Back From the Dead

Abstract

“I think I may have pulmonary edema.” This was the chief complaint voiced by a pleasant, articulate black man who walked in to the triage area of our emergency department (ED). This statement alone quickly got him a room, and as the senior resident in the department at the time, I rushed in to see him when I saw the chief complaint on our computerized track board. He was still fully dressed and not yet changed into a gown when I entered the room. He looked to be in his mid 60s and appeared comfortable and at ease. He smiled and greeted me with a friendly, appreciative demeanor. I immediately perceived a warmth and sense of contentment about him. “Sir, tell me about your symptoms,” I asked in my usual manner. He had been shoveling snow that morning, and afterwards he coughed a couple of times—nothing out of the ordinary—but the unexpected streaks of blood that came up with it scared him. He had a history of congestive heart failure with an ejection fraction of 15% and had experienced frightening decompensations into pulmonary edema before. Pink or bloody sputum was a warning sign he knew all too well. Despite the alarming blood, he felt well. No chest pain, shortness of breath, dizziness, or leg swelling. I probed him regarding a litany of symptoms and all came up negative. His vitals signs were normal and his lungs sounded clear. An EKG was performed—not the prettiest, given his ischemic history— yet it was unchanged from his previous one. I explained that we would do a chest radiograph and check some blood work. Leaving the ED tech to draw the blood, I left the room, reassured at his clinical appearance. Yet at the same time, I felt an inexplicable twinge of unsettledness. His name sounded oddly familiar. Had I seen him before? Working in the ED day after day, the unique names, faces, and stories of the individuals I meet inevitably meld into an amorphous mass of patient encounters. Occasionally I will see a patient who recognizes me from a previous visit. But unless it was a particularly noteworthy interaction, seeing a face or hearing a name is often not enough to trigger my memory. As I scanned the medical record to see if I had met this gentleman before, I finally came to an entry that had occurred nearly 3 years ago, at the very beginning of my residency. An ambulance had brought in an individual in cardiac arrest. He had been in a shopping mall when he was suddenly struck with severe shortness of breath. When EMS arrived he was in s