Surgical Physician Assistant Stunned by a Heart Attack at 45
One in an ongoing series
It’s not surprising that Phil Dolcemascolo wound up in the medical field. “My grandparents constantly told me from the time I was a little boy that someday I was going to be a doctor,” he says.
They were almost right. Dolcemascolo is a physician assistant (PA) at Einstein Medical Center Montgomery, who assists cardiovascular surgeons in and out of the operating room.
What is surprising is that Dolcemascolo wound up at the age of 45 on the other side of the operating table.
He had no elevated risk for a heart attack: he exercised regularly, maintained a healthy weight, never smoked, had no significant family history of cardiovascular disease or illnesses such as high cholesterol, high blood pressure or diabetes.
It Couldn’t Be a Heart Attack, Could It?
Dolcemascolo was so convinced he was unlikely to have a heart attack that he rationalized the burning chest pain he had one early morning in 2017 that began while he was on his way to work.
He thought it must be an ulcer caused by medication he was taking for a back problem. Or a severe case of heartburn. Or maybe reflux. But a heart attack? Absolutely not, he told his colleagues at the hospital that day, resisting their every effort to convince him to go the Emergency Department.
He was still resisting in the ED, when an electrocardiogram provided conclusive evidence that he was, indeed, having a heart attack.
“I was not a good patient,” Dolcemascolo recalls. He continued to object as he was wheeled into the catheterization lab, where the cath team found a blocked artery. And it wasn’t just any blocked artery; it was the artery that causes sudden death so often that it’s called “the widow maker.”
Dolcemascolo’s case was complicated. In the months that followed, he’d need many more invasive medical procedures. Eventually, on Memorial Day in 2018, he had open heart surgery.
Another Perspective on Heart Surgery
He may not have been a good patient, but Dolcemascolo believes that having the same experience as the patients he’d been treating for 17 years has made him a better PA.
“It provided me with a really different perspective of what I do for a living,” he says.
Dolcemascolo was grateful that he’d always had an attentive and caring bedside manner. Now, he’s focused more than ever on preparing patients for every aspect of surgery and recovery, especially the specific post-surgery concerns that provoke the most anxiety: the removal of chest tubes, pacing wires, central IV catheters and other “tubes and lines that open heart patients are burdened with after surgery.”
When patients are in desperate need of reassurance, he tells them about his own experience.
Dolcemascolo is the surgeon’s right-hand assistant during a heart operation. “In movies and TV, when you see someone standing across from the surgeon, that’s me,” he says.
Cardiothoracic PAs are highly skilled and intensively trained by physicians. They surgically remove veins, arteries or both for use in bypass surgery, and assist in all aspects of open heart procedures. They put in central and arterial lines, chest tubes and other support devices during surgery, and provide postoperative care to patients in the ICU.
The Synchronized Dance of Surgeon and PA
Most importantly, Dolcemascolo says, a good surgical PA learns to anticipate, and coordinate with, the surgeon’s style.
“You learn their mannerisms, tendencies and habits,” he says, likening it to a dance. “If you know the steps and don’t step on each other’s feet, the patient will do well.”
“The most gratifying part is knowing that if I do good work, the surgeon will do good work and the patient will have a good outcome,” Dolcemascolo says.
Cardiothoracic surgeon Louis Samuels, MD, agrees.
“Phil instinctively knows what to do in the course of an operation,” Dr. Samuels says. “He is focused, calm and confident in his own skills.
“His presence is a source of reassurance. If you’re going to be a good ballroom dancer, you want Phil as your partner.”