Thursday, March 08, 2007


Inevitably, just as Nathalie and I had gotten ready for a late lunch, my pager went off. I howled with disgust. When you're on call, the Pager Gods always know when you've found some time to yourself and will always interrupt just as you're about to enjoy something.

Me: [glumly on the phone with the ER doc] I'm returning a page for vascular surgery.

ER Doc: [speaking rapid-fire] Hey man, I've got an 82-year old female with a history of a 4.7 centimeter infrarenal abdominal aneurysm, last imaged in 2004, that comes in with an acute onset of penetrating abdominal pain since 10:30 this morning...

I snapped out of my funk immediately. The ER doctor kept on talking, but I stopped listening. My heart sank to the pit of my stomach. I already knew the diagnosis. I kissed Nathalie good-bye, apologized for lunch, got up, and walked out the door to my car even before the ER doc had a chance to finish his sentence. This woman's aneurysm was rupturing, and she was on borrowed time.

15 minutes later, I was at her bedside in the emergency room. One look at the patient and I knew that she wasn't going to survive. Her abdomen was criss-crossed with scars from her previous operations. She had a list of medical conditions half a page long. She had won a lot of battles over her 82 years, but she wasn't going to win this one. And I think she knew it as well.

She motioned over for me, and when I got closer, she reached out for my hand.

Patient: [almost inaudible whisper] Help me, Doctor. What can you do for me?

Nothing. There was nothing I could do. She was dying in front of us, but there was nothing I could do.

She was bleeding internally. Without surgical intervention she would die within the next hour. But if I took her to the operating room, she would die on the table. She was so medically frail, that there was no way her body would tolerate a major operation even if she wasn't actively bleeding. Taking her to the operating room would be the equivalent of taking her for an autopsy.

She had no options. There wasn't a solution.

Her family circled around me quietly, waiting for an answer.

It's amazing just how alone you can feel sometimes. I looked down at my feet and tried to think of the best way I knew how to tell them that she was going to die.

...to be continued.