1 : trifecta; horse racing terminology – a parimutuel bet in which the bettor must predict which horses will finish first, second, and third in exact order
2 : trifecta; a situation when three elements come together at the same time and the synergistic effect is greater than the sum of the individual parts
3 : Terminator 3; a film from 2003, starring Arnold Schwartzenegger, in which humanity is brought to the brink of destruction
Ot volka bezhal, da na medvedya popal.
I ran from the wolf but ran into a bear.
I’m talking with two firefighters as we walk up the exterior stairs to a small apartment deep in the projects. One of them points to the door in front of us, “Yeah, we run on this guy at least twice a week – always the same thing: multiple complaints, all of them chronic.” We call them frequent flyers.
As we wait for the door to open I look around at the surrounding buildings from the vantage point of a second floor patio. The housing development is the size of five city blocks – 12 huge apartment buildings, 30 smaller six unit buildings, all surrounding a scraggly play field and basketball court. Built just a few years ago it’s still in good condition with strong security gates and pastel colors on the exterior walls. This is a community development project (The Projects) which differs from Section-8 housing in that local and state government pays for the project as opposed to private investors.
My medic partner, Kevin, is going to tech this call – I’ll help out if needed. A woman answers the door and only three of us walk in – the apartment is too small for all six of us and its residents.
Kevin’s new patient, Mr. Duval, has a number of chronic complaints and wants to get to the hospital so they will make him feel better. He’s a heavy guy, maybe 240 pounds, and moves very slowly – every step he takes is deliberate. Slowly he makes it down the stairs and onto the gurney. Once loaded into the ambulance I get his wife settled in the passenger seat for the ten mile drive to the ED. Four hospitals are closer than this one but we are obliged to honor his request for the hospital that he says has all of his records.
The resources that are being spent on this call are staggering: one fire engine with three fire fighters and a paramedic, one ambulance with two paramedics, a half hour ride in city traffic to a distant ED, and one hospital bed for six to eight hours minimum. The cost for all of this will undoubtedly be covered by the American tax payer through federal and state programs. It’s not even the direct cost that bothers me – it’s the extended cost to the fire departments, the EMS providers, and the hospitals. At any given time 50% of the resources in these agencies are handling calls just like this. Therefore we are 50% larger than we should be just to handle the call volume.
Being Kevin’s call I’m tuned in just enough to confirm that it’s a non-emergent call and the patient basically has chronic complaints. He has the trifecta: hypertension, diabetes, and heart disease. It’s basically a horse race to see which one kills him first. The progression up to this point is a common one that we see every day. Bad diet and no exercise lead to uncontrolled hypertension, which affects the liver, the kidneys, and heart. As a result he gets Type II diabetes and heart disease. The final outcome of this will depend on which horse wins: heart attack, stroke, or renal failure.
As Kevin calls up the vitals to me for the ring-down to the hospital, I put my money on stroke – his blood pressure is 220/140 (normal is 120/80). My guess is that renal failure will come in second given his blood sugar of 286 (normal is 80-120). Heart attack will come in third – the enlarged left ventricle of the heart is obvious on the 12-lead EKG.