CAN YOU PREDICT DEATH ?

      This is very interesting question. I am not talking about someone sick in ICU and is on respirator and falling blood pressure. I am talking about can we predict death in a regular walking -talking patient ,who has no cancer. But recently I came across a form that I had to complete where the first question was 'Is patient likely to die in one year?' This is recent and it was a patient who was to undergo minimally invasive cardiac surgery. As a lung specialist, I often get forms to ;CLEAR' the patients for various procedures or surgeries - endoscopies to cataract surgery to colon resection and so on. The risk of any surgery is increased when the patients have lung problems and the lung capacity is compromised. This brings me to the story for today.

     I have known this patient for many years . He was  70 years old patient, who had chronic cough . I had done the work up and that included breathing test and Chest x-ray . We even did the CT scan of chest . He had mild to moderate asthma or obstruction on his breathing test. The x- ray was ok and so I gave him inhalers to treat the asthma. He used it and came back and told me he does not know when to use as he did not find any change in cough. So he would  not use it. I also did swallow study to see if he was aspirating-food or liquid going wrong way -instead of going in food pipe , esophagus ,it would go in wind pipe or trachea. This would then trigger the cough reflex. He did have aspiration. But then again he did not feel he had any problem with swallowing. So he did not do anything . I continued to follow him for more than 5 years  and he did well with no hospital admission or major pneumonia. 

   Then he saw a cardiologist and they diagnosed him with a heart valve problem and they wanted to do minimally invasive heart surgery to fix it. I cleared him for the surgery and he did well. He came back to see me. He was doing good and had uneventful recovery from the heart surgery. He however had urinary retention and he was diagnosed with enlarged prostate and needed surgery to fix that. Just as a rule risk of lung problems is increased when the surgery is close to lungs Say for example amputation of a toe is much less risky that having lung surgery with compromised lungs. Now he needed prostate surgery. I cleared him for the surgery. He did well and then was to be discharged. And then HE ASPIRATED . The aspiration caused major pneumonia and his oxygen dropped . He developed respiratory failure and then was struggling. He and family made decision not to put him on respirator and so then hospice was called and he died . 

    So the patient that survied heart surgery dies after prostate surgery -CAN TOY PREDICT DEATH?