Essay

How I Met Your Mother

Jay Bitar, MD

Jay Bitar, MD

Time: Evening, July 1st, 1989

Place: ICU at La Porte Hospital, La Porte, Indiana

I had just finished my final year of training in interventional cardiology in Michigan. I was eager to start my first job as an interventional cardiologist in La Porte, Indiana.

July 1st was my first day on the job, in a new town and a new hospital. Around 7 pm, I got a patient with ST-elevation myocardial infarction and started thrombolytic therapy. Being at a center that did not have percutaneous coronary intervention capability, the standard of care, back then, was to give thrombolytic therapy. The patient did not seem to reperfuse with the thrombolytic therapy and in fact, went into pulmonary edema. I had to intubate him, sedate him, and put him on a ventilator. Later, his blood pressure started to drop. I turned to the nurse taking care of the patient with me and asked, “Do you have a balloon pump? I may have to put one in on this patient.” Her name was Sue Cox. She answered, “Yes, the balloon pump machine and the kit are in the corner in the ICU.” I went to examine the equipment and saw it was the same brand of device I trained in and the exact kit that I was familiar with. I told the nurse, “We are going to put a balloon pump in, and I need you to gown up so you can be my assistant.” She asked, “Do you know what you are doing?” “Yes,” was my answer. She asked, “Would you tell me, step by step, what I am supposed to do?” I said yes, I would.

In my mind, I thought it was reasonable for her to ask if I knew what I was doing, because I was new and she was testing my self-confidence. I also felt it was reasonable for her to ask me to be clear and detailed during the device insertion, since we had never worked together before. 

The procedure went well. The portable x-ray confirmed good placement of the device, and the machine was turned on with good augmentation and improvement in blood pressure. The patient stabilized for about an hour, then had a cardiac arrest and sadly could not be saved. 

By midnight, I was ready to leave the ICU. I thanked everyone for their help and especially Sue Cox for her assistance with the balloon pump insertion. I went home.

The next morning, my pager was going off nonstop. I had messages to call this one and that one, from the CEO to the CNO, from the medical director to the ICU supervisor and cath lab director. Everyone started with the same question, “How dare you place a balloon pump when it was just purchased last week and was not to be used until in service and training is done!?” How dare I insert it at the bedside, when they were told it could only be placed in the cath lab. How dare I use an ICU nurse to assist in the placement when the administration had a plan to limit the assisting role to cath lab members!?

I did not know the hospital had never placed one before. I did not know they had only gotten it the week before, and I did not know that no one had yet undergone any training on the device. It was supposed to be on display only and not to be used yet. I violated the plan. To their knowledge, a balloon pump could only be placed in a cath lab, and they were surprised to find out the bedside option existed.

Looking back, I realized that when Sue Cox asked if I knew what I was doing, she was really trying to say, “I hope you know what to do because nobody here does.” When she said, “Would you tell me step by step what to do,” she was trying to say, “I have no clue what I am doing and I need your clear guidance.” I was naïve and assumed they had used a balloon pump before. I assumed the nurse was familiar with the device, but not familiar with me. 

The hospital drama eventually subsided. After that, Sue Cox and I were friends. A year later, her name became Sue Bitar. Seven years later, you came along, Julia. And that is how I met your mother.

Love, Dad