It was a typical Tuesday afternoon and we started our second set of Mohs surgery patients. Emma had a squamous cell carcinoma on her left temple. After the initial excision, she already had a dime-sized hole in her head! Fortunately, her lesion cleared after two stages of surgery.
We took her back to our ambulatory surgery center, where we listened to her heart and lungs, measured her oxygen level, and took her blood pressure.
While listening to her heart, I noted that the heartbeats were not steady. I asked her about this and she stated that her heart rate was normal and that she was not on any medication to regularize her heart rate. We went ahead and proceeded with the closure which went very well. I felt her pulse again after the procedure. The rate was irregular, typical of Atrial fibrillation.
I asked who her general doctor was and put in a call to him myself. After two phone calls, I reached the triage nurse who asked if it was necessary that she be seen today or if it could wait till tomorrow. I responded: “if you want to take responsibility for this patient having a stroke tonight she can wait till tomorrow otherwise she has to get into see her physician or go into the emergency room immediately.” The nurse clearly heard where I was coming from and scheduled an appointment with her doctor within one hour. I informed my medical assistant to relay the news to the patient Emma and she was to be there at 4:30 PM.
I thought about her the next day and asked my medical assistant to give her a call in order to obtain information on her visit the afternoon prior. She stated she was feeling fine, and that the MD put her on warfarin and is very very comfortable, without any pain from her incision.
Lesson to be learned: The two extra years I spent in an internal medicine residency paid off again, as well as being astute to details and taking action. I’m not just a dermatologist or dermatologic surgeon, I care about my patients as a whole.