Last night, just prior to midnight, I received an urgent page to see a patient in the emergency room. The patient was an 88-year-old man who had a serious diagnosis of an acute aortic dissection. Along with this life-threating problem, he had a list of surgically-adverse comorbidities, including stage IV renal disease, previous valve replacement surgery, chronic anemia, chronic thrombocytopenia and the need for chronic systemic anticoagulation due to persistent atrial fibrillation. To make matters worse (as if that were even possible), his entire aortic “tree” (ascending, arch and descending aortas) was horribly calcified, filled with eggshell-like plaque that would have made replacement of his shattered aorta an act in futility.
In surgery, there are some long-standing mantras that guide our approach to what we do: “To cut is to cure;” “Cut ’em open before they get better;” “If in doubt, cut it out.” To operate on this man, there would have been no cure; he would not have gotten better; and we (my surgeon and myself), the patient and his two grown children, who were at his bedside, had no doubts about our nonsurgical approach.
Even though I had a list of other duties to perform that night, I stayed with the patient and his children. As I continued to shake/hold his left hand (a hand that had three partially amputated fingers from a remote working accident), I came to find out that the patient lived in his own home, and he continued to work for his family, preparing wool sheared from sheep, as well as harvesting maple sap from trees for the making of maple syrup. He was a hard worker his entire life. His callused, large hands spoke of that work.
His wife of 64 years had passed just last year, and he continued to honor that bond by wearing his wedding ring. He told me how proud he was of his children. He then stated to me as he looked at his children: “My wife and I did a pretty good job.” At that time, my eyes started to well up as did those of his children. Standing there with this man, this gentleman, this husband, this father was bittersweet. It was an honor to meet him and to get to know him, to be part of his life. The diagnosis of an aortic dissection did not define this man, but it was the cause of his passing. His life was defined by his family, his wife and his friends (some of whom had passed long before him) who loved him.
As a surgical PA for over 25 years, I have performed thousands of bedside procedures and been a part of just as many incredible operations. It has been an honor and a privilege to be part of this profession and the subspecialty of cardiac surgery. But, on this night, it was an honor to not do surgery, to not “cut.” I was completely satisfied to hold a hand, to offer some comfort.
Michael C. Doll, MPAS, PA-C, DFAAPA, FAPACVS, serves as chief PA, Cardiothoracic Surgery Service, at a medical center in Pennsylvania.