[per]spiration. Croskerry listened intently as McKinley described how his chest pains had increased over the past few days and how they had worsened today. Croskerry questioned him further to get a more precise description of his symptoms. McKinley said the pains stayed in the center of his chest but did not move down his arms, into his neck, or through to his back. The pain got no worse if he changed position, and even taking a really deep breath didn't make him feel faint.
Croskerry went over a checklist of risk factors for heart and lung disease. McKinley had never smoked and had no family history of heart attack, stroke, or diabetes. He laughed, as Croskerry did, when Croskerry used the term "sedentary lifestyle." McKinley added that he felt under no particular stress, his family life was fine and he loved his job, and he had never been overweight. Croskerry then did a physical examination. First he verified that the vital signs recorded by the triage nurse were correct. McKinley's blood pressure was 110 over 60, his pulse 60 and regular, as would be expected of an athletic man. Croskerry listened with particular care to McKinley's lungs and heart, especially when he took a deep breath, but everything sounded fine. His muscles were well developed, and when Croskerry pressed on the junction between McKinley's ribs and breastbone, McKinley felt no pain. There was no swelling or tenderness in his calves or thighs. Finally, the doctor ordered an electrocardiogram, a chest x-ray, and blood work that would include tests for oxygen level and cardiac enzymes that indicate heart damage. As he expected, all of these were normal.
"I'm not at all worried about your chest pain," Croskerry told McKinley. "You probably overexerted yourself in the field and strained some muscle. My suspicion for this coming from your heart is about zero." Deeply reassured, the forest ranger went home.
The next morning, Croskerry was off duty, and read part of a
[Not to give too much of page 43 away, but who do you suppose was back in the E.R. the next morning with serious problems...?]