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Second Opinion

Second Opinion: Magic Words: ‘I Have Chest Pain’

Leap, Edwin MD

doi: 10.1097/01.EEM.0000387712.41997.32

    Propped in her bed, frail and weak, the little grandma sighed. Her complaints were legion: weakness, poor appetite, sleeping poorly, joint pain, cough, dry mouth. Her daughter, eyes rolling, was trying to balance three reasonable emotions. She desperately wanted to go home after spending the day in the ED. She truly wanted to avoid her mother's admission to the hospital, and she was, graciously, sympathetic to the physician who brought the bad news.

    “Mrs. Adkins, I know you feel poorly, and I'm sorry. But I have to say, I can't find any reason to admit you to the hospital. You're right as rain. Isn't that great?”

    “You mean, I've been here all this time, and had a gallon of blood drawn, all them x-rays and a CAT scan, and there ain't nothing wrong? I can't believe that. I feel terrible.”

    When she said “terrible,” she smacked her lips, and looked away. She propped her hands on her lap, and intertwined her fingers, and she managed a subtle but expressive sniffle.

    “Ma'am, I truly understand,” said the doctor with one hopeful hand on the door. His family also waited for him to come home. The shift was at its end. There was a grill and burgers, and the children were splashing in the pool. “Maybe you just have a little virus. These things happen.”

    Virus? I don't have no virus. I feel like I'm dying.”

    “Mama,” her daughter interjected. “Let's go home, and see if you feel better after a good night's sleep. Maybe the doctor can give you something to help you sleep. Can you, doctor? Can you?” She looked at him, pleading, as visions of sleeping pills danced in her head.

    “Yes! Yes, I can! We can help your mom sleep. Absolutely. I'll write you a little prescription for…”

    “I have all the pills I need or want. Pills don't do nothing. I don't want to sleep. I want to feel better.”

    Her daughter and the doctor thought simultaneously, “You haven't felt good since 1976, and haven't wanted to since 1950.”

    Her daughter put head in hand, and slowly shook it from side to side. The drama played out once every month or so. Her mother had tried nursing homes, but said, “Nobody does anything for me there.” She had abused the staff, and signed herself out. Now, in her small trailer in her daughter's backyard, she spent her declining years in endless, robust, purposeful decline. Misery was her art form, complaint her sonnet. And she held her daughter and son-in-law hostage to her whims, her age, and her agony.

    But this day, she focused on the man in the blue scrubs. “I know many things are bothering you,” he said, “but Mrs. Adkins, right now, what is the one thing troubling you most? Can you limit it to one complaint? One problem?”

    “Sure, I can, young man. Ever since I've been here, nobody has even bothered to ask, but I've been having ch…”

    “Chills?” he asked. Her daughter looked up; she knew what was coming. It was the gamemaker, the deal-breaker. It was the trump card.

    “No, you moron, I have chest pain.” The words jumped from her dry lips with remarkable clarity. The words echoed off the walls, and hung in the air. The young doctor saw his burgers burning, his children in towels by the pool, his wife looking at her watch. The woman's daughter was almost relieved. She was out of the equation now. She looked at the doctor with a mixture of pity and admiration but also with the relief the living feel before the dying. Survivor-guilt, that's what it was. Tonight, she would have a reprieve; she would be ransomed for a day, maybe two.

    The sweet lady looked up with a twisted smile. “Yes, that's it. I have chest pain. It's pretty bad. You know, I used to smoke. Today, I was short of breath. Last night, my left arm hurt, and I broke out in a terrible sweat. One doctor told me I had a silent heart attack.”

    Her daughter reached out, one last time. “Your air conditioner was broken, Mama. That's why you were sweating.” Her mother was animated, and sat bolt upright. “You don't know what you're talking about. You want me dead. My daughter wants me dead. She always has.”

    At which, the daughter stood, tearful, and walked to the door. She put her hand on the young doctor's shoulder, and said in a whisper, “Good luck with that. I'm gone. I'm sorry, but I have to leave or else I'll … who knows? You're a fine man; you'll have a crown in heaven.”

    Shifting his weight, her doctor took a deep, cleansing breath, closed his eyes, and advanced on his aged captor, stethoscope in hand. He re-focused his attention, then left and ordered more of this, more of that. He knew where it would all end.

    “Might as well order a telemetry bed for Mrs. Adkins. She isn't going anywhere today.”

    “Chest pain?” asked her nurse. “She'll be down here all night; the unit and stepdown are all full. We'll be fluffing her pillow, and answering her call light for 18 hours. You're weak.”

    “No, she's just too powerful.”

    And the young doctor did what any compassionate, caring professional would do. He called her family doctor, who was on the way out of the parking lot, headed for a movie with his young wife. The name “Mrs. Adkins” almost made him crash into the gate. He put his head on the steering wheel for a few seconds, then turned around and parked. He braced himself, and walked into the ED, into her room, and into his own period of servitude.

    “Where have you been? Nobody has done anything for me here today!”

    “Yes, ma'am,” he said.

    He was one more hostage among many, victims of the whims of an old lady with endless, almost cosmic power to direct those around her.

    She smiled, knowing it would be the best night ever.

    Dr. Leap:
    is a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, SC, and an op-ed columnist for the Greenville News. He welcomes comments about his observations, and readers may write to him at [email protected] and visit his web site and blog at
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