PARTY!
The Strangest Emergency Department Case of “Holiday Heart” Ever Seen
Memorable “Meet and Greet”
This happened 30 years ago, but I remember him still.
🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳 🥳
He was a little messed up, this 20-year-old skinny kid who was suddenly my Emergency Department patient.
Darren had come in “feeling a little weird for a while.”
When hooked up to the cardiac monitor in triage, his heart rate approximated that of a hummingbird on crack, about 200. And irregular as a relief map of tRump’s ass cheeks.
And, as is often the case in these situations, Darren’s blood pressure was marginal at best, about 80 over nothing (120/80 is the conventional “normal.”) The heart tries, but when it’s asked to beat at three times its usual speed it can’t keep up. Its chambers don’t have time to fill fully and disgorge their blood, so blood pressure falls.
Darren was laid flat on a gurney in triage and whisked back to the Emergency Department’s medical acute area, to see me.
Darren’s thatch of thick uncombed brown hair was liberally festooned with bits of weeds and dirt. He stank of metabolized booze, among many other things I didn’t have time to sort through.
Nurses quickly stripped off Darren’s filthy tee shirt and jeans. IVs got started and he was again hooked to the heart monitor. Sticky pads got stuck to his chest, front and back. Their cables snaked to a machine capable of delivering a life-saving shock if needed.
Blood was drawn and sent to the lab. An EKG was done, stat.
As all this occurred I chatted with Darren.
Bottom lines predominate in the Emergency Department. Darren’s was “days of booze, non-stop man. I’m a wild one.”
“Yes you are sir,” I had to agree.
Continuing, I said, “Your EKG shows something called A-Fib. That’s medical shorthand for atrial fibrillation which sometimes happens when people drink too much for a long period of time. Some people call it Holiday Heart.”
Darren couldn’t have cared less.
To the nurses and techs surrounding his bed he spouted nothing but inappropriate drivel.
“Hey you’re cute.”
“When do you get off work.”
“Can I get your number.”
All ignored him, taking his verbal barrage with their usual aplomb.
I pressed on. “We need to shock your heart back into it’s normal rhythm. We need to do it now. I think I can safely give you a little sedation, but not much. The medication may drop your blood pressure still further and that would be a problem.”
“You’re the Doctor, do what you gotta do dude.”
Darren began to drift off as the medication flooded through his IV and into his system.
He also became even more disinhibited and crazily inappropriate, taking gentle swats at the nursing staff and attempting to grope several of them.
ER nurses take no shit from anyone. They just batted him away, intent on their tasks.
“Hey cutie, you got a boyfriend?” Darren slurred.
“OK that’s all the sedation we can safely give you, Darren. Your blood pressure is a little lower than it was and I have to shock you now.”
A gentle snore was Darren’s response.
Cautioning all staff and clearing them from Darren’s bedside, I pressed the electrical shock discharge button.
100 joules hit his chest like a horse’s kick.
Darren instantly arced off the bed. He sat bolt upright, stared straight at me and screamed …
“Let’s PARTY!”
Then he collapsed back onto the sheets.
His heart rate fell to normal. The rhythm returned to regular. His blood pressure rose to normal.
He slept like a babe for about 30 minutes.
Once awake, Darren reclaimed his crusty clothing. His stone-cold normal labs were reported to him. He was advised to refrain from drinking heavily. A follow-up appointment was made for him.
We observed Darren in the Emergency Department for a while longer then discharged him when he could fully care for himself.
He remembered nothing of his stay with us.
All agreed he was charming and fun, easily the best patient we’d had for weeks, a true holiday heart party.