I am on the phone with cardiology. Not my patient's cardiologist, another one. Because the patient's one is gone until Thursday.
The patient's blood pressure is too low. He had a triple bypass in November, so the three medicines that he must be on are an aspirin, a beta blocker and a statin. The trouble is, his blood pressure is too low.
"We are starting to question beta blockers." says the cardiologist cheerfully. "He's had a bypass. Drop it."
"Really?" I say. "But beta blockers are the ALWAYS drugs for coronary artery disease."
"Yep, but at that dose it's just there because it's supposed to be there. Drop it." He ruffles through the electronic chart.
"Ok." I say.
And then he becomes social. Asking how I am.
"A bit flooded." I say, "A clinic closed here and in the county north of us and released 1500 patients into the wild, no primary care provider."
"1500?" he says.
"Yeah. There was a nurse practitioner who has been seeing patients for 30 years or so. I'm picking them up as fast as I can and boy are they grumpy."
"They are lucky to get you." he says warmly.
I do a blush thing on the phone. "Uh, thanks." This cardiology group knows my name because I caught an error, a person with multiple stents sent home without his blood thinner. And I called and questioned them. Cardiologists must have memories like elephants or like the lion who has had a thorn pulled out of their paw. And often people won't question because they are held in awe. I've never been particularly good at awe. Good thing for that patient.
"We've been swamped because the emergency room is swamped." he says. He is in the county south of us, 350,000 people to our 27,000.
"Influenza?" I ask.
"Oh, yeah, and cold weather and stress. Everyone is acting up."
"I've seen influenza and strep pneumonia and pertussis and a grandmother with RSV this season."
"It's hopping." he says. "At least your job is secure."
He sends me the notes on the patient, because I am not on the "system" electronic medical record and we agree that I will have the person check blood pressures in both arms. People can be 20 points lower on the left. "Which do you go with?" I ask.
"Depends." he laughs.
I will call the patient.
It feels good to be liked by this cardiology group. I've caught so much flack from my primary care peers for being different, for being stubborn, for disagreeing with the hospital administration and for being vocal and female. It's nice to be appreciated. I am comforted by the kindness of cardiologists.