Conveyor Belt Medicine: Where Are the Brakes?

"Wisely and slow; they stumble that run fast." —William Shakespeare

I stumbled when Ms B was my patient. I met her for the first time as she lay on the cath lab table, draped in the overflowing sea-blue sheet with only her face visible to me. Her blonde hair was sticking to the beads of sweat on her temples. I felt a familiar heaviness at the center of my chest—an inner voice of caution that is amplified when I don't get time to evaluate or talk to the patient before the procedure.

Jaya Mallidi, MD, MHS

I introduced myself in a muffled voice through my mask. "Ms B, I'm Dr Mallidi. Do you have any chest pain now?" She drowsily replied, "No." I looked at the ECG. The machine-interpreted reading said, "Anterior ST-segment elevation myocardial infarction(STEMI)". I saw the tall T waves in the precordial leads without any reciprocal changes. I looked at Ms B again. A serene countenance. Not what I would expect from an ongoing STEMI. Ignoring the increasingly uncomfortable tightness in my chest, I calmly asked the nurse, "Do we have labs? What is the potassium?" After what seemed like an eternity: "We don't have any lab results. They couldn't be drawn in the emergency department."