I connected instantly with the old man; there was something about his eyes and the way he spoke. I generally have to work a bit at finding something that connects me to another person. I always do though; we are not as different as we think we are. He was from Egypt and spoke softly but firmly in an accent. He explained to me that he came in because he could not breathe. I had already looked at his ultrasound and lab work, and knew what was wrong with him—his heart was not pumping well enough and I just had to figure out why.
I explained that he needed a coronary angiogram, where you go through an artery in the leg, snake up to the arteries supplying blood to the heart and take pictures. He seemed a little taken back and politely asked me if I could speak to his son and daughter. It turned out that his daughter was my colleague, an internist, and his son was an interventional cardiologist, practising in Canada. I did the conference call in front of him, and went through his condition. His kidneys and lungs were an issue, too. There was a general hesitation, but I reassured them that I would get him through and they reluctantly agreed.
We went to the catheterisation lab the next day, and the minute I took the first picture, I knew he needed open-heart bypass surgery. The disease was too extensive for stents. Of the three arteries that supply blood to our heart, one was totally blocked, and the other two had multiple blockages. I told him what I found and I could see his head droop. “I really do not want to go through surgery,” he said. I reassured him, told him open surgery was not a big deal, and that stents would be too risky for him. We did a conference call with his son, had the surgeon look over the films and we were all set for open surgery.
I was having lunch the next day, when I got a text from his son that said: “Can we talk?” I was not surprised. I had already figured out the old man, I knew he would refuse surgery. I called him and he asked me whether I could get him through with stents. “What is your gut feeling?” he asked. I told him that my gut said that I could get him through it, but there was always a risk that he would not pull through. We went through the technicalities. We had different approaches, but to his credit he deferred to me. We ended up with him wishing me luck. The reason for his request was straight forward—bypass surgery was the recommended thing to do, but not necessarily the right thing for this particular patient. The chances of him making the surgery were slim. It was Friday.
I booked the case for Monday and I requested my best scrub tech (part of the surgical team) to be on the job. I went up to meet the old man and tell him the change in plan. He was beaming when he saw me; his daughter was with him. “I knew you would change your mind,” he said, waving his finger at me. “I knew you were my man. There was a connection between us from the moment we met.”
I smiled back and told him that he was a stubborn old man. I talked him down from his euphoria, and explained that there was a chance that he would not make it off the table. “I am ready for that. I could die driving home, too,” he countered. “Very well,” I said. “We have a plan”. His daughter looked at me and asked whether I had eaten lunch, and before I could answer she put a couple of Ferrero Rocher chocolates in my hand. I was a little stunned that she thought of me when her father was fighting for his life. She proceeded to ask whether I wanted a bottle of water, and thrust a bottle into my hand. We had water and chocolates in our lounge, but I took them and walked out a little dumbfounded, with a stupid smile on my face.
I woke up Saturday early morning with a nightmare about losing the old man. I put it out of my mind and went about my weekend.
I presented the case on Monday morning to the rest of the staff, and the response was ominous, with many differing opinions, warnings and approaches. The first two cases of the day turned out to be tricky and longer than expected and I started on the old man at 4pm, not something I wanted to do.
I put an artificial heart pump in to start—these pumps generate blood flow in case the heart decides to stop. I knew that once I got one artery fixed, it would give me (and the old man) some breathing room. I was able to achieve this in the first 30 minutes. There was an audience growing in the room, the chief of anaesthesia and cardiothoracic surgery came over to see if I needed any help. Over the next two and a half hours, I worked slowly and deliberately on his arteries, drilling out areas, and lining them with stents to get blood flow through, using every tool and trick I had learned. In the end, I stood back and looked at the final pictures, satisfied. The procedure had gone flawlessly. “Piece of cake,” I told the old man and winked. He had been awake throughout the procedure. I walked out to find the family.
They ran towards me. The daughter had tears in her eyes as she hugged me. “I am so happy for you,” she said. “I knew how worried and stressed you were about my dad.”
There would be conferences and pats on the back, but right then I wanted to be alone. It was dark when I walked to my car and sat back in the seat and just thanked my stars. I glanced sideways and saw the bottle of water the daughter had given me—I had left it in the car. I opened the bottle and took a swig. It was the sweetest water I ever drank.
dinarab@yahoo.com