Author Topic: Medically trained: Will a heart attack victim argue about the diagnosis?  (Read 1073 times)  

Offline antares

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Situation: Senior detective is presenting symptoms: pain down the left arm, shortness of breath, irregular pulse. He is conscious.

Junior partner reports these symptoms over the radio, and the cop on the other end says it sounds like a heart attack. Senior detective denies that it is a heart attack. Says it ain't. Angry that the other cop said it is.

In your experience, is that a believable scenario?

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Yes because my dad continued to work for two days after he had his. The second day he collapsed and they found it then- I don't remember exactly what it was but the blood or some fluid they drew carried something in it that told them it was a heart attack. ( I was 15 so it seems like a lifetime ago)

Offline Douglas Milewski

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Most heart attacks aren't massive, so yes, that could easily happen. Even if they agree with the diagnosis, they can argue with you.

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Offline LadyG

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Yep. My sister finished a triathlon and grumbled about not feeling well all afternoon before going to the hospital and learning that she'd had a heart attack during the first stage of the triathlon.


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Heart attacks leave scarring behind. So this is another way they can check.

Offline D A Bale

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Watch last season of Deadliest Catch when Captain Sig from the Northwestern had his heart attack out at sea on camera and didn't realize what it was until he was in the hospital several days later after all of the deckhands told him they needed to go in and get him checked.  Like a crusty old fisherman, I could totally see a detective acting the same way.

They use a blood test to tell what the levels of a protein called troponin are to determine the severity of the heart attack.  The higher the levels of protein, the more massive the heart attack.  Captain Sig's was a widow maker.

Offline usedtocare

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Yes, it's a believable scenario.

Yes because my dad continued to work for two days after he had his. The second day he collapsed and they found it then- I don't remember exactly what it was but the blood or some fluid they drew carried something in it that told them it was a heart attack. ( I was 15 so it seems like a lifetime ago)
Yes, cardiac enzymes tell us ER folks if a patient is having an MI right that second, or if there is indication of previous damage. Specifically, an EKG with ST elevation and elevated Troponin level tells us it's an active event and that patient needs a cardiac cath right now to clear the blockage. Patients who have previous cardiac damage will continue to have abnormal ekgs, so in those patients you look for new changes from an old ekg and the cardiac enzymes.

Offline Seshenet

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It's also emotionally realistic. People can be in denial about their health to the degree that they die because of it. A close relative of mine is proof. Luckily he survived and now the family watches him like a hawk. Being in denial can make a character interesting, especially the conflict that arises when others try to convince him or her that they need medical care.

Online Lauriejoyeltahs

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Yes, it's a believable scenario.
Yes, cardiac enzymes tell us ER folks if a patient is having an MI right that second, or if there is indication of previous damage. Specifically, an EKG with ST elevation and elevated Troponin level tells us it's an active event and that patient needs a cardiac cath right now to clear the blockage. Patients who have previous cardiac damage will continue to have abnormal ekgs, so in those patients you look for new changes from an old ekg and the cardiac enzymes.

Thank you, the way you explain it makes much more sense. Even if I had heard it that way the first time, I doubt I would have remembered that well- it was fairly traumatic as a teenager!

Offline antares

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Thanks all for the confirmation!

Offline Kal241

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #10 on: August 16, 2017, 10:35:36 PM »
The human mind can go to great lengths to convince itself that it isn't having issues. Some people have been shot in the head, survived, and even denied it occurred until years later when the bullet gets removed. If that's possible, denying a heart attack certainly is.

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #11 on: August 16, 2017, 11:51:27 PM »
Yes, it's believable but you must sell it as such. There are many people who deny they have medical conditions or play down their illnesses. But you need to present the character's actions to reflect this There are also many people who want to think things are worse that they are and think they have a serious illness when they don't.

Your characterization and dialogue will be the key.
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Offline MarilynVix

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #12 on: August 17, 2017, 12:56:11 AM »
I think you got this scenario on target. But I'm curious to know how you will end it. Will he die because he denies he's having it? Or will they convince him to go, to check, just in case?

Why I'm saying this is because I did have a heart attack and a what my doctor has said was a mini-stroke traveling abroad in Germany. I had feelings of nausea, trouble breathing (shortness of breath, like running marathon) and waves of dizziness while going up stairs. I waved this all away as jet lag fatigue and being tired from work. This almost killed me, because when I came home, I went back to work and had a heart attack (luckily I was in the hospital at the time), so they were able to save me.

I'd tell you the pain of what it felt like except I can't remember because the drugs they put me in a coma with later wiped my memory. But my husband says my eyes rolled up to the back of my head and I fell back and flat lined. I had a monitor on my heart, so all the alarms went off. So, it was clear what was happening really.

But if he is having a heart attack and concious, it might be a small one, and people would totally explain away the symptoms. Use it as a moment to compel people to realize they shouldn't take chances and go to the hospital. If I hadn't already been there with pneumonia, I would have died.

Sorry about being soap boxy, but I noticed there were people that knew their Dad or someone else, or were medically trained, but no one had spoken up that had a heart attack yet. But then, I know it is something that might not be the easiest to survive and tell about later. Happy that I can.  ;)

Oh, just to note, women have different heart attack symptoms than men. If you're detective is a guy, than his arm being painful could be a symptom. Women don't seem to have that. I mostly had nausea, dizziness while walking, and shortness of breath from any kind of assertion. Really, shortness of breath was the biggie for me. I look out for that even now. If I have nausea, I stop what I'm doing and rest. So, gender can play a part in the symptoms. Just saying.  ;)

Offline disordinary

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #13 on: August 17, 2017, 01:38:03 AM »
Situation: Senior detective is presenting symptoms: pain down the left arm, shortness of breath, irregular pulse. He is conscious.

Junior partner reports these symptoms over the radio, and the cop on the other end says it sounds like a heart attack. Senior detective denies that it is a heart attack. Says it ain't. Angry that the other cop said it is.

In your experience, is that a believable scenario?

Another yes here, my grandfather finished his hole of golf despite people trying to convince him to go to hospital, then drove home.

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #14 on: August 17, 2017, 05:24:44 AM »
Yes, this is believable. I've heard many similar stories, and even those that are opposite, in that the person is insisting they're having a heart attack and medical personnel are saying it's not possible. It was, the woman nearly died before getting to another hospital. The first ER kept telling her to be quiet, she was disturbing other patients, but she was trying to get attention for herself after lying in a hallway (!) for hours.
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Offline LovetoWrite

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #15 on: August 17, 2017, 05:25:27 AM »
This happens often. Like others have mentioned, denial is powerful (and you are spot on about your character being angry when his denial is being confronted). Not to mention, many people (especially oftentimes women) don't have all the normal signs of a heart attack when one is happening. They may have an impending sense of doom, a feeling that something is "off," or what feels like really bad acid reflux. And because it's normal for people to try and normalize what they are experiencing, and to not want to been seen as "being drama" they often will go to the bathroom to gather their composure. Which is why many people who have heart attacks die in the bathroom (same with choking victims). Also, the severity of a heart attack is on a spectrum, so they might have a mild one and not even know that's what was going on until they get their blood work done.

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #16 on: August 17, 2017, 06:26:52 AM »
Again, thanks all -- and extra thanks to MarilynVix -- for the confirmation.

I got a lot of 'depends on how you write it', so the scene follows. You be the judge. Nik is the hero; junior partner; a corporal detective and the ONLY corporal detective the constabulary has ever had. (Policy is that only sergeants and above make detective, but the PM overrode constabulary policy.) Aggie is the senior partner; picture Idris Elba but 20 kilos overweight; seriously tough but fair; knows the dirt on corruption in the constabulary.

Enjoy.
<<
Nik did not comprehend that when he twisted his hand on the scanner plate, he had chosen maximum acceleration. The elevator walls contorted themselves, and he and Aggie lay down on the extruded acceleration couches. The elevator paused while it satisfied itself that its passengers were in safe positions before it began to accelerate. As the velocity increased, the couches adjusted to lessen the passengers discomfort. Niks couch surprised him when it snaked restraints across his shins, arms, and chest. It surprised him more when the acceleration ceased, and his couch turned and flowed to the ceiling. The deceleration hit him all at once, and he heard Aggie grunt. He tried to turn his head, but the shape-shifting couch that had flowed up to his temples to protect his head also prevented him from turning to see Aggie. Even if he could, this headrest-cum-restraint blocked his view.

The crush of deceleration ended. Again the couch turned and flowed, this time to the floor. The elevator chimed, the door hissed open, and a synthetic voice intoned, Torus Level. Welcome, guest. This level is restricted. Acceleration on this level is one-tenth gee. Mind your step. The restraints withdrew back to the couch.

Nik remembered his null-gee training from his conscript year and levered himself erect with his arms. Empty, his couch receded into the wall. He now stood, more or less, but Aggie did not. Nik looked over to find Aggie showing teeth clinched together, eyes squeezed shut, and his right hand clasping his left triceps.

Nik called to Aggie, You all right?

Aggie grimaced. Arm hurts. Cant breathe.

At the constabulary academy, all the instructors every one had drilled into Nik the dictum Take care of your partner and hell take care of you. Nik had a partner down and a killer loose. He needed to help the first and capture the second. At the same time.

The door began to close. Nik stuck his arm out, across the threshold, and the safety kicked in to slide the door back into its recesses. Nik shucked off his coat and threw it across the threshold to keep the door open and hold the elevator at the Torus level.

Nik knelt to his partner on the floor, an effort that took two seconds of careful movement. Aggie still held his left arm and gritted his teeth. Nik pressed two fingers to Aggies neck and found his pulse weak and irregular.

Did you make it to the Torus? Renssalaers voice came from the palmtop on Aggies chest. With twenty-twenty hindsight, Nik figured that had not been the best place for it. He unhooked it and laid it beside Aggies head.

Nik answered the call. Were at the Torus. Sergeant McGlockton has problems. Stand by. He remembered Renssalaer outranked him and added, Sir.

Renssalaer did not stand by. Problem? What problem?

Hes down. Says his left arm hurts and he cant breathe.

Sounds like a heart attack.

Through gritted teeth, Aggie said, Its not a heart attack! His voice came out at near-normal volume. Nik figured that was as close as Aggie could get to a shout just then. He decided to calm his partner and send him to medical help.

Youre right, sir. Its not a heart attack, Nik lied. I dont know what it is. Im not a doctor. But you are incapacitated and need medical help. Im sending you down to the half-gee hospital.

Aggie grabbed Niks arm and protested. Thats a cardiac hospital. I dont need a cardiac hospital.

Nik pulled Aggies fist from his arm. Aggie immediately clasped it to his left arm again.

I know, sir, but its the closest hospital. The docs there can get you stable and diagnose you and then send you to the right place. That seemed to pacify the big sergeant. Nik glanced at Aggies palmtop. Inspector, are you still there?

Renssalaer answered, Im here.

Get word to the hospital that hes coming. Okay?

Im doing it now. When are you sending him?

Now. Nik patted his partners shoulder and smiled to encourage him.

Aggie looked at him and forced a smile. Remember, we always get our man. Alive or dead. Bring him in. Do it, kid, and Ill owe you one.

Nik nodded. He turned and stretched himself to the elevator controls. He punched the button for the half-gee level. He peered at Aggie, who was holding his arm and gasping for breath in one-tenth gee, and decided to err on the side of safety. He pressed his badge to the scanner for additional orders.

Elevator, constabulary emergency override. Not more than seven tenths gee in the car for this run. Confirm.

Acceleration or deceleration shall not exceed zero decimal seven gee for the duration of this transit.

Good confirm. Nik bounced across the threshold and kicked his coat clear of the doors. He barked, Execute! and the doors slid shut.
>>

Offline Jan Hurst-Nicholson

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #17 on: August 17, 2017, 08:22:32 AM »
Looks like we can now get a diagnosis via KBoards   :)

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #18 on: August 17, 2017, 09:12:58 AM »
My friend had a heart attack and knew nothing about it till she went for a check up a week later. My husband had very much the same symptoms as your detective, but didn't want me to call an ambulance because we'd have to pay for it. If we called an ambulance unnecessarily, we would have had to pay, so that is what he thought. He died the following day.


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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #19 on: August 17, 2017, 09:42:27 AM »
It's not only the victim who can get it wrong or be in denial. My husband was a prime heart attack candidate -- middle-aged, smoked, overweight -- and had been having chest pains and becoming breathless. His cardiac specialist refused to order an angiogram, insisted he was fine and that it was probably gallstones causing the symptoms. So when a week later, my husband collapsed in the hallway, saying it felt like something was crushing his chest, I didn't realize it was a heart attack until the paramedics came and said that was the probable diagnosis. He was rushed to hospital at 2 a.m. where the heart attack was confirmed and two arterial stents fitted. The specialist never admitted he was wrong.


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Offline Jan Hurst-Nicholson

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #20 on: August 17, 2017, 11:03:09 AM »
My friend had a heart attack and knew nothing about it till she went for a check up a week later. My husband had very much the same symptoms as your detective, but didn't want me to call an ambulance because we'd have to pay for it. If we called an ambulance unnecessarily, we would have had to pay, so that is what he thought. He died the following day.

That's very sad. I didn't realise that you had to pay for an ambulance in the UK. My husband had a triple bypass and after he'd been home for a week he complained about not feeling well and I called the paramedics. After doing a couple of tests they pronounced him ok and there was no charge (fortunately)

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #21 on: August 17, 2017, 11:18:23 AM »
That's very sad. I didn't realise that you had to pay for an ambulance in the UK. My husband had a triple bypass and after he'd been home for a week he complained about not feeling well and I called the paramedics. After doing a couple of tests they pronounced him ok and there was no charge (fortunately)
Perhaps it varies from NHS trust to another. My husband was taken to hospital in Oxford, although he did have to wait an hour because the available ambulances were occupied scooping drunks off the pavements. But everything was covered by the NHS.


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Offline Jan Hurst-Nicholson

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #22 on: August 17, 2017, 11:38:04 AM »
Perhaps it varies from NHS trust to another. My husband was taken to hospital in Oxford, although he did have to wait an hour because the available ambulances were occupied scooping drunks off the pavements. But everything was covered by the NHS.

I'm in SA, so it's not the NHS. We have govt hospitals and private hospitals. We have to pay for medical aid to use the private hospitals.

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Offline Lydiajoyce

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #23 on: August 17, 2017, 01:08:21 PM »
I'm another woman who's had a heart attack. I had been having left arm pain for a couple of months (!), which I thought was arthritis because the pain was only in my elbow and shoulder joints. Even after I started having chest pain I assumed that was pulled muscles from putting on a sports bra after taking a shower. Those are a b*tch to pull on when your skin is damp. That started while I was in bed and woke me, but after I got up it got better so I thought nothing of it. Later that evening the pain came back but it wasn't until I started getting nauseous and sweaty that I realized there were too many coincidental symptoms for it to be something I ate.

I finally went online and looked up heart attacks in women and realized what was probably going on. Called 911, the paramedic did an ekg , and I got my first ever ambulance ride. (which is not nearly as fun as I always thought it would be). Went straight from the ambulance to surgery, and have minimal damage thank goodness. Have to take a pile of pills now.

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Re: Medically trained: Will a heart attack victim argue about the diagnosis?
« Reply #24 on: August 17, 2017, 01:22:54 PM »
Cool plot point. Now I want to read the finished product!

When I volunteered as an EMT, we had several patients that did this.
"I'm fine. I just need to rest for a minute."
"Here's some oxygen anyway. Let's go to the hospital and be sure."
"No. I don't wanna.  It's too expensive."
[Take patient's blood pressure and its shooting through the roof as the patient is sweating and turning white.]
"Let's get you into the ambulance anyway."
[Quietly nod to partner and begin preparing the rig for CPR and defibrillation. Sure enough, EKG shows problems.]




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