Never too late

Abstract

Mr. ‘‘Wally’’ Poto arrived, via ambulance from Valley Hospital, with a thrombosed abdominal aortic aneurysm and bilaterally occluded common iliac arteries. I was there to admit him, excited because it was an emergency and delighted that I was admitting my very first patient. As I performed the physical exam, Mr. Poto remained pleasant and alert, even cracking a few jokes in a voice ragged from years of cigarette smoke as I asked about his symptoms, the pain he had had in his abdomen for 17 years (‘‘I wish I had come in 17 years ago,’’ he told me ruefully), his family and children, and his life since retirement. In just a few minutes, I learned of our shared love for Asian cuisine and the recent opening of his own restaurant after a lifetime of laboring and saving. ‘‘It’s never too late,’’ he winked at me, his gray eyes glittering even as the rest of his body lay limp across the hospital sheets. His feet appeared as if they belonged to the body of a corpse freshly dug from the earth: ice-cold, pale white bone peering through waxy blue skin, they led up to mottled, skeletal legs that yielded no pulses bilaterally. A cursory glance through his chart confirmed his status: at age 78, Mr. Poto had long since affirmed his wish to be DNR/DNI (‘‘do not resuscitate, do not intubate’’). When my attending arrived minutes later and explained the emergent surgery needed to restore blood flow to his legs, however, Mr. Poto was adamant. ‘‘Do everything you can’’ was his instruction. His code status tossed aside for the moment, my team rushed to the OR that afternoon, emerging at 10 pm that night with what seemed to be pulses in both feet detectable by Doppler ultrasound. Each morning for the next 2 weeks, Mr. Poto became my responsibility. I greeted him every morning and took down his dressings, palpated his newly restored pulses, and asked him how