Joe passed away outside in the parking lot while they were getting on a helicopter for transport to a hospital equipped to do his surgery.
He had presented to the ED in terrible pain with lots of thrashing and writhing. His right hand was very cold. His right arm tingled to the point of hurting bad. The vision in his right eye was cloudy, and his hearing was muffled on the right. This was in addition to being very pale and diaphoretic upon admission. This is when I felt a dissecting aorta should have been suspected.
I don’t recall the vitals in the beginning, but they were changing and his blood pressure was dropping very fast. As soon as they finished the EKG-in the first 5 minutes of the visit, I asked the doctor about John Ritters death [the actor died of a dissecting thoracic aneurysm in 2003]. First I asked if he could check for the condition that caused John Ritters death. I called it an abdominal aortic aneurysm. The doc corrected me and said that it wasn’t an AAA it was a dissected aorta. I said OK, then check for that. This was 1 hour before the CT scan that led to his diagnosis.
After the conversation about the dissected aorta the doctor said they are going to check for a lot of things. I am getting pretty anxious at this point because Joe was in so much pain. I have never seen anything like it. The nurse walked in really slowly with a syringe and a paper cup. She went to the keyboard and starting asking him questions. Again...really slowly. I kept looking at that syringe wanting her to give him that shot. It turns out the shot was for nausea.
Then she gave him the cup with Maalox and lidocaine and said that would let us know if it was heartburn or not. She said we had to wait about 5 minutes. Joe assured her that it was not heartburn. After about 15 minutes, I went to the nurses station to ask for help. I said that I hated to be one of those kind of people that go to the nurses station to ask for help, but we really needed it. I said please do something for his pain. The response was “The doctor is putting in an order now”. Then she told me that first they are going to take him for a chest x-ray. After x-ray he got his first dose of morphine. That was the end of the casual part of the visit.
When the CXR came back there was a noticeable “flare” of the ascending aorta. Then we had to wait for the radiologist to call back and confirm. That ate up about another 20 minutes. Confirmation was made and CT scan was ordered and another dose of morphine was given because Joe couldn’t be still for the CT. Things went into full tilt at this point. Life flight was called; surgeons were contacted. We had to go to another hospital because they couldn’t crack a chest at the hospital where we were. I did not realize hospitals had these kind of limitations. Had I known, I would have taken him straight to our medical center.
He went into cardiac arrest as they put him in the helicopter. The doctor came out and started doing chest compressions. Common sense told me that chest compressions were not going to restart a heart with a tear in the aorta. I knew it was over at that point. The doc came to me and said they were going to take him back in and put a tube in to get him breathing. I knew he had bled to death and the tube was not going to do anything.
When he was recapping after Joe died, the doctor said to me that he had wanted to make sure this was not a lot of drama. I could tell that was his attitude from the get-go. Joe had every symptom of an aortic dissection. He may have had about a 30% chance of surviving the surgery, but they let the clock run out.
My husband was 54. We had two children late in life—my husbands only children.
I do blame misuse of the ED. As doctors, you have to sort out the motivations of every patient, not just the symptoms. Not to mention the people that use the ED as a regular doctors office. I get irritated when patients complain that the ED doc wasn’t nice and compassionate when they went to the ER for pink eye. They don’t know if this doctor just had to tell a mans wife that her husband died of an aortic dissection. That can affect a doctors mood.
I feel like I am doing something good for my husband by creating awareness for ED misuse and overuse. I think the doc was skeptical about Joe’s pain. ED docs see all kind of crazy stuff. They see the good, the bad, and the ugly. I believe a kind of “burn out” contributed to Joe’s death. There were 2 pink eye patients the night we were at the hospital. How can an ED doc not be burned out?
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