ABSTRACT
Enok Hansen was a 65-year-old, slightly worrisome but sturdy man with a mission. Whatever treatment he underwent had to be effective and efficient because he had to get home quickly to take care of his wife. They had been married for almost 45 years and still lived in their first house in a small village in the woods. Unfortunately, his wife had begun showing the first signs of dementia. Mr Hansen had a mission in life: he needed to look after his wife. He did not have time to stay in a hospital for long. I met Mr Hansen for the first time when the vascular surgeon consulted me. It was the first warm day of March. I distinctly remember because I had found time to eat my lunch outside in the sun. The surgeon paged me because the patient had developed chest pain in the wake of vascular surgery on his leg. I ordered an ECG that didn’t show any abnormalities. I had his heart enzymes tested, and these were also normal. I explained to Mr Hansen that there were no indications of heart failure at this moment and he consented to wait and see how the symptoms developed. He was admitted to the surgery ward for postoperative surveillance. The following day his ECG and heart enzymes were abnormal and typical for a minor heart attack, of the non-ST segment elevation myocardial infarction (NSTEMI) type. I prescribed him therapeutic anticoagulants. In the following 2 days Mr Hansen sometimes complained he had chest pain. The pain could be managed with nitroglycerine. But after 3 days I had a bad feeling and, having discussed the case with my colleague cardiologists, decided that we needed more diagnostics. I called the nearest academic hospital to plan a diagnostic angiogram. This would show any blockages of the cardiac
arterial system. The following morning I was paged again, because the chest pain was not manageable anymore. We decided to admit Mr Hansen to the ICU, and administer nitroglycerine and pain medication intravenously. I called my academic colleague and explained that the situation had become more urgent. We needed to transfer the patient today. He agreed. We discussed the preparation needed for the procedure and decided to deviate from the normal procedure: we would not give the patient the antiplatelet drug, clopidogrel, yet, because he was still recovering from vascular surgery. Clopidogrel would increase the chance his wounds would start bleeding. They would administer the clopidogrel at the academic hospital, just before the procedure. With everything agreed upon, we had Mr Hansen transported to the academic hospital at the end of the morning. He was returned to our hospital the same evening and admitted to the ICU, as protocol dictated in these situations.
