He shoots...

The other day a man came in to the emergency room. He was 89 years old, partially deaf, yet somehow living on his own. The medics brought him in quickly – he was nearly unresponsive and his blood pressure was dangerously low. The ER doctor was able to feel a pulsating mass in the patient’s abdomen, and that’s when I got the call. You better come quick, she said, we may have a ruptured AAA.

I dropped everything and ran. A “triple A” stands for abdominal aortic aneurysm, and when they rupture patients normally exsanguinate rather quickly. We had to move fast. An ultrasound and then a CT scan to confirm the diagnosis. Calls to vascular surgery, anesthesia, and the OR. A central line to assure good access. A sample sent to the blood bank – they would need to have blood available for transfusions.

The man ended up doing well. He survived the surgery, and last I saw him we had a nice conservation. In medicine, this is called a “save.” A nearly certain death that, through the efficiency of the system and those in it, results in a second chance. “Good save” people would say, and pat me on the back.

As a former goaltender I’m used to people telling me “good save” and patting me on the back. And at this time of year – the overlap of hockey and lacrosse seasons – my memories are thicker than ever. The dull yet satisfying thud of a puck hitting an outstretched leg pad, or the quick snap of a lacrosse ball hitting the strings of a stick – in a real sense, the prospect of making the incredible save is what attracted me to a life in surgery.

What we would later learn about our gentlemen is that he had known about this aneurysm for several years, and that a vascular surgeon had offered to repair it electively – in the cool safety of outpatient surgery – 5 years ago. For whatever reason the patient decided not to have the surgery then. Our efforts – termed “heroic” by insurance companies – were entirely preventable. Statically, he should have died.

My friend is a priest, and her soon, nearly 7, had been battling a rare form of cancer for about 2 years. They did everything parents could have done, but their boy finally died just recently. There was simply no “save” to be had.

In surgery, we have a front row seat for the apparent randomness of survival. In 21st century America, we’re getting further and further away from survival of the fittest and moving a lot closer to survival of the luckiest. It is a strange thing to witness on a nearly daily basis.

I guess all I can do is save the ones I can.