I have had the pleasure of getting to know Ms. Daniels** over the past eight months. She is a jolly 64-year-old woman with a round face and a kind smile. At appointments she remains pleasant, always — even when informing me about the pain her bunions cause her daily.
One day, Ms. Daniels called and left a voicemail on the clinic phone line: “Hello, this is Samantha Daniels. I’ve started feeling this fluttering in my chest and it feels kind of like what happened to me about ten years ago. I seem to be having a bit of trouble breathing when the fluttering happens. I’d like to make an appointment when you get the chance. Thank you.” Though Ms. Daniels spoke as calmly as usual, her inflection suggested something new, disquieting. These words concerned me enough to call her back immediately. She told me about going to the pharmacy down the street from her house to get a blood pressure check. “The machine must be broken,” she said, “Sometimes it says my heart rate is in the 80s and other times it says 150s.”
When she came into the office she told me about the chest pain that started just a day-or-two before. We used an electrocardiogram to examine her heart’s electrical rhythm, and diagnosed an atrial flutter. Atrial flutter is a dangerous condition, especially in combination with chest pain and shortness of breath. As the heart pumps blood throughout the body, electrical signals initiate each beat. When the signal travels down abnormal pathways, the heart “flutters,” or pumps shallowly and quickly. Sometimes it moves so quickly that it can’t properly refill between beats. Rarely, the heartbeat degenerates into extreme irregularity, and the heart just stops. With these serious risks in mind, we sent Ms. Daniels on to the hospital.
Right after the hospitalization, I called Ms. Daniels to check in. Joy and amazement permeated her voice, as she informed me that all the symptoms from the previous week were gone. Even more so, while she had been waking up late for the weeks before she went into the hospital, now she was suddenly waking up at 5:00 a.m., ready for the day. Luckily we caught her condition early, and she is now fully cured.
What makes this story unique is that the patient was seen at the Weill Cornell Community Clinic (WCCC), the medical student run clinic for the uninsured. This patient is not just any woman. She is a well-educated woman laid-off from her job on the cusp of retirement. She came to our clinic because she could not afford insurance for the nine months between losing her job and turning sixty-five, when Medicare will accept her. In that absence though, we students, with the help of incredible volunteer physicians, protected her from harm; we diagnosed, we brought her to treatment and we followed up afterward. The WCCC, located in Manhattan, sees approximately 300 uninsured patients per year. In an average week we see a middle-aged woman with diabetes who is self-employed and cannot afford the cost of insurance; a man who lost his job and has heart disease; and a student who needs asthma medication. We grant each of these people access to health care with dignity and integrity.
**Details about the patient have been changed to protect her identity.
Mahala Schlagman is in her final year at Weill Cornell Medical College. She may be reached at email@example.com. What’s Up, Doc? appears alternate Fridays this semester.