what do you do?

​Tonight, I was impressed by Jay.
 
Jay is a musician.   He plays in a jazz quartet.    He plays bass, but when he transitions over to the acoustic guitar, boy, can he make it sing.  Effortlessly.  I listened to his music for 3 hours, as he switched from double bass to double string guitar, quietly lifting the performance from the shadows.
 
Jay must be 72.   He is 6 ft tall, 230lb.   He has graying hair, and rounded jovial face.  He dresses well: nothing shabby about Jay.
 
So why am I writing about Jay?  As I observed his stance, his manner, his deportment, his skill with strings, the ease with which he gave accompaniment, I thought ‘What if Jay came to the ER of my hospital with an MI?’.
 
J Smith, 72, male.
90982929301
Bed C4
 
‘Chest pain in a lounge bar, came on suddenly.   Had been working hard all night, pressure came on about 10pm and affected the left arm.   Unable to continue playing guitar.   Sweaty and breathless, he attributed the latter to the smoky room.   Denies alcohol intake.   No cigarettes for 4 years.   Widowed.   On ASA and vitamins.   Diet controlled diabetes, poor control.  No known allergies.  Exam obese Caucasian male, pulse 58 irregular, BP 160/90, no JVD or edema, quiet heart sounds, chest clear.  EKG AF with slow ventricular rate, acute inferior MI.   Tn 40.   CXR nil acute.   BS 12.2  K3.1.  GFR48. 
IMP/Plan:  acute inferior MI, thrombolysis, admit telemetry, schedule cath.   Enoxaparin, ASA, nitrates, betablocker when HR allows.   Consult to IM/Cardiology, notify GP in am.’
 
What is missing here?   As I looked at Jay, I said, “Nothing in my exchange with this overweight man tells me he is a remarkable human being.   He is talented, personable and experienced.  He is a sought after, self-effacing, locally-famous bandsman”.   But the social history is what we gloss over first when time is at a premium.  
 
Jay has a first-class sense of rhythm.   But tonight, his rhythm is atrial fibrillation, and he is anxious.  He is not in his element.   He worries about his friends, Iris, Bennett and Lorraine, who have 2 more sets lined up at the end of the week.   Will he be better by then?   Will this illness mean a change in his life, a drop in his income, and in future – a stroke?   Will he be able to play again?  Will he be able to afford his drugs, will they take his driving licence away?
 
Jay lives in a small house in Park Royal, with a dog, Bonaparte.  His neighbours will see that Bonaparte is ok.  Jay’s name is on a dozen album releases: that he isn’t known to nurses and doctors in this venue is odd.   Jay lives for music, but there are no sounds in this emergency room cubicle.  Jay, like most of our patients, has become a number, a bed, a stay, a transfer, a procedure, and a disposition.   Jay the bass player, the Gibson’s wizard, the feted soloist and stellar team member – is facing his demons alone.   If only we knew.
 
Who hasn’t said ‘WOW’ when learning our patient (a) defused IEDs in Afghanistan (b) rebuilds antique cars for a hobby (c) is an accomplished portrait painter (d) travelled the world as a National Geographic photographer (e) was ski-ing in the Alps last winter at the age of 71 (f) has 20 grandchildren and great-grandchildren?
 
But this information trickles out later, when time allows us the opportunity to make that essential contact and healing touch with the simple question “What do you do, or did you do, for a living?”  It is one of the most interesting portals to understanding any patient.
 
To be honest, I don’t even like jazz.   But I know greatness when I see it:  it is in everyone.