I

was called to the ER as an elderly woman, who had suffered an out-of-hospital cardiac arrest and was found to have inferior ST-elevations on field EKG after successful resuscitation, was brought to our hospital. I was informed by my colleagues, who had heard about the patient, that I should recommend conservative management as there was constant scrutiny on hospital mortality statistics and she was at high risk for not surviving with or without any cardiac intervention. I was puzzled by this pre-emptive life or death decision making when none of us had seen the patient or talked to the family members. I rushed to the ER, where I saw an elderly person intubated and cardiac monitor showing ST elevations. Fortunately, she was hemodynamically stable and had concerned family members with her, one of whom was a cardiologist practicing at another hospital. He informed me that she was the matriarch of the family and they would like everything done.

As a cardiologist he was also aware of the implications on the hospital reputation regarding the impact of mortality statistics, but he conveyed the family’s wishes with the facial expression of uneasiness as the final decision was still up to me. I grabbed his hand and reassured him that I would be happy to take the patient to the cath lab and take good care of her. He shook my hand firmly and thanked me for the family regardless of the outcome. I was met with some passive-aggressive attitudes by everyone in the cath lab as they seemed certain that she would not survive and we were wasting our resources. It was a very uncomfortable feeling, given our mission to help patients first and not to be concerned as much about non-medical issues. Fortunately. I was able to promptly recanalize her occluded dominant right coronary artery. I went to the waiting room and informed the family that the procedure went well and hoped for the best as the outcome of these cardiac arrest patients depended more on their neurologic recovery rather than cardiac performance. They seemed both relieved and still concerned for their loved one.

As I did not take care of in-patients, she was sent to the Coronary Care Unit after the procedure and I didn’t get to see the patient again until I had to visit another patient after a procedure on the step-down floor several days later. I heard much happy noise coming from a patient room and just happened to glance at the open door, when I saw the same patient surrounded by many family members, both young and middle-aged and they were having a fun family time. The cardiologist, who was a nephew of the patient, saw me and came out smiling, saying that she had made a remarkable recovery and that the entire family was so grateful that she had undergone the cath lab procedure. I was elated to hear about both her recovery and the impact it had had on so many family members. I promised myself then again that I would put the patient’s health above any artificial dilemmas posed by non-medical issues. I also reminded myself that a patient’s health does not impact just him or her, but the entire family and social network. Our mission and work become much more focused when we concentrate on patient care first rather than be influenced by artificial dilemmas.