Looking Through a Different Lens: What I learned from my day as a STEMI patient

It’s 11:00 in the morning and I am at a friend’s house. I develop severe chest pain, become short of breath and believe I’m having a heart attack. My friend calls 911 and EMS personnel arrive within four minutes. Within ten minutes of their arrival, the paramedics have me in the rig, perform a 12-lead electrocardiogram (EKG), and confirm an inferior myocardial infarction (MI). The paramedics call the emergency department (ED) physician, and then the cath lab is activated for a Field Activation Acute Myocardial Infarction. My right coronary artery (RCA) is reperfused 34 minutes from the time the first 12-lead was performed. In addition, the time from calling 911 to performing that ever-important 12-lead is under fifteen minutes. This mock scenario played out almost flawlessly, thanks to the efforts of all those involved. I am a cath lab technologist, and ten-year veteran in the cath lab. I serve on the AMI Pathway Committee at Maine Medical Center in Portland, Maine. Hospital staff, EMS personnel, and ED and cardiology physicians acted out a scenario that we hoped would make the process of bringing in and treating an acute MI patient feel like the real thing. We had a set plan and purposefully put this process under a microscopic lens, taking notes and videos. Follow-up meetings were held to discuss what worked, and what didn’t. All involved in the chain of survival took this mock process very seriously, as those that work in patient care always tend to do. We all realized that this event would help expose little things we could fix that would help make the door-to-balloon process better. Yet it came by surprise that I learned an invaluable lesson. I saw what it was like to be on the other side of a heart attack. My lens, or perspective, was through a patient’s eyes. Things we take for granted or perceive as no big deal were magnified by my over-sensitive perceptions of my surroundings. I was fully aware of all that was taking place. Ambulances, emergency rooms and cath labs don’t provide a calming effect. Paramedics, doctors, nurses, and cath lab techs standing over you and asking question after question leads to anxiety, and to my surprise, embarrassment. Losing control, feeling weak, vulnerable and helpless are ways to describe my response. I liken my experience to a combination of confession, being cornered by a large pit bull, flunking out of college and tripping at your wedding. It is truly that stressful. A large part of my stress resulted from my interaction with so many people. I physically talked with very few people, but had sort of a sensory interaction with many. What I mean by that is in an emergent situation as a patient, your physical and emotional state causes all of your senses to be maxed out. I’m speaking not only of sight, sound, and temperature, but I am also referring to an incredible increase in perception. I could sense concern, compassion, frustration and apathy in people’s eyes. I could read confidence, mood, anxiety and nervousness in my caregivers’ body language. What really surprised me was an ability to perceive a person’s enjoyment or disdain at their role in my care. Strange as that sounds, it was very obvious when you are at the mercy of others. One may argue that we were acting out a mock drill, so therefore what I experienced may not be true or real. I saw it differently. I witnessed professionals treating me as if I were their own family member having a heart attack. It may be a cardiology fellow that looks you in the eye and carefully explains the risks and benefits of a procedure, instead of just having you sign a consent. It may be a paramedic that explains every step to you, instead of moving at a silent and frantic pace. It may be a nurse or tech that stands over you, performing an apparent task in robotic fashion, never acknowledging your presence. I am in no way stating that my care was anything less than exceptional. During the entire process I could see that patients were well cared for by a group of professionals. While my experience did expose me to the entire process of emergent care, I was also exposed to something much more important. As a health care professional, I have a job to do, and something more. I have the responsibility to constantly monitor myself in my interactions with patients. All of our patients are scared and look to us to help them. We help them when we stent 100%-occluded proximal RCAs and preserve normal left ventricular function. We also help them with a smile, a calm and assertive/confident demeanor, and by taking a comforting second to introduce yourself to the patient. We have to constantly filter our words, for a harmless word with a negative connotation can wreak havoc in the mind of a terrified patient. A crash coming out of the elevator or a sudden exposure of a patient’s groin without explanation will leave some patients that much more traumatized. I mention the last two things from my personal experience as the mock patient. While these events may just have been part of the process, I still remember that exact feelings and sensations of those events, and those events were over a year ago. I feel very fortunate to have been able to participate in a life-saving mock scenario. I wish all of us that work in emergent care could experience what I did (minus the actual STEMI). My experience forever changed the way in which I interact with patients, and, in fact, all health care providers. My hope is that by sharing my experience that maybe we all put ourselves in the shoes of that next acute MI patient (or patients in general), and then he or she will be able to deal with one of the most traumatic events in their lives a little bit better, because of you. David Tapley can be contacted at tapled@mmc.org

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