This is actually an advertisement for laundry detergent.

I guess this guy never has to even do laundry because I assume only women are responsible for the purchase of the precious powder of cleanliness.

Woe to that woman who chooseth not the right soap, for she puts her family at risk for disease and pestilence!

I better treat my Tide with more respect!

I knew it kept my clothes smelling spring-time fresh, but I never knew it was keeping me alive!

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This story will be familiar to the readers of Emergiblog. I’m giving a different take on it here, and if you sense a bit of “snarkiness”, it is purely intentional.

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Got something on your chest?

I mean, does it ever feel like you’ve got something on your chest?

LIke……oh…..pressure? Aching? Indigestion? Twinge of nausea?

While you are just sitting and reading?

Concerned enough that you take an aspirin an hour after onset?

Concerned enough that you actually go to the ER after three hours because it is a nagging, unrelenting discomfort?

A wee bit clammy en route? Just a tad?

Concerned because at the age of 48, you have already been diagnosed with high blood pressure, high cholesterol?

That your father died a sudden death at age of 62 of heart related issues (after blowing out his entire right cerebral hemisphere three weeks prior)?

That you are considered by the “charts” to be “morbidly obese” (how rude!), that you have a BMI that puts Joe Montana’s pass completion record to shame? And, with the exception of running your butt off about 36 hours a week in an ER as a nurse, you have not exercised since you could fit in a leotard for Jazzercize?

Concerned that your EKGs are consistently abnormal in that you have no R waves in thre anterior chest leads with a follow up echocardiogram showing mild left ventricular hypertrophy (a big heart…awww) and the fact that at rest, your ventricles do not “relax” like they should?

Concerned that maybe, just maybe, all these things might lead you to believe that the pain that will not change and does not leave might be cardiac?

Are you a woman?

Then prepare yourself.

You will not be taken seriously.

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Oh, the ER will did all the right things. They brought me in to triage quickly and found me a room and hooked me up to the monitor and grabbed an EKG.

All the while I will be gave them my history and medications. If you are an ER nurse like I am you will rattle off your history, medications and symptoms of your present illness like a pro. Not an extraneous word in the entire history.

No anxiety shown externally, you do this every day. No histrionics here. You didn’t rush in at the first sign of discomfort. You took the aspirin just in case. You know the score.

You’re cool, calm, collected and you even brought a book to read, knowing it would be hours before you were released.

Sinus Rhythm (that’s normal beating, to the uninitiated). No ectopy(extra beats). Slightly elevated BP. To be expected under the circumstances. Oxygen. All routine.

Then in walks the ER doc.

He sits down, looks at my EKG and tells me it is normal. (At that point he had no old record to see that the R wave progression abnormality was “normal” for me.)

Right then and there he writes me off. You can see it in his eyes.

Without laying a hand on me and without palpating my abdomen, he tells me this is a gastrointestinal problem. After all, you naughty girl, you have been taking ibuprofen for your back.

Then he listened to my lungs, my heart sounds and my bowel sounds (down around my belly button/umbilicus/navel/innie)

Thank goodness for small favors.

He smirks when I mention I might have a sensitivity to nitrates (almost fainted when I got in the way of a Nitrospray once! That’s a story for the other blog….) and says he has no intention of “going there”.

That took all of 90 seconds.

“Could be gallbladder,” he opines.

(Gee, in all my years of ER, I have never seen someone with cholecystitis present with left anterior chest pain radiating to the left scapula and shoulder with left arm heaviness. And a painfree abdomen, by the way.)

My goodness, they are teaching ultrasonic vision in med schools now! Never mind that this is the most atypical pain for gallbladder I’ve ever heard of.

So, Maalox and Protonix. The new standard of care for chest pain! I knew the AHA was changing some protocols, but wow!

Forty minutes later, as the pain is localized in my left shoulder and my left arm remains heavy, Ultrasonic ER Doc pops his head back in and says that it must be musculoskeletal pain.

Um…………okay………….

So I get IV Toradol. Wonderful! An anti-inflammatory for a gastrointestinal disturbance turned musculoskeletal.

Two hours later, five to six hours after onset, I am finally pain free.

This means I have earned another sixty seconds of Ultrasonic ER Doc’s time. During which he tells me my repeat EKG is unchanged, this is not cardiac and he has talked to my regular physician.

Thank God. Because you see, I really was a bit anxious.

And then he said the words that pissed me off more than anything else.

“After all, you have no risk factors.”

Pardon my language, but WTF?

Had I been a man of the same age with the same risk factors I would have been kept at least over night and given a stress test the next day.

How do I know?

Because I work in one of the top cardiac centers in the Bay Area. And we don’t write off women with chest pain.

I know that the doctor I saw at local-ER-with-trauma-center wrote me off because I am female.

And no, before you think that I’m a card-carrying feminist who sees anti-women bias in a cup of tea leaves, that is not the case.

Ever read Dr. Helen?

And if my family history and personal health issues weren’t enough to evoke concern in an ER physician, then……

What’s “blood” got to do with it?