Heart Attack Patient

In 1991, I was the RN research coordinator for a heart attack study called “GUSTO.”  It stood for “Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries” and was overseen by Duke University in North Carolina.  All Gusto patients had confirmed heart attacks (as opposed to just chest pain), myocardial infarctions (MI), and received thrombolytic clot buster therapy as life-saving measures.  The greatest damage to a victim’s heart muscle happened in the early hours after the symptoms appeared, so they were all emergency patients in the true sense of the word.    

A “Gusto” was one of 41,000 patients worldwide enrolled in the study.  Mr. Sherner particularly interested me because he’d never once been very sick in his life.  Being Gusto’d was his first experience as a patient in the hospital. 

Before his heart attack, Mr. Sherner had been casually walking the scenic five-mile Noland Trail at the Mariners Museum in Newport News, Virginia.  It was a beautiful spring day, and he was glad to take a break from his job managing a chain of convenience stores.  About a half-mile into the wooded walk, he noticed some twinges of chest discomfort, which also went down his left arm. With the heart being  on the left side of the body, it made sense that the nerves in Mr. Sherner’s  left arm were irritated and aching. 

His friend suggested, “Hey, you should probably have that checked out next time you’re at Dr. Milson’s.”  Mr. Sherner agreed and continued walking, admiring the turtles which congregated near the bridge at the lake.  It wasn’t a real pain, just a nuisance, and he remained calm. Perhaps if he recognized this chest pain as a sign of impending heart attack he would have been more upset and had a rapid heart rate.  A rapid heartbeat can set off a weird arrhythmia, which may contribute to blood clots that travel through the arteries (coronaries) that supply the heart.  

Awhile later, Mr. Sherner felt so washed out he couldn’t finish the walk but didn’t consider calling an ambulance.  He drove to his office, which took him right past my hospital, but he didn’t think of stopping in the ER.  He experienced a heaviness in his chest, and started to feel sweaty, cold, and clammy.  His heart was suffocating and needed oxygen.  

Mr. Sherner called his wife from the office to come and get him.  He felt weak and shaky.  She sensed something was terribly wrong.  The pain was so intense he couldn’t take a deep breath.  She asked if he wanted to go to the hospital.

“No, I’ll be alright.”

After a short time, Mrs. Sherner persuaded her stubborn husband to go to their doctor’s office.

“I don’t care what you say, I’m calling the children.”

He said, “OK, but it’s probably just the flu.  I’ve never been sick before in my life except for strep throat in the Army.  Besides, I’m not even sixty years old yet.”

Mrs. Sherner got her now staggering husband into their car and drove him to the doctor’s office, where he passed my ER for a second time that day.  On arrival to Dr. Milson’s office, the physician took one look at Mr. S in his weakened and pale state, did a 12-lead EKG and sent him straight to the hospital intensive care unit.

Dr. Milson said, “No need to go through the ER first. I’ll admit you to the CCU.  You’re having a heart attack and need clot-buster drugs. . . ”

Since time was of essence, the doctor recommended Mrs. Sherner drive him to the hospital to save the fifteen minutes it would take for the ambulance to come.  On their way out the door, the doctor also advised Mr. Sherner to participate in a heart attack study.  The patient and his wife were “good patients” and readily agreed.

Dr. Milson called the ER and gave me a physician order to “Gusto the hell out of him.”  Shortly after Mr. Sherner’s arrival in the heart intensive care unit, I was notified to come to see him.  Mr. Sherner was a handsome, well-educated, articulate businessman.  I asked what his doctor had already told him about the GUSTO study, and he replied, “I’m going to get an experimental drug and then bleed from it.” This wasn’t the case at all.  I re-directed him, yes he was having a heart attack, but the drugs used in the GUSTO study were approved by the FDA.  There was a risk of bleeding from them, but not a guarantee.

Mr. Sherner ended up spending five days in the hospital.  He had an angioplasty to repair his coronary arteries and suffered no complications from the heart attack or procedure.  He told me that he was happy to be enrolled in the Gusto study that would help heart attack patients in the future. 

Five years later, he was still doing well.  I hope that if he ever has chest pain again, he’ll head straight to the ER instead of driving past it twice.

Note:  This story was originally published as “Patient Teaching and Readiness to Learn” in  The Color of Their Eyes:  Celebrating the Art and Science of Nursing (2007).