Zebra

Part Two, The Hunt

This is the second in a series of posts about Emily’s past few months. If you missed part one you can read it here.

The next morning after her episode the ER doctor taking care of Emily got her an echocardiogram. It’s essentially an ultrasound for your heart. It came back fine. No abnormalities. A cardiologist came by and ran down some of the basics. They finally gave her a beta blocker, which effectively slows down your heart rate. After a few days of no one being able to find anything physically wrong with her, Emily was discharged from the ER. She was given no follow up instructions. They said is was a fluke.

So she went back to work. She took a beta blocker in the morning and it seemed to keep her rate down. We had decided that she probably shouldn’t drive until we had this thing managed so I drove her there in the morning and picked her up in the afternoon. Around noon on her second day back I got a call from her. For the second time in a week it was not her on the other end.

I rushed back down to the ER. I was told that she was taking an exam at work and almost passed out sitting down. Luckily her attending was next door and came by to check on her. By the time I was allowed back to see her she was stabilized. Pumping her full of IV fluids seemed to help. It was a rainy day so the ER was flooded with accident victims and there were no beds in the hospital. The only bed they had was in the trauma bay. She was placed between two people who had been in a car accident. With each other. It made for an interesting human drama and helped to pass the time.

On your second visit to the ER for the same problem, you tend to be taken more seriously. An electrophysiologist came by and checked on her. This time the tests were getting a little more serious, checking for thyroid disorders and blood clots. He had her stand up and sit down to see how she reacted. She nearly passed out. All her tests and labs came back normal. You could tell by the look on his face that he was puzzled. He told her that he wanted to have her admitted onto the cardiac floor. There were, of course, no available beds. So we stayed in the ER overnight and on into the next afternoon.

Fact. the environmental services team buffs the floor in the MVC ER at 4 in the morning, every morning.

Fact. If you have a vagina you will have your blood taken at 5 in the morning, every morning to make sure you did not become pregnant at some point during the night.

We received some worrying news early the next morning. She was listed as NPO, a designation given to someone who is about to have surgery so that they will not be given anything to eat or drink. When we asked about it the resident told us that she was scheduled for a heart ablation, a procedure where they insert a catheter into your heart and use radiation to kill part of it, forcing your heart to beat permanently slower.

She was eventually admitted. We fought to hold off on the ablation and the doctors agreed that that was a step too far at this point. She spent a total of 6 days on the cardiac floor for monitoring purposes. No one had any clue what was wrong with her. They were starting to see some of the symptoms though. She was retaining fluid like someone suffering from dehydration, although her labs were coming back that she was hydrated. There was no evidence of any virus having effected her recently. Without a beta blocker, her heart rate would jump to 140 upon standing and return to normal when she laid back down. Her blood pressure was dangerously low upon standing. She had no appetite.

Quite a few specialists came by to see her. Cardiology, electrophysiology, endocrine, etcetera. As expected they all ran the tests that they knew how to run. Have you ever heard the saying, “when all you have is a hammer everything looks like a nail”? I’ve come to realize that many specialists tend to fall victim to that. Heavily. If you see a cardiologist, for example, they’ll examine your heart in detail without looking at anything else. They all assume that the last guy did a good job checking the other stuff. Needless to say, none of them were of any help.

Speaking of sayings, doctors have one as well. “When you hear hoofbeats, think horses, not zebras”.

This is part of their basic training. Work up the most basic possibilities and rule them out. 99 out of 100 problems are diagnosed this way. Sometimes, however, this brand of logic leads to misdiagnosis, or no diagnosis at all. Sometimes a patient is that 1 out of 100.

It was time to start looking for stripes.