarkably there appeared to be no long-term damage to the heart muscle.

A few months later, having completed cardiac rehabilitation and returning to work, it struck me how lucky I was to have had caring professionals around me despite an initially disappointing encounter with the male cardiologist. Then I was mad; how dare he ignore me and tell me to eat a low-fat diet? How dare he joke about my teeth when there was such a serious health issue at stake? How different the situation was with the new cardiologist; we were on texting terms with each other (careful not to abuse the relationship but thankful for the reassurance) and, at her suggestion, I took on the crusade for women's heart health.

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