Medical Human Story-Episode 52-The Time of the Aorta(3)

 Thoracic Aortic Dissection and the Final Choice of a 78-Year-Old Man

 

Part III. The Patient Who Does Not Wake

The morning sun filtered through the hospital windows. Yet, within the Intensive Care Unit, the distinction between day and night ceased to exist. There was only the glow of monitors, the rhythmic hiss of ventilators, and the incessant, piercing chirps of alarms.

I stood before Bed 12.

Patient Name: Park Jeong-ho. Diagnosis: Stanford Type A Thoracic Aortic Dissection.

The First Hour Post-Surgery

He had not yet regained consciousness. An endotracheal tube was seated in his airway, with the ventilator mechanically forcing air into his lungs in a steady, artificial cadence. The monitor displayed his vital signs:

  • Blood Pressure: 110/65 mmHg
  • Heart Rate: 84 bpm
  • Oxygen Saturation: 99%

On the surface, the surgery appeared to be a success. But I knew better. In cases of aortic dissection, the true battle often begins only after the surgeon steps away from the operating table.

Six Hours Later

It was 3:10 PM. I returned to the ICU to find a neurosurgery resident examining the patient.

"Any response?" I asked.

He shook his head slowly. "...Still no sign of consciousness."

A weight settled in my chest. "Pupillary reflex?"

"Present," he replied.

I exhaled a brief sigh of relief, but the reprieve was short-lived. "The problem lies elsewhere," he continued. "There is no movement in his left extremities."

I closed my eyes.

Cerebral Ischemia

I re-examined the CT scans. The dissection had extended into the left common carotid artery. This was a risk we had recognized before the first incision was even made. Now, that risk was manifesting as a grim reality.

"...Cerebral ischemia," I whispered to myself.

A Daughter’s Vigil

The patient's daughter was still in the corridor. She hadn't gone home once throughout the night.

"Doctor..." she said, catching my eye. "...My father—is he going to be okay?"

I hesitated for a heartbeat. "The surgery itself was successful," I began. Her expression softened slightly. But I had to continue: "...However, he has not yet regained consciousness."

Her eyes flickered with fear. "Why?"

"There is a possibility that the blood flow to his brain was compromised," I said, choosing honesty over comfort.

Her lips began to tremble. "Does that mean... my father will..."

I cut her off gently. "It’s not certain yet."

The Patient's Past

Late that night, I found myself sitting across from her in the hospital café.

"My father was..." she paused, gathering her strength. "...He was a doctor."

I was taken aback. "A doctor?"

She nodded. "A cardiothoracic surgeon. He spent his entire life repairing hearts."

"So... did he know?" I asked quietly.

"Yes," she replied. "In the ambulance on the way to the emergency room..." She choked back a sob. "...He told me."

I held my breath. "What did he say?"

Wiping away a tear, she whispered, "He said it might be an aortic dissection."

The Burden of Knowledge

Suddenly, the patient’s words from before the surgery echoed in my mind: "Everyone dies eventually."

He had known exactly what was happening to him. He understood the gravity of his condition—Thoracic Aortic Dissection—and the slim margin for survival.

Night in the ICU

11:20 PM. I returned to the ICU. The patient remained lost in the depths of unconsciousness. Only the rhythmic pinging of the monitor broke the silence.

I stood by his bedside. "Dr. Park," I said.

There was, of course, no reply. But I continued speaking. "You must have saved countless hearts in your time ." I reached out and took his hand. "Now, it is our turn to save yours."

A Glimmer of Hope

It happened then. A subtle shift on the monitor, and then—a flicker. The patient’s finger moved, ever so slightly.

My breath caught. "Nurse!"

The nurse rushed over. "He just moved," she confirmed, her voice filled with surprise.

I nodded, my gaze fixed on him. "Dr. Park."

A few seconds passed. Then, his eyelids began to flutter, slowly opening to the world once more.

In that moment, a single thought took hold: This fight is far from over. 

To be continued!

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