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A few weeks ago a 52-year-old man we'll call Jerry got the scare of his life. Taking off a Friday to help his brother move furniture into his new third floor walk-up apartment, Jerry woke up Saturday morning with a feeling of a dull pain in his chest.
The pain was not especially intense, but since Jerry's father had had heart attack a few years earlier, Jerry put his family's Saturday plans on hold to make sure the problem wasn't something serious. He drove himself down to the local ER, walked inside, and told the triage nurse he was having chest pains.
That was when Jerry's nightmare began.
Chest pain is usually given priority treatment in American emergency rooms, and Jerry's case was no exception to the rule. Jerry was told two chew four children's aspirin, and given a nitroglycerin tablet to put under his tongue. A technician came by to draw blood--Jerry was not told why--and another came by to sit him up in his bed for a chest x-ray. The nitroglycerin pill gave Jerry an intense headache.
Yet another technician came by to hook up Jerry to an EKG, and the phlebotomist came by for yet another blood sample. After forty five minutes, the ER doctor arrives and asks a long list of questions.
"Has there been blood in your bowel movements lately?" the doctor asked. Jerry answered, "No, but I'm here because I had a little chest pain." The doctor continues going down the list.
"Do you need to sleep on two pillows?" the doctor asks next. "No," Jerry says, "And I'm not here because I woke up feeling sleepy. Can you tell me what is going on?"
But the doctor can't tell Jerry what is going on. "Your EKG and blood tests" for an enzyme called troponin, which measures damage to the heart muscle during a heart attack, "are normal, but we need to keep you overnight to be sure," the doctor said. In the morning we'll give you a stress test (in which a chemical forcing the heart to beat hard and fast is injected into the bloodstream, the patient is given a radioactive dye, and a series of images of the heart are taken--if the procedure doesn't cause a heart attack itself), and then we will decide if we need to do a procedure called a cardiac catheterization."
By that time Jerry had already missed his son's soccer match, and he needed to tell friends to cancel his weekly golf game. His bill was already over $15,000. And nobody had asked him about moving furniture, checked for a pulled muscle, or inquired whether his chest still hurt after he took the Aspirin. The $10,000 test ordered the next morning didn't show any heart damage, either, so Jerry was sent home with orders to follow up with his family doctor.