Monday, February 22, 2010

Dick vs. Bill

Bill Clinton gets chest pain, hits the hospital, gets a few stents and, voilĂ , is back at work. A veritable poster child for stents. No doubt JNJ stock climbed on the news.

On the flip side today: Dick Cheney gets chest pain, hits the hospital, and (I'll bet) he stays a while.

What do you mean, Dr. Wes? Can't cardiologist magically fix everything? Do a cath! Give him a stent! Cardiology is so slam bam thank you ma'am, isn't it? Heck, he's got an ICD! He's the bionic man!

Cardiology is easy until it isn't.

No doubt Mr. Cheney has had impecable cardiovacular care. But despite that care, after three bypasses, a history of atrial fibrillation, deep venous thrombosis, a cardiomyopathy that requires a defibrillator or two, and scores of medications to stabilize the angina - you've suddenly got a tough case. One thing's for sure, a re-do bypass is pretty much out of the question (he probably has limited vascular conduits left to borrow).

For the treating cardiologists hoping for an obvious target to angioplasty, I wouldn't be surprised the "target" vessel will not be so obvious to determine after his angiogram today. Look for a nuclear scan tomorrow to figure which wall of his heart is affected (yes, Congress, he'll get one of those all-too-often ordered i-m-a-g-i-n-g studies!). Then look for either a risky angioplasty atempt to improve his symptoms or a (more appropriate) "tuning" of his medication regimen that will take time.

Bill vs. Dick: it's not about Democrats vs. Republicans. Rather, it's about the multifasceted care required of the same disease in two different patients that demonstrates nicely how health care for the individual will never be adequately managed through cookbook means.



The Happy Hospitalist said...

But I thought nurse practitioners could practice independent primary care equally with their internist and family medicine physicians.

You mean that's not the case either? I'm shocked to learn of the great variation in disease presentation.

Leigh Ann Otte said...

What a great idea for a post—and an interesting comparison. Thank for the insight.

Anonymous said...

Since Dick had his first MI at the age of 35 he is also much further along in the course of his CAD. Considering the difference in their ages and the differing ages of first presentation of symptomatic heart disease it is not surprising that their treatment course is different. There was a time when Dick too was able to enter and leave the hospital in a swift timeframe. Add 20 or 30 years to Bill's disease process and you may very well have a similar picture- though I hope not. I still think that it was a good comparison of the care given at various points of the disease process.

By the way...Happy, must you continually prove that you are a tool? This post had nothing to do with advanced nursing education or practice guidelines.