Carl Gladstone woke on the west side of Manhattan in the small hours of June 18, 2008. The professor, as was his custom, put on a pot of coffee and loped into the shower. After trimming his mustache and inspecting his thinning brown mane, he may have revisited a question that had been nagging him. Did he, in fact, look like Theodore Roosevelt, as one of his students had recently suggested?
Gladstone grabbed his briefcase and Yankees baseball cap and headed out of the Hell’s Kitchen apartment to his office. A northbound train ride deposited him at a college in Westchester County, where he’d spent the entirety of his academic career, teaching accounting. After catching up on email, scanning the Yankees box score, and perhaps agonizing over the one thing that could possibly drive him to an early retirement—deriving new questions for his exams—he stood up, tucked in his shirt, and walked down the hall to an empty classroom.
As the students filed in for the 11:00 A.M. class, Gladstone methodically began to write on a chalkboard. Satisfied with his work, he pivoted to survey the room. He cleared his throat to call the chattering students to order. Then he felt a twinge in his right arm.
A moment later, he was on the floor.
Quick-thinking students dropped their backpacks and phones and lunged into action; an ambulance was called, and despite momentary doubts (“Do we really give our teacher mouth-to-mouth?”), a young man initiated CPR. After several awkward attempts at chest compressions, Gladstone regained consciousness as quickly as he had lost it. He stood up, backed away from the students, and asked everyone to return to their seats.
Within minutes, an ambulance arrived. After some haggling with the emergency medical technicians, Gladstone acknowledged that he was still having chest pain and agreed to be transported to the Columbia University Medical Center. As the ambulance took off, emergency room physicians and nurses received notification of Gladstone’s impending arrival. By the time his stretcher burst through the swinging doors of the ER, a cardiologist was waiting for him.
Nurses instantly slapped twelve EKG leads on his chest as the team transferred him from the ambulance stretcher to an emergency cot. Gladstone was surely unaware of the unusual EKG report the leads were generating just a few feet from his head. The report, which resembled a red-and-white checkered seismograph, was retrieved by the bedside cardiologist. It revealed broad, irregular waves that plateaued rather than forming sharp points, a finding known as tombstoning because of its grave prognostic implications. A large segment of his heart had suddenly and unexpectedly lost blood flow.
Seeing the tombstones, the cardiologist informed the emergency room staff that there was no time for X-rays or blood tests. Gladstone was rushed upstairs and into a dark room—the cardiac catheterization lab—where a team of interventional cardiologists went to work on his convulsing, failing heart. Gasping for air, Gladstone was quickly sedated and a large tube called a cardiac catheter was plunged into his groin, then snaked into his aorta. A doctor shot dye through the catheter and into his heart’s blood vessels, and the image was projected onto a flat-screen monitor for the team to see. There were a few silent nods as the image became clear. His left main coronary artery was blocked—an abnormality known as the widow maker’s lesion—and the cardiologists quickly went about opening it up by inflating and deflating a small balloon that rested on a guide wire at the end of the catheter.
Time to treatment is critical; restoration of blood flow in the obstructed artery is the key determinant of both short- and long-term outcomes for patients suffering heart attacks. Hospitals are now evaluated by the time that elapses from a patient’s arrival in the emergency room until the balloon has been inflated inside the clogged artery. This door-to-balloon time should be no more than ninety minutes according to the American Heart Association. For Carl Gladstone, it had been less than fifty.
After the senior interventional cardiologist deemed the procedure a success, a still-sedated Gladstone was placed on yet another stretcher and transported to the cardiac care unit, an eighteen-bed intensive care unit on the fifth floor of the hospital for cardiac patients requiring continuous monitoring. Dr. Gladstone would live to see another day, but he would not be able to appreciate the statistical misfortune of being placed in the care of a physician who had been practicing medicine for less than a week, a physician who could not yet interpret a subtle but potentially devastating clinical finding.
Me.