Lester Burr was alone in the office Friday afternoon. Doris had dropped him off to go to the hairdresser. His diabetes visit went smoothly; he had normal blood pressure, cholesterol, kidney function and foot exam. His eye doctor report was up to date and none of his medications needed to be renewed. He has no history of heart disease and had not had any chest pain, heart palpitations or shortness of breath.
Just as I was preparing to leave the exam room, Lester gave me a funny look and said in a tentative voice:
“Why am I so dizzy?”
“Have you been dizzy for a long time?” I asked.
“No, it just started.”
“Do you feel like you or the room are moving or spinning?”
“Do you feel sick to your stomach or lightheaded? Tell me more about what it feels like.”
“I don’t know.”
A quick neuro exam was unremarkable, but Lester started to look more and more uncomfortable. He wiped his forehead. I could see pearls of sweat. Suddenly, he burped and then said in a low voice:
“I think I’m going to be sick.”
I got him to lie down on the exam table and put an emesis basin in front of him. With my other hand on his wrist I checked his pulse. It was slow and weak. He vomited profusely.
“Hold on”, I said and stuck my head out the door to call Autumn, my nurse. She appeared instantly in the hallway.
“Autumn, call the ambulance and let’s get an EKG.”
She reappeared within moments with the EKG cart. I got another blood pressure, much lower than when Lester first checked in. His EKG had a hint of ST elevation – a possible anterior myocardial infarction.
One of the office nurses started an IV before the ambulance came.
“Which hairdresser does Doris go to?” I asked.
“The one next to the Post Office”, Lester whispered.
Autumn dashed out to call Doris, who soon appeared with her head wrapped in what looked like a turban.
By then the ambulance arrived and soon Lester was on his way to the hospital.
I knocked and entered the next exam room.
“I’m sorry to have kept you waiting. We had a little surprise with another patient…”