At 42, she has no business showing up here. Why are we trying to rule out a heart attack on an otherwise seemingly-healthy 42-year-old woman?
The admission questionnaire prompts me to ask, "Do you presently or have you in the past had any stressors in your life?" In my many years of being a nurse and a human, period, I realize that questions like that put people on the defense, so I ask instead, "Do you work hard?" She belts back as if to guilt me for asking. "Of course I work hard, I am a single mom," she responds as she holds back tears.
And then I engage her story. The story is all too familiar: single mother, Wall Street, trying to crack the glass ceiling. I needed to pay closer attention to this.
Some of my most memorable moments in nursing have been on a cardiac unit. In dealing with an organ as delicate as the heart, it is amazing to see how far we've come. Placing stents to open up clogged up arteries is pretty standard for cardiologists, and knowledge on how to convert lethal arrythmias is standard training for critical care nurses.
I received a bouquet of roses from a boisterous patient one Saturday afternoon. Strapped to him was a life vest defibrillator. This was put in place to immediately treat any arrythmias as soon as they were detected because he may not be as lucky as the first time. It was temporary while he waited for a permanent one to be surgically placed. He was cardioeverted just two days prior after a lethal arrhythmia sent him almost flying out of his bed. I would be his nurse on the first day he started to feel like himself again.
He had beaten death, he claimed, and he was especially grateful to the nursing crew for this. Sometimes, surviving a heart attack makes you do strange things, like claiming you beat death or giving a bouquet of roses to a complete stranger. Or maybe not. Before the day was over, I had been introduced to the entire family, their personal stories and plans for the future -- now that he was getting "a second chance" at life. We were living a miracle. This is nursing.
There were many scary events on the cardiac units I worked on, but perhaps none as disturbing, for me, as the trend of seeing younger patients presenting with heart attacks.
She smokes, and she is stressed! This is a bad combination concerning the arteries. I thought this would be common knowledge to a 42-year-old corporate executive. Of course, I am wrong. The culture of the corporate world is sometimes harsh on a person's reasoning as well.
The first troponin level is elevated, I make the announcement, she remains on her computer typing away. "I have some work I have to finish," she says, tears streaming down her eyes, eyes firmly fixed on the laptop screen.
I am thinking, she may have suffered a heart attack, and she thinks work is more important! I excuse myself from the room because I am very sad for her, and I am feeling uncomfortable. Soon enough, I may start to cry.
Two days later, another seemingly-healthy 45-year-old has a heart attack right in front of my face. The day started out normal; he came in with chest pain. The first troponin level was normal and we waited eight hours to recheck the level.
I receive a call from the lab: The second troponin level is critical! The cardiologist scrubs into the cardiac lab within minutes, he needs a cardiac catheterization immediately. A little while later, the verdict is in, stents won't do it. We are all sad. He is perfect, perfectly healthy, except he just had a heart attack at 45!
Sitting at the edge of his bed, we make the announcement, "You need a bypass, more than three arteries are occluded, stents won't do it... it's open heart surgery." He is crying, I am confused. This is a lot for me. I leave the scene to go inhale my environment. I am not in a geriatric bay, or am I? Yes as we grow older our body changes, we clog up our arteries. But 40s isn't the new 70s, or is it?
A few days later, another 40-year-old female corporate executive is discharged. Despite the horrible chest pain, the troponin level is normal after the three routine checks. No signs of a heart attack! Not this time at least. "We advise that you rest," I say, as I go through the discharge instructions. When I bring her to the front lobby to be discharged, she announces that she is going on a cruise and will keep all electronic devices at a distance. Her husband assures me that this time, it may be true. I'll take their word, not like I have a choice. I'll probably never see them again; that's also nursing. Patients come and go.
But I remained really worried, because I was seeing more and more younger people suffer heart attacks. The recent death of Moritz Erhardt, an intern at Bank of America Merril Lynch -- of still-unknown conditions -- has prompted a closer look into the stress young corporate employees face on the job. It personally put me on the edge! Stress-related heart attacks never used to be common in young people, and perhaps many of my patients started out working as hard as Moritz was described to be working in the days prior to his death.
Yes, there are other risk factors for heart attacks including family history, diabetes and smoking, but stress is bad business for your heart, especially as a young person. I question the "fad" among young employees that to get an edge in the corporate world. They must work harder than their peers -- to exhaustion. What happened to the ethics of efficiency? Working "well" and not necessarily "more."
The corporate world -- as part of orientation 101 -- needs to ensure that young employees understand that building an amazing career will only worth if they are healthy -- and with a good heart --- to enjoy it!
This reflection is in commemoration of World Heart Day: Sept. 29, 2013
For more by Ajarat Bada, click here.
For more on stress, click here.