Don’t Ignore Chest Pain


She was an active patient, who I am still trying to see once a week until I direct her in how to survive and flourish in the universe. She was in her forties, depressed and anxious.  She had “a little panic attack,” some chest pain and the feeling her breath was cut off. I wasted no time sending her to an Emergency Room, (or, if she really did not feel it was that bad, to an Urgent Care — what we used to call it a “doc in a box”) because it is cheaper, sounds less foreboding, and any doctor who is sentient and has a pulse and is on duty would send her to an Emergency Room if anything was really wrong.

Chest pain or tightness or shortness of breath or a “tight feeling, like a vice” could always be a heart problem, and could always be life threatening until proven otherwise.  I tend to send  even the most mild discomforts of this nature, that people had for years to primary physicians for a “cardiocentric examination.”  For “auscultation,” the old fashioned Latin-origin word for a good listening to the well as generally an electrocardiogram and sometimes even an echocardiogram.

I have pretty much given up on cherished words of latin origin, because nobody else seems to use or understand them and they take long to explain. I will never, repeat “never” give up on sending people for heart checks if pretty much anyone complains of anything funny in their chest. People die from heart attacks — a lot. Who cares about the numbers?  I care about the individuals.

Pain can be hard to localize.  I mean, there are lots of organs in a chest.  There are lots of nerves with lots of branches.  The nerves are different in mostly everybody, so if you get a problem with pain and the pain is deep, you can’t exactly figure out where it is. We know people who have died suddenly and much too young for failing to check out chest pain.  One who comes to mind was a gifted writer, a teacher of writing with whom both my husband and I studied, author of much published in “works for hire” under more famous names so you wouldn’t recognize his name even if I told you.  I think he wrote “for hire” things like the “military action novels” that were virtually the only printed matter read (recreationally and voluntarily) by many of my patients when I was in the Army at Fort Bragg. He had chest pain not once or twice and never was too excited about my profession, except that it certainly could provide good writing material.  He fell dead as a doornail. He was mourned by many, on many levels.

Lives are precious.  It is irrational to measure them on the same scale as money. But this illustrates another point.  Things that may seem like psychiatry are not always psychiatry.  I tell my beloved charges that is why I ask for pretty much everyone to get some blood tests and a general medical consult sooner or later. Psychiatric consultation may be caused by a medical diagnosis not yet known.

This is for certain: whatever Creator you believe in did not create humans already divided into medical specialties.  Both my cleverer diagnoses and my most piquant research interests have always fallen between the cracks that separate arbitrarily defined specialties, good for the academics who perpetuate the system, but not necessarily for patients. Practicing medicine should ideally consist of locating and identifying problems and fixing them.  Period.

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