Wyatt arrived home about three – thirty after the golf outing and one pint at lunch.  Katherine called to say she and the boys would be late, but that he could go ahead and help himself to the beef roast, which he did. He then fell asleep on the couch with his beeper next to his head. Exactly at 4:30, sure enough, the beeper sounded off, awakening Wyatt from a nice slumber on the soft leather couch.

Damn.  It’s almost as if the ER is waiting, watching the clock until my on-call duties start so they can immediately hammer me hard.

“Hello, Dr. Barton.  This is the answering service.  We have Doctor Evans in the Emergency Department who would like to speak to you.”

“Patch him through.”

Wyatt was an avid cyclist and his resting pulse rate was a forty-five.  But not now.  He felt the rapid pounding and checked his pulse quickly.  It catapulted up to one hundred while he waited for the Emergency Department doctor to be patched through.

C’mon Wyatt, you moron.  You know better than to drink before on call. But there’s no problem. You’ve got all your faculties and that was over two hours ago and only one beer.

“Well whaddya know? The big dog’s on-call tonight; we’re in luck.  Hey. Wyatt, I’m glad you’ve got the duty for interventional tonight.  We can count on you to always call back quickly and take care of business without throwing roadblocks at us.”

“Yeah, Rick, I know you.  You just want a cardiologist that you can punt to.  What’ya got?”

“Got a seventy-five year old VIP lawyer here having a heart attack.  He’s unstable and he worries me.  Gave him blood thinners, aspirin and beta blockers to slow his heart rate.  He got nitroglycerin in the field and some morphine here in the department.  Still with some pain – about a two out of ten.  Blood pressure hundred-fifteen over sixty with an irregular pulse.  Apparently, he was on the golf course today when he had his attack.  Oh, yeah, and you need to know that he apparently has more money than the state of Illinois and is the senior partner of a major international law firm downtown.”

Wyatt’s mind clicked into turbo mode.  “You know me, Rick. I don’t care if he digs ditches for a living; I treat all patients the same.  I might make an exception for an Al Qaeda operative, though, because then I would have to give him the really special treatment, if you know what I mean.”

“Hee hee.  Clint Eastwood Barton.  Make my day.  What do you want me to do now?”

“Call a cardiac alert and I’ll notify the catheterization team and see him in the cardiac lab.  Does he have any family with him?”

“No, but he has his company doctor named Freeman and his company lawyer with him too, forgot his name.  Lots of initials before his name.  Freeman said they were all golfing together today at the country club and the old boy had too many Cubans and martinis in the clubhouse.   Guess his son is a hot shot lawyer with the firm too, and he’s on his way.”

“I know a guy named Larry Freeman.  He used to work in the ER years ago.  Good doc.  Looks like he found himself a nice cushy job.  I’m on my way.”

Wyatt’s confidence soared when he realized his words were clearly not slurred, and his mind was engaged completely.  But he couldn’t get that VIP lawyer statement out of his head.  He threw on his shoes and socks, pounded down a glass of orange juice, brushed his teeth, gargled, and loaded up on breath mints.  He knew he was perfectly fine, but he had never had a drink when he was on-call before, and knew he shouldn’t have listened to Tom.

Wyatt arrived in the interventional cardiac catheterization lab to find the patient, Sean Flanagan, on the procedure table, still conscious and talking. Nurses and technicians scurried around organizing the equipment and gathering the sterile drapes and medications for the procedure. Multiple wide-screen video monitors surrounded the operating table, lights blinking and ready for action.  He quickly reviewed the electrocardiogram tracing and labs, and then went to see the patient.

“Hello, Mr. Flanagan. My name is Wyatt Barton.”  They shook hands. “I’ll be performing an emergency cardiac catheterization on you because you’re having what we call and ‘acute anterior myocardial infarction’ or ‘heart attack’, and I need to open up the blockage in your coronary arteries to allow good blood flow again.”

“Nice to meet you, Dr. Barton, and here’s my older son, Gavin.”

Wyatt smiled while he and Gavin shook hands, but Gavin showed no emotion.  Wyatt felt a cold chill during the handshake, but decided the son must be nervous about his father’s condition.

“Mr. Flanagan, I need you to sign the consent before we proceed, and we don’t have the luxury of time.  I’m happy that your son is here, because he may have to sign the consent for you because you’ve already received a significant amount of morphine and you won’t understand the procedure and risks very well.”

“I understand.  What are the risks, doc?”

“Severe heart arrhythmias, rupture of the coronary artery, shock from worsened coronary blood flow, emergency open heart surgery and death.  I won’t know what’s wrong with your coronary artery anatomy until I actually look into your arteries using a catheter tube and X-ray dye.  I may have to open up the culprit artery with a balloon and then place a stent in to keep it open.  If I’m unsuccessful, you may need emergency open heart surgery.”

“No, I will not have open heart surgery.”

“Even if it’s the only procedure available to save your life?”

“I don’t want a heart butcher near me.”

Gavin took command of matters with his ailing father, for the first time in his life.  “Dad, you’re being unreasonable.  Sign the consent and I’ll cosign it.  For God’s sakes don’t tie the doc’s hands behind his back.  Give him a chance to save you.”

“Fine, Dr. Barton,” said Sean.  “Fix me with your damn magic stent, and if it becomes necessary, I’ll have open-heart surgery.  Sean’s pain roared back and he clutched his chest with his fist while motioning with the other hand for Gavin to sign for him.  After signing the consent, Gavin said goodbye to his father and went to the waiting room to join Dr. Freeman and E. David Carson, the firm’s corporate counsel.

“Larry, do you know this Barton guy?” asked Gavin.

“Yeah, I remember him when I worked in the ER a few years ago, before I retired.  He’s a respected cardiologist and top-notch interventionalist.  Sean’s in excellent hands. They call him a cowboy though.”

“Why?  Does he wear boots and a cowboy hat?  If so, I don’t want him near Dad.”

“No, it’s because he has a reputation for taking the worst cases and diving in without fear and he ends up winning, unscathed.  Kinda like a medical bull rider I guess.”

“Cowboy or not, he damn well better be stellar or he won’t know what hit him.”

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