GETTYSBURG MEDICAL NEWS
THE CLINICAL VIEW
By: Phillip E. Hoffsten, M.D.
08, March 2001 

Every So Often We Do Something Right.

It was the spring of 1980 on one of those cold April mornings when a gentleman was driving to an early meeting. The state patrol came upon his automobile in the ditch on the side of the road with the gentleman still behind the wheel now with a broken leg and a broken collarbone. He had several abrasions on his face and was brought by ambulance to the emergency room. The state patrol car that followed him to the emergency room described how the car had just seemed to run off the road in a slow steady way with no attempt on the driver’s part to right the automobile. The patrolman said that he thought the patient was unconscious when the accident occurred. I asked if he meant “asleep at the wheel”, and the patrolman indicated that usually people will pull back on the road as soon as the ride gets a little rough from the gravel on the side of the road but on this occasion there was no attempt to right the automobile. In the emergency room, the patient was alert, and he indicated that he did not know what had happened. He said that he remembered driving towards town, and the next thing he knew, he was in the ditch on the side of the road and the state patrolman had arrived. This story was an alert that there was something wrong with this gentleman’s heart. 

Later that day in the intensive care unit at the hospital, the gentleman had a cardiac arrest lasting approximately 30 seconds. This is a type of rhythm called “torsades de pointe” in which the heart will develop a chaotic ineffective heart rhythm for seconds to minutes and then very often self-correct. If allowed to pursue natural history, this rhythm is very frequently, eventually fatal. Episodes of dizziness, fainting and unsteadiness are the warning signs that this type of rhythm may be occurring. Indeed, on further questioning of the gentleman in this case, he had been having those types of symptoms. An involved evaluation followed and it turned out that this gentleman had a hereditary condition in which the wiring system for his heart degenerated causing the abnormal rhythm. In years past, there was no real treatment for this particular problem. However, in 1980, when this occurred, a new drug called amiodarone was still in the experimental stage. Amiodarone stabilizes the wiring system for the heart and prevents the abnormal fatal rhythms that occur. This medication was started and now 21 years later, this gentleman continues to do well and is still professionally active in his business. Along the way, the wiring system in his heart degenerated to the point where it would no longer initiate a heartbeat and a pacemaker had to be placed. With the aging of his heart and the deconditioning there associated, his heart developed an irritability that again allowed an abnormal rhythm in spite of his amiodarone drug treatment. In 1995, he was provided with a device called an “implantable automatic defibrillator”. This type of device is so sophisticated that it can recognize the rhythm the heart is generating, analyze the rhythm to determine if it is normal or abnormal and then deliver an electric shock to correct an abnormal rhythm if such is occurring. Thus, if this gentleman develops the abnormal rhythm, he is automatically shocked back into a normal rhythm by this device which is no bigger than a compass and implanted beneath the skin on his left shoulder. This same device also now incorporates his pacemaker. The batteries last for four to seven years depending upon how many heartbeats and electric shocks the device is required to deliver. It is amazing to contemplate that if a person has a pulse of 60 beats a minute, this pacemaker device can deliver 72,000 heartbeats per day for four years before the battery has to be changed.

I saw this gentleman recently approaching his ₈₀th birthday. He indicates that he has some arthritic complaints, some difficulty with constipation and cannot do all of the things that he would like to do. But, he says that the 21 years that he has had since his original automobile accident at age 59 have been very dear. He has had the chance to see his grandchildren get married and have his great-grandchildren, something that would not have been possible without modern cardiac care. 

I am often discouraged by the unrelenting negative press attacking healthcare in the United States. We hear about side effects of drugs, devices that don’t work, operations that don’t work, Medicare fraud and abuse, the high cost of drugs, etc, etc, etc. Each one of these are spectacularized and describe how somebody was maimed or died or crippled by another medical mistake. The press needs to terrorize the public with stories such as mad cow disease which this country has never seen. 

The story of the gentleman in the automobile accident above was recently used in a presentation to a group of heart patients. As the story was finished, a member of the audience stated, “Every once in awhile, you guys get one right.” It needs to be stated that the healthcare profession including the nurses, the pharmacists, the lab technicians, the physicians, the nurse practitioners, the electronics industry, the pharmaceutical industry, the physical therapists, the occupational therapists and countless other members of the healthcare profession “get a lot of them right”. Making no claims of perfection, the continued improvement in the provision and excellence of your healthcare is the thrust of the entire group of providers. 

The provision of your healthcare starts with you. You need to be aware of the risks and benefits of your healthcare endeavors. Advice regarding those healthcare practices is best obtained through your local clinic with periodic checkups and discussions. Who knows? You may be the next one that we get right.