A few years back my father had a valve replacement due to childhood rheumatic fever. At ten days post op he woke up with an unstable heart rhythm and went to th

A few years back my father had a valve replacement due to childhood rheumatic fever. At ten days post op he woke up with an unstable heart rhythm and went to the hospital. They gave him drugs to get the rhythm under control, which failed. After two days, I get a call from my sister, a neurologist, telling me to get to the hospital immediately. When I arrived, he was short of breath and in a bad way. At the hospital my sister took one look at his EKG and remarked that he was at risk of going into tamponade at any moment. She asked if anyone had bothered to do an echocardiogram when he was admitted -- they hadn't. She just about chewed out his nurse and they ran the echo. Lo and behold, he had pericardial effusion: a half litre of fluid was compressing his heart. They rushed him into the catheter lab, drained the fluid and his symptoms resolved immediately. On Monday I was having coffee with a coworker and mentioned that my father had a valve replaced and he'd been in the hospital over the weekend. My coworkers immediately remarked, "Oh, he had a pericardial effusion." The medical staff had become so fixated on his erratic rhythm that they had forgotten the context of his case: if someone shows up with symptoms of a post op complication, don't start by trying to diagnose an unrelated malady. My coworker? His mother had a valve replacement and had a pericardial effusion. That's a lot of words to say: checklists save lives.