Sometimes I Hate Being Good
I saw a little old lady -- 87 pounds soaking wet -- for a gyn exam. We'd done the rest of the physical when I first met her last month, and everything was fine. A little hypertension, well-controlled with minimal meds; nothing else.
It had been about 8 years since her last pap and she was delighted to finally be having it done again. Although usually very conscientious about her health, she had been caring for her husband for the last few years. After his death several months ago, she was ready to take care of herself again.
She felt great. No complaints at all. So today I was just playing gynecologist: weight, BP, thyroid, breast, abdomen and pelvic exam. (She'd had eight kids; no problems there.) Nothing to it.
Silly me. I had to take her blood pressure.
Listening to her pulse between the systolic and diastolic (a nice 132/70) I thought, Man, that's fast. Kind of irregular, too. Felt the pulse at her wrist: surprise! Fast and irregular. I even took a quick listen to her heart. Shock of shocks: fast and irregular.
The gyn exam was perfectly normal for age, but -- silly me -- I just had to go get my EKG machine and grab a quick tracing: rate 150, irregularly irregular; nary a P wave to be found. As I could tell just from taking her blood pressure, she was in atrial fibrillation.
So then I had to go explain to this perfectly healthy, asymptomatic little old lady (and the daughter who brought her) that I wanted her to go over to the ER and be admitted to the hospital for a bunch of tests and drugs and maybe a little cardioversion. (No, I didn't use that word. I said, "They may decide to put you to sleep for a minute and give your heart a little electric shock to see if they can get it back into its normal rhythm again.")
They had a busy day planned, and here I had gone and ruined it for them.