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Guest Blog: A Profound Arrhythmia

By Phil Johnston, MD

Physician Phil Johnston was deeply affected by work with disadvantaged groups overseas as a medical student and in inner city Indianapolisas a resident in Family Medicine.  He followed this as a calling and has practiced for nearly 40 years at SoutheastHealthCenter, one of six Indianapolis HealthNet clinics.  NACHC invited Dr. Johnston to share some of his collection of stories about life as a health center doctor in two part series.  The patients names have been changed to protect their privacy:

David McMillan became one of my patients against his will. He was a machine operator who had the misfortune of developing a cardiac problem that caused fainting spells. Tests showed that he had these spells from a cardiac arrhythmia – ventricular tachycardia. At that time there were few effective medical treatments for his condition.

David lost his job. He was depressed at the prospect of not being able to support his wife and family and faced the necessity of having to depend on food stamps and the stigma of welfare”- to get by. His fainting spells continued. Correcting his arrhythmia often required stays at the hospital. He was also given a drug which suppressed most of his fainting spells, but caused his skin to turn a dusky, silvery color. This added to his self consciousness and distress and didn’t restore what he most wanted – the independence and security of a respectable job.

Several months after his last check up, I received a panicky call from the hospital. Mr. McMillan just checked out of the hospital where he had been on a monitored bed. The nurse reported that pulled off his chest leads and left. Later that week, Mr. McMillan appeared, quite alive, at my clinic. When I saw him, he had a sheepish look on his silvery face but was still stubbornly defiant about his behavior. Taking his history, I asked, “Mr. McMillan, the heart doctor called me about your leaving the hospital. You know how serious your condition is. You could have DIED! Why did you to leave the hospital under those circumstances?”

He replied, “I just got tired of people telling me what to do.”

As I imagined his perspective, I began to appreciate what it would be like to go into a food stamp office and be ordered, “Take this form and fill it out. Do you have your proof of income?” And, in the hospital, to be told, “No, Mr. McMillan, you cannot have that for lunch; it’s got too much sodium in it.” Or, “Yes, Mr. McMillan, we may have to try to cardiovert you again – yes, I know that’s painful…”

Mr. McMillan chaffed at the indignity of being in a hospital, especially when he didn’t have the anchor of a job to come back to.

Years later, I saw Mr. McMillan’s wife, long after he had succumbed to his heart problems. I recounted this event to her for the first time. Tears came to her eyes as she said, “Yes, my husband was a stubborn man. But he always did what he thought was right – and he was good to us!”

Tomorrow: Lawrence Welk Comes to Dinner