By Amin H. Karim MD
It was a late autumn night with typical torrential Houston rain, and I was on call for the ST eleva‐ tion myocardial infarction (STEMI) team, which consists of an interventional cardiologist, a traineefellow, a cath lab registered nurse, and cath lab and radiology technicians. It was 3:30 AM and Iwas deep in sleep, only vaguely aware of my beeper going off and quite unaware of the storm out‐ side. The emergency room (ER) physician wanted my opinion on an electrocardiogram (EKG) of apatient with chest pain to see if it qualified as an acute myocardial infarction. He texted the EKGimage to my mobile phone, and I staggered to the closet to turn on the light and read it. I relayedthat I was not impressed at the degree of ST elevation, he concurred, and I sank back into bed. Awhile later, the ER physician called again with a repeat EKG, this time with more ST elevation andan elevated serum troponin level. Hastily, I slipped into my scrubs and quietly tiptoed to avoidwaking my wife.
Rain pelted my car as I drove through the neighborhood in utter darkness. Within a few blocks, Inoticed that the water level had risen but couldn’t gauge how high—simply because there were noother cars or street signs for comparison. I slowly slogged through, only to find my car splutteringbefore eventually stopping completely. It restarted just long enough to hobble to a slightly lessflooded spot on the main road, where it completely died, the dreaded engine warning light flash‐ ing on the dashboard.
I started to sweat as the gravity of the situation took hold. The patient was probably in the cardiaccath lab by now, and the cardiologists’ guiding principle, “time is muscle,” ran through my head:The longer it took to open the vessel, the more myocardial damage. I looked around and the streetwas desolate. The hospital was a good 3 miles away, and the road ahead looked flooded. Walkingwould mean wading through the water with its attendant dangers of electrical wires and the like.
Wade back to my house?
I thought. Only a few blocks away, this seemed like the logical option.
Call the ER physician and tell him to treat the patient with a thrombolytic drug?
Since thrombolytictherapy is the second-best way to treat an acute myocardial infarction, this was another sound op‐ tion, albeit one that does not always work.
Call 911?
And tell them what?
Suddenly, the solution popped into my head: Uber! Although I had never used it, the app was onmy iPhone. I signed in, entered my location and the hospital address, and sure enough there was adriver on the freeway just minutes away. The cost, of course, would be double. I watched the appas it traced the car coming towards me. After getting in, I directed the driver through a route thatis usually not flooded. Remarkably, I made it to the cath lab before the rest of the team, and wewere able to perform the procedure under the mandatory 90-minute door-to-balloon time. Thepatient did well, and as I breathed a sigh of relief, I remembered that there was still one morething to tackle.
For the second time that night, I called Uber. The driver dropped me off at my car, where I thencalled a wrecker. My car had sucked up water and blown a hole in the engine, but the wreckerdriver refused to give me a tow until I gave him cash, which required another trip to the ATM ma‐ chine. After a month of haggling with the car dealership and insurance company, I finally had theengine replaced at a cost of several thousand dollars, and I was back in business.
While in the midst of this ordeal, I felt some regret at being an interventional cardiologist with itsnecessary obligations to care for patients in acute situations. Yet after the procedure, I felt gratefulfor being able to use my skills to save heart muscle and, potentially, a life. Still, I resolved to resignfrom the STEMI call schedule the following year, feeling too old (or maybe too tired) for all thisexcitement.
The next year, however, I found myself signing up for twice as many calls. I guess for some die-hard physicians,
chronic workalcholism and patient dedication are incurable conditions!
PUBLISHED IN THE METHODIST DEBAKEY CARDIOVASCULAR JOURNAL Methodist Debakey Cardiovasc J. 2019 Apr-Jun; 15(2): e1. doi:
10.14797/mdcj-15-2-e1 PMCID: PMC6668749 PMID: 31384387
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