Tuesday, October 21, 2008


I had to take some time yesterday afternoon to sit by the river with the dog. We watched a kingfisher fly, screeching, along the water. We watched the fading light change on the yellow leaves as the sun went down.

It was a draining day. One of my morning patients had recently been diagnosed with breast cancer. She was still reeling from the recent suicide of her son. Her grandchildren had been taken out of state by their mother. My patient sat in the exam room in tears, apologizing for making a scene. She lives alone in her little house in the mountains, only coming into Las Vegas for food and doctor's appointments.

I told her to make a scene. A big one.

At lunch, I recieved a text message from my father "atrial fibrillation. Pres ER". I panicked. I was calculating how long it would take me to get home on my bike and drive the two hours to Albuquerque. I was trying to sort out who could feed the dog. When I was finally able to get ahold of my dad, he was stable and in the process of being discharged, and had an appointment with a cardiologist. This morning he sent a text message that said he felt great.

I made a big scene.

Atrial fibrillation is serious, but not fatal if corrected. Its a fairly easy to manage cardiac condition in which the electrical system is disrupted and the normal, regular heart beat is short-circuited. The rate increases and the rhythm is jerky. That's how I was feeling, short-circuited and jerky. But, though this is a condition that should cause concern, its certainly not panic-worthy. Unless its your father and you are two hours away.

If this was a patient, I would very calmly give some oxygen, call the ambulance, and take the other appropriate actions. If this was a patient, I would explain what was happening in a rational, calm matter, being certain to reassure them and their family. It wasn't, though, and I lost my cool.

So, Wanda and I spent some quiet time on a ledge above a bend in the Gallinas river, feeling the wind, and watching the storm blow in.

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