2026 RICHARD SPEAR, MD, MEMORIAL ESSAY CONTEST
2026 RICHARD SPEAR, MD, MEMORIAL ESSAY CONTEST
Practicing & Life Member Category Winner Trust and Time in Medicine
by Melissa Platt, MD
The EKG was unmistakable. ST elevations stared back at me in concave, unambiguous lines: the artery closing, myocardium dying. In the language of emergency medicine, it was simple: activate the cath lab. Time is muscle. Move.
But medicine is rarely simple. He was sitting upright, wary rather than frightened. I explained that he was having a heart attack and needed to go immediately to the cardiac catheterization lab to open the blocked artery. The interventional cardiologist was on the way. Instead of urgency, I met resistance.
He reminded me of the times he had come to the emergency department with a cough. How no one had found anything serious. How he felt dismissed. He wondered aloud whether this, too, was being exaggerated. Now, suddenly, we were rushing him, pushing him, asking him to consent to something invasive.
In my mind, the clock was ticking loudly. Every minute meant more heart muscle lost. But for him, this was not just about an artery. It was about trust, about whether the same system that he felt had overlooked him before was now worthy of guiding him through something life-altering.
He wanted to see his wife. We brought her to the bedside. She was younger than he was, dressed in cultural clothing, her presence quiet but steady. She took his hand and listened intently as I explained again:
this was a heart attack. The treatment was urgent. We needed to go now. She listened without interrupting; her eyes fixed on mine. When I finished, she said softly and firmly that they should wait for his uncle. She clutched her cell phone saying he was coming but didn’ t say when: minutes we didn’ t have.
Even the chaplain, standing gently at her side, emphasized the importance of time for saving his heart. Still, she repeated that the uncle should come first. It was not defiance. It was deference. In their world, decisions of gravity were not made alone, nor even as a couple. Wisdom resided with an elder.
I felt the tension between two value systems pressing against each other. In my training, decisiveness is virtue. In theirs, counsel is wisdom. I was asking them to act quickly; they were asking for guidance. Eventually, after more conversation, after reassurance that consent would be obtained before any procedure, after repeating what was at stake, she agreed. He would go to the cath lab without waiting for the uncle. The doors closed behind his stretcher, and the chaplain walked with his wife down the hall.
I stood there longer than I needed to. What stayed with me was not the STEMI or even the urgency. It was the mistrust, the fragility of our authority. I had always assumed that in moments of crisis, patients instinctively lean toward physicians. But that assumption is shaped by
6 LOUISVILLE MEDICINE