By Drs. Jay and Paulette Mehta
It was almost time to go home after a busy clinic day seeing patients with a wide variety of heart diseases. I looked at my schedule – there was one more patient, a woman. She had been referred by a physician, who I respected, for my opinion for assessment of tachycardia. I thought this case would be simple. I could just OK what he had suggested.
The patient said she had heard about me and wanted to get a second opinion.
“Shall I call her in?” nurse L asked me.
“Did you see her already?” I asked my nurse. During these Covid days, the nurses were empowered to do more and to take extensive history. It saved me time, and I respected L’s ability to filter out the unnecessary and extract just the important information.
“Yes, Doctor, she seems a little anxious to me and her blood pressure is high and she is tachycardic. She seems a little depressed to me as well, Doc.”
“Let her in,” I answered.
I watched as she entered. She was tall, thin, and a little gaunt. She had very light-colored skin, blonde hair and blue eyes. She was dressed in all black. Her long dress was black as were her scarf, belt and shoes. Her hair was long and pulled back into a ponytail. She was wearing dark red nail polish but wore no makeup on. She looked much older than her stated age of 54 years.
“Please come in and have a seat,” I said as she slowly entered the room.
“Thank you, Doctor,” she said with a strong southern accent.
“What brings you here?” I asked.
“My cardiologist BG says I may need medications and perhaps a cardioversion, but I wanted your opinion first.”
“Why me?” I asked.
“Well, you’re the doctor who wrote about heart disease sometimes being a plea for help and I thought…,” she started as her voice trailed off.
I remembered the paper I had authored several years back about a friend who had developed atrial fibrillation while his daughter was having trouble with her then-fiancé and refused marriage a day before it was to take place. Friends and family had come from afar, and wedding preparations had been made. I listened to my friend and his daughter and comforted them, and he recovered completely after the daughter reconciled with her fiancé and the two were married in a traditional Indian wedding and later went on to have two beautiful children.
I could see her eyes water and turn red and her arm twitch.
I looked at the history that the nurse had taken. There was no mention of marriage or family problems or of any stress in her life currently. She had been successful, with grown-up children, and she had been widowed for about five years. So why was she bringing up this paper about a very different patient I had seen many years ago, I wondered?
I decided to ask my own questions:
“Have you had any stress in your life recently?”
“No, Doctor, I am not stressed. You know I am not working so there is no stress there. My children are grown up. My husband and I were very close, but he died quite a few years ago.”
“Tell me how you spend the day.”
“Well, I don’t really have a regular job anymore.”
“What do you mean anymore?”
“Well, I was an executive, a buyer at one of the big department stores. But then the virus came, and they fired me.”
“Why did they fire you?”
“Well, they downsized, the whole mall was going under and they had to let people go.”
“Then what did you do?”
“Then I got a job as a fund raiser for a college, but I couldn’t raise enough money in these Corona days, so they let me go too,” she said, tears welling up in her eyes again.
“I couldn’t find any job after that, I looked and looked, and there was nothing available. So, I decided, well, I am a caregiver I may as well give ‘care.’ After all, I know how to care for people. I cared for and raised two girls, but they are grown up. And I’m here all by myself. I may as well become a caregiver. Therefore, I signed up with care.com. And I had a few patients but there was one, who I spent most of my time with.”
“What did you do?”
“Well, I read to him. I would read the most beautiful books. My favorite book was Walden by Henry David Thoreau about living alone in the woods and his inspiration from nature.
“After we finished that one, we read the Bhagavad Gita together. I took the part of Arjuna and he took the part of Krishna. We read each other’s parts and we laughed together.”
As she spoke about this and other books, I saw her eyes sparkle and saw her smile and laugh.
Then I asked her. “Tell me more about this man you cared for. How old was he?”
“Oh, doctor he was 90 years old. He was everything; he could not see clearly, but he was so loving and jolly. He laughed at all my jokes; we had such a good time together.”
“Let me examine you.” I said, and I walked out of the room with her chart while she changed into a hospital robe. I went outside to switch out my mask to a N95 and to put on gloves, gown and face shield, and the nurse performed an ECG.
I wondered about the nature of her problem, which had just started only a week ago. I needed to find out more.
I knocked three times before entering.
“Come in, I’m ready,” she responded to the knock.
Meanwhile my nurse L came up to me, handed me the ECG and rhythm strip, which showed sinus tachycardia — heart rate 120 beats per minute.
I went into my patient’s room, and performed a physical examination, which was normal except for cold clammy skin and a fast heart rate.
“I have a few more questions I need to ask you,” I told her. “Tell me how often you see this man.”
“Oh no, Doctor, I don’t see him anymore. They let me go.”
“Who let you go?”
“Why did they let you go?”
“They fired me because they were worried that I could transmit Corona to him. They just wanted to minimize his exposure to outside people. Doctor, I don’t have the disease, nor have I been exposed to anyone with Corona.”
“Then what happened?” I asked. Tears started to gush from her eyes. I did not know what to do.
I held on to the edge of my chair, and asked again, “what happened? Tell me!” I was wondering had she done something to him; had she done something to the family? What was the trauma that she was hiding behind those blue eyes?
“And,” she said to me, “Doctor. He died. He died three days after they let me go.”
“Did he die from Corona?”
“No, it wasn’t Corona that he died from. It was the loneliness and the fear of getting Corona. The family was so afraid they fired me they would not let anyone come and visit him. They tried to protect him from Corona, but in the process, he died because of loneliness and isolation”
“And that killed my spirit, Doctor. I loved that man, I took such good care of him, he needed me, I needed him…”
Then I looked up. “You need to heal from what you have been through, and you need to go back to caring the way you used to do.”
She got up to leave; she was smiling now. Her eyes had a sparkle, and her muscles relaxed.
“Thank you, Doctor; I knew you could help me.”
I thought – fear of Corona and loneliness resulting from being alone can kill.
This story is by Dr. Jay Mehta as told to and recorded by Dr. Paulette Mehta.
Jay Mehta, M.D., Ph.D., is a Distinguished Professor of Medicine and Physiology and Biophysics and holds the Stebbins Chair in Cardiology at UAMS. He is also a senior clinician scientist with the VA Central Office.
Paulette Mehta, M.D., MBA, is a Professor of Medicine (Hematology/Oncology) at UAMS.