For some inexplicable reasons, patients with complete heart block seem to know exactly when Jimbo would be on call.
For the 3rd time the other day, on his 3rd on call duty this year, a 70+ year old man decided that Wednesday would be a good day to faint at home and was subsequently brought to the peripheral clinic. His BP was low, his heart rate was barely above 30/min and the ECG showed complete heart block and so he was referred to Jimbo!
For the less informed, complete heart block (a.k.a 3rd degree heart block) is a condition whereby cardiac electrical impulses fail to flow from the atrium to the ventricles resulting in the ventricles going autonomous and pumping on its own slow rhythm. Unfortunately, the ventricular rhythm usually is not fast nor strong enough to sustain normal blood pressure in a person and thus the person faints because of low blood pressure. The person may also experience anything from profuse sweating to palpitations to chest pains. It is a potentially life-threatening condition.
To treat this condition, a procedure called cardiac pacing is done. There are 2 ways about it. One is with a ‘external pacer’ whereby a cardiac pacemaker is attached to the person’s chest and the gadget will send electrical impulses through the skin to stimulate the heart to pump faster.
The other method is more invasive. A thick vessel is cannulated in the neck and a pacing wire is passed through it to the heart to rest upon the ventricular muscle and electrical impulses are then passed through the wire to pace the heart. This method requires the use of an Image Intensifier (a nice name for big big repeated blasts of X-rays onto the doer (person inserting the cathether) and the doee (the person who has the heart problem) thus eliminating any future heirs (unless you want an heir with 2 tails and a rhino horn).
Not sure if the above sentences made any sense.
Jimbo seems to be a heart block magnet because every time he is on call, one person with a complete heart block will walk in/wheeled in/stumble in.
Nothing to it, right? Just employ any of the 2 methods above and the patient is saved! Easy-peasy…
There is ONE problem.
Jimbo only knows how to do the first method and not the second and the latter is the one practiced in this hospital! Gaargh!!!
This is a legacy of people who are trained in highly specialised hospitals. Back where Jimbo trained, there are cardiologists who would immediately jump in and do their magic. All Jimbo got to do was place an external pacemaker before them cardio-demi-gods come and take over. Not so here, the nearest cardiologist is in KL and so, the invasive method has to be employed.
Heaven must really want to test Jimbo and build character in him by sending one complete heart block patient per on call duty for Jimbo. Darn! Darn! Darn!
And so, each time, Jimbo eats the humble pie and concedes that he hasn’t the foggiest idea how to pace a patient invasively and got others to do it for him. It’s kinda embarrassing and humbling. People (Jimbo imagine) would think Jimbo is so inadequately trained!
And indeed he is.
He really can’t pace a person. So, better to fess up rather than poke around with a wire in a person and have the wire coming out of unexpected undesirable orifices or places on the patient or create a fountain of blood……
So, to all you guys out there who feels like having a complete heart block, please check if Jimbo’s on call that day that your ticker decides to act up and if he is on call, make a U-turnhead to KL… please….
And to all of Jimbo’s gracious colleagues who have paced on behalf of Jimbo, a big THANK YOU to you.
Psst…Jimbo is hoping that the people in higher authority will decide that since he can’t pace a person, he shouldn’t be put on call anymore….
Fri, 060109 @ 0700