News & Events :: Media Mentions

This Can't be Happening! A Personal Experience with Palomar Medical Center.

By Lyle E. Davis
The Paper, May 26, 2005

You feel a sharp pain in your chest...it gets sharper, more painful...you begin to feel some numbness in one of your arms...you think, “this can’t be happening to me! This happens to other people. But, I might be having a heart attack!”

Don’t mess around, pal. Call 911. Now. Don’t wait for a spouse, a neighbor, a friend, to drive you to the hospital. Call 911. Why? Paramedics can hook you up to an EKG (electrocardiogram) while on board the ambulance. They can quickly tell if you’re having a heart attack, and if you are, how severe it is. They can radio the results ahead and the hospital ER staff can be waiting for you, ready to administer immediate treatment and save your life.

What happens if your spouse, friend, neighbor, drives you? You may make it. You may not. The difference is in the fact that you don’t have life saving equipment in that car, monitoring your condition...and, if necessary, administer medical treatment.

Now, I have to admit...I’m one of the worst violators of the advice I’ve just given you. Yes, I’ve been reluctant to call 911 on several occasions last summer when I had chest pains. I didn’t want to be "embarrassed." Didn’t want to go for a ride in the pretty red ambulance, get to the ER, have a bunch of tests and then find there was nothing wrong but indigestion...or a chest muscle pull. I’d feel, I thought, like a big baby...calling an ambulance when there really wasn’t anything wrong with me. Kinda wimpy, I thought.

I thought wrong. Nurses, doctors, paramedics, EMT’s, they’ll all tell you, this type of thinking could literally cost you your life.

“Unfortunately, about 50% of heart attack victims walk-in to the Emergency Room. It’s far better, far safer, to call 911. They’ve got the facilities to help ensure you’ll survive.” Cheryl Groydon, RN, Head of the Cardiac Alert Team. Plus, if you need additional incentive, your treatment is faster if you call 911. If you walk in you have to see a Triage Nurse, then be taken to the Rapid Medical Evaluation Room, be given an EKG, have the doctor read your electrocardiogram, and then either assigned to the cardiac catheterization unit, or to a hospital room. They still move quickly (you mention chest pains around medical staff and they move out smartly), but it’s far, far faster via 911 service.

Another personal admission. I’m a cheap skinflint. I couldn’t see the logic of paying $150 for an ambulance ride of about 12 blocks to the hospital from our home. Less expensive and less hassle to let Evelyn drive me. (I’m a Kaiser patient and it costs me $150 for an ambulance ride, $100 to be admitted to ER. Granted, not a lot of money). Logic would suggest that my life is probably worth a tad more than $150. So, I need to change my thinking and my ways, just as you likely need to change yours.

The Adventure

Let me take you along on one of these exciting rides in the pretty red ambulance (for that did happen on at least one occasion last summer. The decision was made for me...stubborn old goat that I am). The highly trained paramedics arrive, check your blood pressure, determine your symptoms, probably hook you up with an IV, place you on a gurney, move you to the ambulance and hook up an electrocardiogram. You hear radio traffic, code words that probably have something to do with you and your condition...and maybe with some other poor soul in the county who had a car wreck. The radio is busy, between ambulances and the hospital.

The Emergency Room

You arrive at the Palomar Hospital’s Emergency Room. You are already expected by the Cardiac Alert Team. “Palomar Hospital is the only hospital in the state with the Cardiac Alert program and is one of only nine nationwide that offers the service. That automatically increases the probability you are going to survive. You’ll get the correct treatment more quickly than anywhere else.” Cheryl Groydon, RN, Head of Cardiac Alert

They’ve already been given a heads up by the paramedics. If your condition will require treatment by the cardiac catheterization lab, you will probably be in the cath lab promptly.

The American Heart Standard has established a goal of “from (ER) door to balloon (Cath Lab) in 92 minutes or less.” The average at Palomar Hospital is 90 minutes...they have on occasion gone “from door to balloon” in 20 minutes.

The ER personnel most likely already have your ECG/EKG . (electrocardiogram - sent ahead of time by the paramedics, while you were en route via the ambulance). A doctor will promptly read that and route you to the next appropriate treatment center.

You may meet an Emergency Room Doctor, similar to Dr. Jaime Rivas, Medical Director for California Emergency Physicians. He’s a product of San Diego, chose to specialize in Emergency Room medicine because . . “you get an opportunity to learn so many elements of so many different disciplines. It keeps you on your toes. You have to constantly study and consult to keep up with medical advances and treatments.”

The Cardiac Catheterization Lab

If it’s the Cardiac Catheteriza-tion Lab, you’ll be there in, literally, minutes. This procedure sounds terrible. It’s a piece of cake. Trust me. I’ve had it. There’s nothing to it. Well, it’s a highly technical, modern medical procedure, but it’s done by highly trained, brilliant, medical doctors, nurses, and techncians. In addition to the doctor(s) and nurse(s) present, you also are likely to have Tiffany Chavez there. She’s the Cardiovascular Invasive Specialist. She knows about everything there is to know about a cardiac catheterization lab and how it works.

I was a bit nervous when I went in for mine. The thought of inserting a catheter into an artery in my groin and then snaking that sucker up into my heart chamber, and then releasing some dye into my pure, pure heart . . . why, it was downright invasive! And it would probably hurt like hell. Or so I thought. Didn’t hurt a bit. One of the nurses had told me that but I thought she was just blowing smoke in my face, trying to calm me down. “You’ll feel a small prick when they give you a local anesthetic in your groin area,” she said. “And that’s it. You won’t even feel the catheter. Oh, you might feel a bit of warmth when they inject the dye, but that’s not bad.” And she was 100% correct. She wasn’t giving me a snow job.

It just isn’t as bad as you would imagine. Upon arriving in the cath lab I received the promised local anesthetic. I relaxed and listened as the various team members of the unit went about their orchestrated procedures, preparing for the event that was new to me but something they did everyday . . . and had it down to a fine art. There was some medical discussion but more friendly banter between close friends, talking about the upcoming weekend barbecue . . an interesting new training assignment.

Clearly, these were people who were comfortable with themselves, with their jobs, and with their responsibilty. They knew nothing would go wrong. They were too highly trained for that to happen. I was to have Dr. Roger Acheatel do my angiogram (for that’s what a catherization is called.

An angioplasty is when they insert a balloon into your artery to strengthen an otherwise weakened or damaged artery.) It was almost surreal, lying there, very comfortable, watching the catheter enter your heart, watching your heart pumping rhythmically, and, there! There’s the dye! (They don’t call it dye . . . they call it “an opaque agent.”)

I don’t think hospital personnel like the word “dye” in any way, shape, form, or spelling. “Nothing wrong with your heart,” said Dr. Acheatel. “There’s no blockage there.” And it was done. He finished the procedure, chatted briefly, and then was gone. In no time at all I was back in my room in the Cardiac Care Unit. Puzzling results, I thought. Blood enzymes came back normal, no blockage in the heart or its arteries, no indication of a heart attack, thus no muscle damage to the heart.

So what was causing the chest pain? We would find out. Later. The Cardiac Care Unit For the next several days I would be closely monitored by machine and by efficient nurses. I was treated promptly, professionally, and cordially . . .every single step of the way. From the time the paramedics arrived, to the arrival at the ER, to the cath lab experience, to the cardiac care unit . . . top notch service all the way. We are really lucky to have a great hospital like Palomar Hospital serving North San Diego County.

Throughout my stay I was treated, comforted, pampered, (some might even say ‘spoiled rotten’). I also had a chance to get to know some of the medical staff. I had three nurses attend me while I was there.

As luck would have it, two of the three were what is known as ‘traveling nurses.’ A ‘traveling nurse’ accepts an assignment for 90 days, six months, a year . . . and then moves on. It’s a great life if you don’t have any responsibilities that tie you down. A chance to see the world.

John was a local nurse. Loved his work, trained locally, had a lot of time with his family (nurses work a three day week of 12 hours per day). Derek is a Filipino who had just come from Oxford England. When he finished that assignment he accepted a 90 day assignment at Palomar and then was off for another assignment to New Zealand.

Tabitha was from Illinois. She had her heart broken by a boyfriend, accepted an assignment as a traveling nurse to get away for awhile, found that she loved it, and had adopted it as a lifestyle. For the moment at least. She was particularly fond of this assignment as not only did she enjoy excellent salary and fringe benefits as a nurse, but she also had her rent paid as well as utilities, and the use of a rental car, all while on assignment.

I wondered if this might not generate professional jealousy among her fellow nurses. “No, we’re glad to have the traveling nurses,” said several nurses I spoke with. “They’re well trained. They know their job. And in medicine, that’s what is most important.” Gerald Bracht, Palomar’s Administrator agreed: “Our first obligation is to look after patient safety and comfort,” he said. “Naturally, as administrators, we are also respsonsible for keeping tight control of the budget, managing costs. But, the facts of life are that there is a nursing shortage. We have to have them. If they are not available locally, then we have to hire traveling, or international nurses, no matter what the cost. The patient comes first.”

I found this attitude at every level of medical treatment within Palomar Hospital. It is an attitude, I am sure, within the medical community as a whole.

But whether it is as a traveling nurse, an international nurse, or nursing within your home community, nursing is rapidly becoming one of the most desirable professions in the business and professional world. It takes a special person to become a good nurse. “It’s a very rewarding career,. It can be intense . . . but it’s a great profession. You are able to, literally, save people’s lives. That in itself is a great reward. Yet we are very well paid for our services as well. And you’re never out of work.” “To be a good nurse, you must like people, you must want to help, you need to be compassionate, and understand the need to help.” - Cathy Mendez, Chief of the Cardiac Stepdown Unit, Palomar Hospital.

Cathy became a nurse by going to a community college for a two year nursing program, then she worked for a time as a BSN and NSN, then went to San Diego City College for her nursing degree. Took her state boards, passed, and became a Registered Nurse. She worked at Kaiser Hospital for 15 years before joining Palomar Hospital.

More and more young people are recognizing nursing as an outstanding profession. And more and more hospitals are all but begging for nurses to come work with them.

They have recruited, literally, worldwide. Many nurses have come from the Phillipines . . . but even that market has become limited. Sadly, we have a waiting list of potential nurses to go to nursing school and they sometimes have to wait from one to two years just to be admitted to nursing school. There simply are not enought nursing schools to teach the many students that want to become nurses. “There are all kinds of opportunities in nursing,” says Pamela Hoppie, Head of the Palomar Hospital Emergency Room. “There are opportunities in Research, Operating Rooms, Pediatrics, Geriatric, Registry, or in General Nursing.”

Trying to meet the urgent need for nurses is part of the job for Deb Bennett, Director of Nursing Studies at Cal State University, San Marcos. “Many nurses will come back into service, after having taken time off to raise their families. We are offering a Nurse Refresher course under the Continuing Education program at CSUSM. We can handle 18-20 nurses at a time. That is not a large number . . . but every nurse we can add back into the nursing pool helps.” Those interested in nursing as a career will need basic sciences in a two year Associate Degree course, followed by a four year course leading to a Bachelor of Science degree. The Registered Nurse license is awarded after successfully completing state board exams.

The training process is one that automatically ‘weeds out’ those who ought not to become nurses. Those who lack compassion, or who don’t have the work ethic, or who are unable to grasp the educational tools necessary to become a good nurse, usully recognize that themselves and move into another educational program more suited for their personal needs and goals. Those who sincerely want to succeed, however, are given great assistance by the faculty. They want you to succeed, and will help, within reason.

According to the Palomar Medical Center Marketing Staff, the starting salary for a new nurse coming into the district is $25.69 per hour. Nurses normally work a three day week at 12 hours per day. That translates to 924.84 per week, or $48,091 per year, plus benefits. As training and skills increase, or as experienced nurses are hired, obviously the pay grade goes up.

The philosophy of health care at Palomar Medical Center is one to both be proud of and look forward to . . . knowing that if and when that time comes when your or I need medical treatment it will be ranked with the finest we could expect to find anywhere in this nation, or, indeed, in the world.