Reverse Culture-Shock

Since I was just rudely awakened by the CCU charge nurse that we have a patient with an ST-elevation myocardial infarction (translation: bad heart attack) being flown in from South Jersey at 4:30 in the friggin' am, I thought since I'm up, why not throw in a blog entry?

I guess I shouldn't be surprised at the degree of reverse culture-shock I am experiencing as a result of going straight from a public hospital in Botswana, Africa to the Presbyterian Medical Center CCU. For starters, there's the 73-year-old male patient with a history of heart disease bad enough that he's already had a triple bypass surgery, bad emphysema due to smoking so much so that he has a chronic tracheostomy (a hole going into his trachea which allows him to be attached to a ventilator easily since he often can't breathe on his own), diabetes, hypertension, severe peripheral vascular disease with stents already having been placed throughout his body, and heart failure. Why is he admitted? He's admitted for an ICD evaluation. An ICD is an intracardic defibrillator--a device which is implanted in the heart and when it detects a potentially fatal arrhythmia delivers a brief shock intended to flip the heart back into a normal rhythm. So an ICD in this gentleman will basically prevent him from having any chance of passing slowly and peacefully into the night.

No who am I to say that he shouldn't get one? Maybe he wants to fight the good fight up until the end, and if the technology exists and he's willing to take advantage of it--let's go for it. It is, however, hard to justify from the perspective of limited health care resources. ICD's cost good money, and spending it on a 73-year old guy with multiple horrendous medical problems and a limited quality of life (he currently lives at a ventilator facility--basically, a nursing home which knows how to take care of patients with tracheostomies who may periodically need to be hooked up to a ventilator) are probably not the best bang for your buck.

Anyways, it turns out that he may not even get the ICD...we need to do a bunch of tests first and then decide. But this dude would have run out of options about 20 years ago had he been living in Botswana...