“Sorry Felix, I am Bea. I am calling you from the Emergency Room Observation. The 061 has just brought a 73 year old patient with chest pain and ECG similar than another made a month ago. He had and acute myocardial infarction eight years ago. He has moderate efforts dyspnea, good compliance with medication and although he presents frequent precordial pain both at rest and with effort, this evening has been more prolonged and strong. The pain started about 00.00, when he was going to lie to his wife. He takes care from her, by not having another family or assistance. The 061 told us that until he has not lying her, he did not want to come to the hospital”.
I ask what the situation is now. “Very discreet discomfort, other ECG without changes, and he is very worried because he has left his wife alone”. I told Bea to start conventional therapy, curse analytical markers and phoning me back with the results.
04:38 AM. The phone rings again. “Hi Felix, I’m Bea, troponin 3.56 and CK 331”.
“Good night sir. My name is Félix Martín. I am a doctor of the ICU. Tell me what has happened to you”. After repiting the story above, he adds: “I’m well and I want to go. My wife is alone and I do not have anyone to stay with her”. I explain his situation and the convenience of staying to treat and doing an hemodynamic study. “No. I’m going. My wife is alone and I must be with her. We have been 54 years together and she needs me now more than ever”. I ask him time to start therapy and contact with the social services at 8:00 AM to send someone their home to stay with his wife. He is not very convinced, the chest discomfort reappears. He breaks into tears, emotionally shaken. “Give me until 8:00 AM and if I have not resolved the company to your wife, I will give you the discharge with an accurate prescription”. He accepts with reluctance.
Someone goes to their home, so he is informed and agrees to be for angiographic procedure. The angiographic report is crucial: he requires surgery. We tell him the situation. He is very sick and there is only surgical solution. “Dear doctor, I will be with my wife while God wills, we think go to a residence and we have agreed that the first coming will soon expect the another.”
He was discharged home the next day. Sometimes, less is more.