Tonight I was called to see a 27-year-old gentleman who had been admitted following an out of hospital cardiac arrest. In this case what this means is that this gentleman had been at work, going about his day as per normal, when he simply fell to the ground, and his heart stopped. This is a story that generally does not end well, as even if a person is resuscitated following a cardiac arrest, more often than not they are left ‘brain dead’, or with severe brain damage, and the only decision left to make is when to turn off the life support.
           Fortunately for this gentleman, following a few rounds of CPR, some adrenaline and some shocks from the defibrillator, he was resuscitated – and he has no brain damage at all. He is, for all intents and purposes, still a fully functioning human being.
       Unfortunately, he is still a young man whose heart just stopped, for no obvious reason, at age 27. He has been in our hospital for 5 days now, and was moved from the intensive care unit to the ward today. Despite many blood tests, complicated cardiac imaging and other advanced medical diagnostics nobody has any idea why his heart one day just decided to cease to beat. Which of course means that there is nothing definite that we can do to stop it happening again.
                I only became a part of this young mans story tonight, when I was called to see him because he was having chest pain. As a junior doctor I do not cover the ‘Coronary Care Unit’, which is where all of the patients who have had major heart surgery or major heart attacks are; for some reason as a junior doctor I do cover the Cardiology unit – which is how, at 1am on this Thursday morning I became responsible for the life and well being of this 27 year old gentleman.
                  Getting called to see a patient with chest pain is not an unusual occurrence at all in the life of a junior doctor. Day to day it’s one of the most common things I deal with. Normally I am very confident and equipped at knowing which tests to run and how to treat accordingly, and I very rarely call my superiors for help. So, looking at the facts of this case it would be appear no different to any other case that I have dealt with over the past weeks and months, except for this: the hearts of 27 year old man are not just supposed to stop. 67, 77, 87 and 97 year old men, yes. Those situations do not scare me, that background does not alter my management. This case, objectively, should be like any of those – the symptoms are the same as many elderly gentleman I have seen this year.

But it is not. The sad but stark fact is that we do treat patients who are seriously ill and so young differently to those who are seriously ill and past the prime of their life. Medicine should be objective, and everyone, regardless of age, should be entitled to the same treatment. But the fact is that if I miss something when I am reviewing my patient who is 87 and he dies, we will all be sad and briefly mourn his loss, but it will not reverberate through our lives for long – he was old, he was sick, it was his time. Whether or not it could have been prevented we will fall back on his age and not blame ourselves too much – for a he lived a good, reasonably long life. But 27 year olds are not supposed to die – 27 has too much wasted potential. If I miss something it will not be ok. Which is why I took my notes, all of his ECG/EKGs, and all of his test results and discussed it with my superiors to ensure that there was nothing at all that I could have overlooked.
When someone is young you don’t take chances. It makes you realise that medicine is not just a science; you cannot be a doctor and at the same time also not be a human being. The only thing that made me so much more thorough on this occasion was not a certain alarming symptom or sign that was different in this case, it was that the tragedy of the loss of this life would be too great to take a chance with.
All of this makes me sad, I guess. It’s not that I am negligent when I am assessing and treating the elderly amongst my patients, it’s that I do not always take the extra, extra steps to make sure that there is absolutely nothing that I could have missed. I hope that meeting this young man tonight has opened my eyes to how differently we treat our patients based on their age, and that maybe next time I am called to see an old man with the same history and the same problems as his younger counterpart, I will think twice about what else I can do to make sure that nothing is left to chance – for who am I to judge, even subconsciously, the merit of his remaining years?