Saturday, September 29, 2012


     We as human beings often wonder about the life and death.We can neither predict the 'time ' of birth or the time when someone is going to die.So we talk to fortune teller, horoscope reader and palmist, and so on . Sometimes we see people who should not be alive , live for long time , and those who should not die , die . So how is our "life " or to be specific duration of life determined ? There are many explanations.Some are so called scientific and some are philosophical. We sometimes say that the life is a wound up spring and when is is done unwinding , then we die . Then there is theory of reincarnation . We are born with certain seeds of 'karma' which will come to fruition in this life . Then there are some 'karma' which are added , that will come to fruition in this life . e.g. we ate too much or ate spoiled food , and we get sick . So when these karmic effect is done with, we die . This can be compared to annual plants , once they are done with flowering, then they are done .  So in my practice of medicine ,when  I  come across some patients those who should not have 'survived  ' but survive,  this law of karma comes to my mind . Only question sometimes remain is what is it that they are waiting for ?
     When I saw Dorothy, not her real name , she was 70 years old female who was some what short, fragile lady . She was accompanied by her daughter . She was a smoker and had emphysema . She was short of breath walking few feet . Many of my patients are similar or have very similar history . The reason I remembered at that time was that she was married to one of my patients, who also had emphysema and he was smoker too . This also is not very uncommon . Only unusual thing was that he was only 52 years old . So there was a difference of 18 years . She had  bad lung disease, needed oxygen , which she would take off when she would smoke .She was admitted to the hospital several times , During the work up one time , we did a CT scan of abdomen and found out that she had a aortic aneurysm. It was not very large , but needed to be watched . There was no way that she would be a good surgical candidate , so this was the only option .
   She continued to do OK , had finally quit smoking .and had reached 72years of age . She was admitted to the hospital .She was short of breath,and had some belly pain . We did CT scan of abdomen and found that the aortic aneurysm had increased in size . It was not 'leaking '.I called the surgeon , who had seen her in the past . He came and saw her , The aneurysm had reached such a level that he felt that the surgery was unavoidable . In those days there was no endovascular grafting , which is done now a days . (in this procedure no surgery is needed , but a graft is inserted under local anesthesia . ).He wanted to do the surgery next morning . She was transferred to intensive care unit for the safety reasons . She was scheduled for the surgery next morning at 7 am . I had talked to the family , the husband and the daughter . They understood the risk , but also knew that there was no other option , as we had postponed the  operation as long as we could and now the time had come to do it .
    I got a call at 3 am that night that her blood pressure had started dropping . I knew what had happened . HER ANEURYSM WAS LEAKING AND WAS GOING TO RUPTURE . They had called the surgeon , who had called the operating room . She was taken to surgery in next 30 mins and 'made ' it . She was on respirator ,for long time . We had  to do the tracheaostomy and it took about 4 weeks to get her off the respirator. She still had the trach. and as she was not eating and her weight had gone down to 60 lbs , we did a feeding tube . She was discharged to a nursing home with the feeding tube and trach. I continued to do office follow up . She went home in about 8 weeks . The trach was taken out as her breathing was better and we do take out the feeding tube after about 6 months as her caloric intake improved . She continued to live for another 18 months or so .
     On that eventful day when the aneurysm started leaking and then almost ruptured, she was in the best place that she could be ----the hospital intensive care unit . If she was home or even if she was on regular floor or if we had not done the CT scan of the abdomen , she would have died . And even with the surgery with her overall status she made it , only because the " THE TIME HAD NOT COME "!!!!!

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