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A Nurse in Crisis: The Family Doctor as Case Manager in the Multidimensional Aftermath of Complex Myocardial Infarction

Justin BONNICI

This report details the complex care of a 69-year-old retired nurse following a critical ST-Elevation Myocardial Infarction (STEMI), complicated by hemodynamic collapse and subsequent surgical and infectious complications. This case reflects the edge-group of healthcare professionals as patients, often experiencing problematic access to unbiased self-assessment and care acceptance.The patient, a former nurse, demonstrated professional denial, minimizing her own symptoms and struggling to relinquish control, which led to significant emotional distress. The clinical course included a successful but complex percutaneous coronary intervention, followed by a necessary vascular repair after ECMO decannulation, prolonged IV antibiotic therapy due to bacteremia and suspected endocarditis, and a persistent surgical wound infection requiring VAC therapy (Vacuum-Assisted Closure) The family physician provided comprehensive, integrated management: 1) Case Manager: Serving as the central hub coordinating specialized care (Cardiology, Vascular) and managing: secondary prevention, polypharmacy and chronic wound care in the community setting. 2) Psycho-Social: Addressing her professional identity crisis, supporting the patient through concurrent bereavement, and providing continuous emotional and psychological support, mitigating the impact of the critical events on the patient’s well-being.This case highlights the psychological burden when a medical professional transitions to patienthood, as clinical knowledge paradoxically becomes a barrier to recovery and trust. It also models the Family Doctor's essential role in transcending this barrier, providing holistic, longitudinal care continuity across acute, tertiary, and community settings, particularly following multiple complications.Future practice should integrate explicit communication strategies tailored for healthcare workers to ensure their recovery is not impeded by their professional identity.The challenges for medical professionals as patients – denial, self-diagnosis, and delayed care acceptance – are significant and exacerbate the patient’s distress. This case confirms the family physician's vital role as the bio-psycho-social anchor. The family doctor's established, continuous relationship was the reliable mechanism used to bypass this cognitive and emotional barrier, facilitating essential coordination and acceptance.This case confirms the Family Doctor’s indispensable role in facilitating comprehensive recovery by integrating complex clinical management with crucial psychological and social support, ensuring care overcomes the patient's professional barriers.