Remember That Day

Chapter 19

Earlier...

“I’ll be there. Get back to work,” Gon had announced before he ended the call.

Lunchtime was finally over, but Damek was not yet over drinking his beers.

“Damek?” Gon called as he inched towards his desk and took his lab coat.

Eyes barely closed, Damek replied in his hoarse voice, “What?”

Damek was lying on the couch and he kept on murmuring, still with a bottle of beer on his hand.

“I have a meeting I need to attend to and some rounds to do again. Would you be okay here?” he asked.

“Ah,” he whispered. “I’m fine. Go ahead.”

Gon let out a sigh. “Stop drinking. You had too much already! I’ll drop you to your place later, so stay here, okay? Don’t make any more trouble.”

Damek had just nodded his head before he curled up on the couch. Gon shook his head as he finally went outside his office.

Hours passed by. Although Gon was worried about his friend, he just couldn’t leave his work for he had so many things to finish first.

“I just finished a case,” Gon said as he stood in front of the other Surgeons and doctors from different hospitals inside the conference room. “I would like the group’s input on a man with acute chest pain who came to us from an outside hospital in San Diego after I was asked to help in the decision-making. ECG had ST elevation in 2, 3, f and V3-6. He is a smoker with positive family history, but no other CAD risk factors. Hemodynamics were stable with 3/10 chest pain.”

Just as he took a glance at the big screen behind him, he further said, “Cines flashed here in the screen show a filling defect in the left main coronary artery with distal occlusion of the left anterior descending coronary artery. A transthoracic echocardiogram with bubble study was negative with only an apical wall motion abnormality. What are the group’s thoughts on management?”

Doctor Ali, a Professor of Medicine and Surgery from San Felipe spoke, “Well, it’s odd to have inferior lateral STEs especially with a normal right coronary artery. A mobile filling defect in the LM without evidence of atherosclerotic or other vascular disease suggests thrombus, but from what source? Could this be multiple vessel spasm, first RCA, then LM with clot forming in LM asymptomatic? Check for other regions where clot might go. Check for patent foramen ovale and hematologic procoagulant state. Vasculitis is low on my list.”

“The amputated wraparound LAD might explain the EKG. I would run a drug screen,” Doctor Bill from San Gregorio announced.

“I’d start heparin and an anti-spasm regimen, clopidogrel maybe, but likely ASA. Repeat angiogram in week to 12 days for resolution of LM thrombus, but I’m not sure what to do if still there. Great case. Let us have follow up,” added by Doctor Ali.

At the right corner of the room, Doctor Cain from San Carlos commented, “Definitely looks like clot in the LM. I agree that this is most likely embolic and EKG changes may be from other, more distal emboli that had resolved by the time of the angiogram. Questions of hormone therapy and menstrual cycle timing need to be considered, particularly in a smoker. I rather doubt spasm, but think this is more about clotting. It will be difficult acutely to know the best anticoagulant strategy unless a clear source is identified. Although it will be hard to avoid warfarin, I think. Despite his age, you have to look for a neoplastic process.”

The meeting abode with several comments and thoughts from other professionals inside the conference room. As Gon was mindful with every ideas, another voice was heard next.

“After a period of time with IIb/IIIa blockers and heparin, repeat angiogram should be done. If thrombus still there, intravascular ultrasound, definitely!” Doctor Don, Director of Division of Cardiology in San Nicolas said. “IVUS or instrumentation at this time risks further embolization and myocardial damage, so I wouldn’t do it now. I have seen a similar looking thing in a mid LAD and it turned out to be a calcified, eccentric plaque.”

Doctor Emily from San Juan uttered, “It sounds like we are fairly split on embolus and thrombus. Would IVUS help? If there is no plaque disruption, embolus is more likely and it would change therapy and strategy significantly.”

And the conversation remained until six. After the mind-bending discussion with the other doctors, Gon headed back quickly to his office only to learn that Damek was not in the couch anymore.

“Damek?” he called once he entered his office, but Damek didn’t response. Until he heard a noise coming from the bathroom.

“Damek!” he called once more and inched towards the bathroom at the corner.

Gon clicked his tongue upon seeing him lying asleep, wasted and drenched in the tub. He almost bathed himself with clothes on when Gon realized that he was perhaps slipped himself.

“What on Earth have I done wrong to get punished by taking care a stubborn and jerk like you?” Gon whispered as he stared at him. “Damek? Come on, get up! I’m taking you to your place!”

Gon had taken a little while before he could take him to his car. No one would look after him, so he was obliged to do it for him not because he needed to, but because he was like a brother to him.

Few minutes of driving and they arrived at the hotel, and when they were finally in front of Damek’s room, Gon suddenly received a call he couldn’t answer yet as he was carrying a big guy on his back.

“Um. Where am I?” Damek whispered and started to hit Gon’s back.

“Hey, Damek! Stay still! You’re too heavy!” Gon exclaimed as he tried to help Damek to stay still while he opened the door for him.

“I’m... I’m...” Damek tried to push Gon away and he gave up. Gon eventually lost his strength to stop him the reason why Damek fell to the floor.

“Ugh! You annoying man!”

Gon ignored him for a while and slid his hand inside his pocket to get his phone. It had been ringing and he thought it to be important.

“Yes, Nurse Gwen?” he asked.

After hearing an urgent matter from the other line, Gon quickly took Damek inside his room.

“Damek, I have an emergency,” he said to him although he was certain that he was not yet sober to fully understand what he was trying to say.

Gon tucked him on his bed. He added, “You can take care of yourself, right? Or should I call Jayda to at least look after you? Ah, I really have no time. I’ll be off now. I really need to go back at the hospital.”

“Um...”

It was almost seven. Gon had nothing to do, but to leave Damek already. He got a call from the Operating Room and he was needed there to do and emergency heart transplant.

Meanwhile, Damek slowly stood up from his bed. In spite of feeling dizzy, he managed to walk towards the bathroom as he suddenly felt peeing. He swayed from left then to right until he reached the door. But instead of going the right way, he ended up going outside his room where Jayda saw him already lying on the floor.