The power of denial

Bill came in today with an earache, and left in an ambulance. Two weeks ago he suffered a heart attack. While checking him for his ear pain today, he admitted that he was having chest pains across the upper chest and into the left underarm, and that he had had the same symptoms yesterday. He has nitroglycerin to take for chest pain but hasn't taken it. "It's not my heart," he stated emphatically and we rolled in the EKG machine and started an IV and oxygen. The EKG readout told a different story, flipped T-waves in the lateral leads suggested that the left side of the heart was not getting enough oxygen and he was at risk for another heart attack. He started to become agitated and threaten to leave. He wanted his breakfast and he was sure the breakfast would not be good at the hospital. At this point I called his wife who was able to calm him down and convince him to go to the emergency room for further evaluation. While he was leaving on the stretcher, I ducked back in the room with the African-American girl with fevers for 3 weeks for which there is no answer so far. No time to think about why this man could put breakfast ahead of saving his heart. Denial can be an incredibly powerful defense against reality.