( continued from page 23 ) call 12 hours , every 48 hours . A young lady was admitted and was well-known to the staff because she frequently attempted suicide . She would overdose , be admitted and then recover . On this admission , it was my responsibility to find out what she had taken . The young girl had ingested a lethal amount of a rat poison that contained yellow phosphorus . When I called the CDC poison control in 1974 , they said there was no treatment , the substance could not be dialyzed and she would die . By early afternoon , the young girl was extubated , sitting up in bed and told us she was ready to go home . Sadly , we knew differently . About 2 a . m ., she started with non-sustained , then sustained ventricular tachycardia , then fibrillation . After a long Code 300 , she died . Just starting my internship , her death was devastating to me and one I would not forget for years to come .
St . Joseph Hospital was still open when I arrived in Louisville in 1979 . At that time , a cardiologist went to almost all Code 300s . A man in his 40s suffered a cardiac arrest in the emergency room . Having just completed my fellowship , I was up to date on the Code 300 protocols for that era . I followed the protocol , and we continued the code for approximately 30 minutes ; however , the patient remained in asystole . The heart did not respond and I stopped the code . In the corner of the room , I observed the respiratory technician was crying . I asked her what was wrong . She said , “ Dr . Dageforde , I have a strong feeling this man will live . Will you please continue the code ?”
We started the protocol again . I blindly floated a temporary pacemaker since no fluoroscopy was available . After making a few adjustments , the heart started pacing and eventually the young man was discharged from the hospital . I thanked the respiratory technician for her concern and wisdom . The patient lived another 10-12 years .
When Dr . Richard Allen and I started balloon angioplasty in 1982 , it was literally , see one ( we observed one case with a friend of mine in Indianapolis ), do one ( the friend came from Indianapolis to watch our first case ) and teach one ( we taught each other case by case ). Since we used a brachial artery technique and the early equipment was cumbersome , we performed the initial procedures together . During the first six months , I performed my first circumflex artery balloon angioplasty using the Gruentzig balloon with a small , fixed guide wire catheter . The case was lengthy and the only sedation for the patient was 10mg oral Valium ; thus , patients were always awake during the procedure . The procedure was successful and we were pleased .
When the patient came to the office for follow-up , she was very thankful , but said , “ Doctor , can I make a suggestion ?” “ Sure ,” I responded . “ When you were doing my case , you said ‘ oops ’ at least six to eight times . I was not comforted while lying on the table hearing ‘ oops ,’ and I wondered what ‘ oops ’ meant .” Since the circumflex was the hardest vessel to treat with a fixed wire balloon , I was saying “ oops ” when I had trouble directing the stiff fixed wire balloon . Wow , I thought afterwards , I would not want to hear “ oops ” while I had a procedure performed on me . I profusely thanked her for her honesty and advice .
In 1984 , not only was balloon angioplasty still in its early phase of development , a cardiology group from Kansas City presented case work on acute myocardial infarction angioplasty at a national meeting . Over the wire technology had just been released , so we started performing acute MI angioplasty . With the new technology available , we no longer performed our procedures together . What we quickly realized in that first year was the much higher risk of acute MI angioplasty compared to elective angioplasty , especially since perfusion balloons had not been developed . The early cases of acute MI angioplasty were quite tense and many times there were difficulties to overcome , although most patients lived . On several occasions I would be involved in an acute MI case during the night , the cath lab door would open and one of my non-invasive partners who was also on call would be there for support and suggestions – it was overwhelming to me that he or she would do so .
I remember another acute MI angioplasty during those early years . The patient went into ventricular fibrillation over a dozen times . I was trying to keep the artery open ( no stents at that time ), and the patient went into third degree block . In the chaotic frenzy of placing a temporary pacemaker while during the same time the patient received repeated shocks for ventricular fibrillation all while trying to keep the artery open , the only reason the patient survived was because a superb , united cath lab staff worked as a team in the midst of a crisis . Both complicated MI angioplasties reminded me that the success of the case was not because of me , but because of a team effort by colleagues giving support and working together .
In 1995 , on my second trip to Western Ethiopia , we were holding a clinic in a large village . A young mother brought in her 8-to-10-year-old daughter who was ill , but not critically ill . Using the medicines available , I treated her , not certain of her diagnosis . During the next three days , the mother returned each day with the child who became worse . We were hundreds of miles from any type of medical facility , and all I had was my London Tropical School of Medicine material . I was aware of the local diseases , but no diagnosis fit her symptoms . I was quite distressed . Ray , the career missionary , sat with us each day , and offered prayer and talked with the mother . On the fourth morning , the little girl was in shock . I had read and re-read the material , concentrating on the section regarding causes and treatment of shock in tropical climates . I started two IVs , one in each leg , and I gave steroids and followed all the recommendations from the London school ’ s material . Finally , the little girl seemed at least stable enough to go home with her mother . At 5 a . m . the next morning , I woke up startled because there were drums pounding
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