The Heart of It All

REFLECT:  Step 1 – REMEMBER why you came to healthcare in the first place! Reconnect to your pure and simple desire to care, to comfort, to console, to make things better and make a difference! Realize that what you want is the sweet satisfaction that comes from knowing your care matters!


“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness………”

—Charles Dickens,
A Tale of Two Cities, Book 1, Recalled by Life


Teaching the best

In my role as a teaching attending, I had the pleasure to work with a senior resident who was chief resident in his Internal Medicine program. He was so good that I was truly impressed, and I felt bad, as the shift went on, that there was not much I could teach him. It was a busy shift and for much of the time, we were focused on direct patient care.

When there was a brief lull in the action, I told him how impressed I was with his performance, and I asked him what he was going to do when he finished the residency. He told me he had matched in a cardiology fellowship and that his goal was to be an interventional cardiologist.

I thought about that for a second, and I told him that in all of the advances I have seen in my thirty years of practice, the cardiac interventionist, and the angioplasty that they do and the stents they deploy, have been the most significant, spectacular and practical accomplishments in all of modern medicine. This process is the one thing we do today that impacts so many patients in miraculous ways.

How care changes

When I first started to practice, if a patient came in having a heart attack, we gave them an aspirin, nitroglycerine and some morphine, then, hoped for the best. Later, we added a beta-blocker, and when the thrombolytics, [TPA], came along, we gave them too. We often sat at the bedside watching the patient and the monitor, hoping at least to make them pain free. But, all we could really do back then, was hope for the best.

Today when a patient shows up with chest pain, as soon as we get the EKG that shows the heart attack, we move all of heaven and earth to get the patient to the cath lab and the cardiac interventionist as soon as possible. We still give the aspirin, the nitroglycerine, the beta blocker and the morphine, but we are in a huge hurry, a race against time, because we all know, “Time is muscle!”

Our patient is overwhelmed with the news that they are having a heart attack, and there are so many different “providers”, coming to get information; “When did your pain start? Do you smoke? Do you have any family history of heart disease? What meds do you take? When did you last eat? What is your pain now, an 8, a 2, a zero?” Then there is the phlebotomist, the EKG technician, the ED Nurse, the ED Doctor, The Nurse from the CCU, the Hospitalist, the Cardiologist, and we all pride ourselves on our metrics, and we measure and boast about our door to open vessel time. But somehow, the patient gets lost in all of this.

Making a point to express to your care

In the old days, the patients rarely complained because we sat with them, lamented with them, wished the best for them, and we had time to tell them what was happening. Today, patients are often so overwhelmed by the frantic processes we go through to deliver for them a miracle, of being able to tell them that there “is no damage to your heart….. you are not a cardiac cripple, you have another chance at a healthy life,” that our patients don’t even realize what a miracle has just happened for them, or been created for them, by us.

So now our patients and their families complain about how rushed we were, how we did not spend any time with them, and how nobody told them what was going on or what was happening. They complain that the ED Doctor was coldhearted and rude. The IV hurt and the Blood Pressure Cuff was too tight! The Registration Clerk was insensitive and the bill was outrageous! These days, even with all the spectacular medicine we deliver, there is sometimes little, if any, satisfaction on either side of the stethoscope.

So, I told the young doctor, that if he wants to stay fresh and enthusiastic, and to have a long and happy career, to always make a point, either before or after he opens that vessel, to connect with his patients and let them know exactly how much he cares.


The satisfaction you crave is in the knowing that your care has made a difference. Care is an intangible, it is not one of the metrics we can measure.  Unless you pay attention to this intangible, unless you take a moment to connect with your frightened patient to let them know why you are in such a hurry for them, what could happen if you were not moving quickly enough and how this will impact their life and their future, you will miss the opportunity to go home at the end of your shift knowing that your care made a difference and that what you do matters is immeasurable.

You may never see that patient again, and they may not remember your name, what you did, or what you said, but they will always remember how you made them feel, (and so will you). Care, make a difference, and change (y)our world!

All the best,


Frank D. Gabrin, D.O

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