My mother-in-law called us at about 6 am to let us know my wife's brother was admitted to a local hospital at approximately 2 am for chest pain.
He's 38 y/o and smokes 1 pack a day.
I stopped by the hospital on my way to the office but he was off having tests done.
The hospitalist who had admitted him had left for the day.
I called during the day but he was off having tests done.
I finally saw him at about 6 pm.
He had just recently gotten back to his room.
Every time he would move in bed his chest would hurt.
Me: Did you do anything yesterday to strain yourself?
Brother-in-law: Not that I can remember.
Mother-in-law: Don't you remember, you trimmed the palm tree in the front of the house yesterday.
Me: You did? Did you use a power saw?
Brother-in-law: No, I used a hand saw.
He then imitated the cutting motion and experienced the same chest pain.
Me: Did you tell anyone that?
Brother-in-law: No, they just kept saying that because of my age and since I smoke, they need to make sure my heart is OK.
Shortly after, another hospitalist came by. He reviewed the normal findings from the labs that were done over the course of the day, the serial ekg's, the chest x-ray, the CT angiogram, the echocardiogram and the nuclear stress test.
When given the added information about the palm tree trimming, he agreed that my brother-in-law probably had irritated the serratus anterior chest wall muscle.
He was advised to take a medication called ibuprofen (wow!) and apply topical heat.
I'll never look at the palm tree outside their house in the same way.
Its last trimming cost about $20,000.
Another good reminder to all health care providers: A cook book work-up should never replace a good history.