I was staring into the viewfinder of my video camera, taking a family photo at my in-laws' 50th wedding anniversary party, when I noticed my father-in-law had a peculiar look on his face. "Iâ€™ve seen that look before," I said to myself. "Why does it make me uncomfortable?" Then it came to me, and I shuddered.
A Quiet Family Crisis
It had been 5 years earlier, at my daughterâ€™s high school graduation from Interlochen Arts Academy in beautiful upper Michigan. The family had rented a condo where we spent several days of non-stop celebrations. One morning, as usual, I awoke early, and while others were sleeping, went out to the patio to do some reading. There stood my father-in-law.
"Hi," he said.
"Hi Dad, how are you doing?"
"Not good. I think Iâ€™m dying."
"What's wrong? Are you having pain somewhere?"
"No, I just feel like I'm dying."
Puzzled, I took out my equipment and checked his ENT, heart and lungs, circulation. Nothing.
Later, when my wife awoke, I filled her in.
"Don't worry, honey, that's just my dad. You know he has mental problems. He says things like that all the time."
Still, I worried, and spent the next few days watching him carefully, until my in-laws got in the van and set off for their home in Virginia. The next I heard, he was admitted to a hospital in Virginia for congestive heart failure. He had had a heart attack at the graduation, causing cardiac muscle damage leading to congestive heart failure! And I had missed it! What kind of doctor am I anyway, when I miss a family member having a heart attack right in front of my eyes, and I do nothing?
Staring into my viewfinder, I realized that this was the exact same look he had had 5 years before!
"Dad, are you ok?"
"Are you having chest pains?"
I sought out my wife.
"Honey, I think your father is having another heart attack."
"He can't, we're in the middle of the party. Can you be sure?"
I thought to myself, "You've got a problem. You've got a guy here who's having a heart attack, and he cannot admit it. If you make a scene about it, sounding the alarm to the crowd, who would believe you? He insists he is fine. But if you do nothing, the party could be interrupted by paramedics doing CPR on your father-in-law in the middle of the dance floor. That would be bad. It's time to get creative. Work behind the scenes."
First, find out where the nearest ER is. Ask a hostess. Great, it's not too far from the hotel. Then, talk to Dad. "Dad, you look tired. I could drive you to the hotel where you could lie down for a few minutes. I insist."
Subtlety Triumphs Over Stubbornness
It worked! As I escorted him from the banquet hall, I grabbed my brother-in-law. Best to have someone in the car who can help if Dad arrests on the way to the ER. "Don't ask questions; just get in the car with us."
As we passed the hotel, he became suspicious.
"Where are we going?"
"I just have to stop by the hospital here for a minute. Doctor business. Why don't you come in with me, you'll be more comfortable."
As we walked in the door of the ER at this very small hospital, my heart sank, because there was no one in sight. What do I do now? Try bluffing. I walked down the hall until I found someone sitting at a desk. "I've got a 70-year-old man out here in the waiting room who's having chest pain." Suddenly people in white coats appeared out of nowhere, Dad was put on a stretcher before he could object, then hooked up to a monitor, an IV placed. Moments later, a cardiologist was looking at his monitor strip with concern and asking, "So, Mr. West, how long have you been having chest pains?"
"Not long, about 4 hours."
Whew, that was a relief. If he had denied having chest pain, or if I had been wrong and his monitor did not indicate he was having a heart attack, would I have been in trouble? On the other hand, what an awful thing to have happen. You're at your 50th wedding anniversary party with all your family and friends and you have a heart attack.
Allâ€™s Well That Ends Well
I left the ER, telling my brother-in-law I would be right back, and returned to the party. As I stepped into the banquet hall, I found the crowd strangely silent, and everyone turned around to look at me. I motioned for my wife and took my mother-in-law by the arm. She deserved to know first. "Mom, Dad just had a heart attack. He's at the hospital with Paul. Honey, would you explain to the crowd? I'll take Mom to the hospital."
It all turned out well in the end. Dad was transferred the next day to a medical center, had his bypass, and never had another problem with his heart. The family never asked how I knew what was happening or how I managed to convince Dad, an expert at denial, to get medical care. They just stared at me a lot as though I had done something magical. I can only say that sometimes you, as a doctor, just know something, in spite of any arguments to the contrary. You summon up your creativity, learned from years of dealing with patients, and you make it happen. Or maybe it really is magic.
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