Monday, December 25, 2006

At 97, the inventor of a complex heart surgery undergoes the same surgery


A heart-warming tale (with lots of complications to keep you hooked all the way to its end!) for these Festivus holidays:

But when his heart kept beating, Dr. [Michael] DeBakey suspected that he was not having a heart attack. As he sat alone, he decided that a ballooning had probably weakened the aorta, the main artery leading from the heart, and that the inner lining of the artery had torn, known as a dissecting aortic aneurysm.

No one in the world was more qualified to make that diagnosis than Dr. DeBakey because, as a younger man, he devised the operation to repair such torn aortas, a condition virtually always fatal. The operation has been performed at least 10,000 times around the world and is among the most demanding for surgeons and patients.

Over the past 60 years, Dr. DeBakey has changed the way heart surgery is performed. He was one of the first to perform coronary bypass operations. He trained generations of surgeons at the Baylor College of Medicine; operated on more than 60,000 patients; and in 1996 was summoned to Moscow by Boris Yeltsin, then the president of Russia, to aid in his quintuple heart bypass operation.

Now Dr. DeBakey is making history in a different way — as a patient. He was released from Methodist Hospital in Houston in September and is back at work. At 98, he is the oldest survivor of his own operation, proving that a healthy man of his age could endure it.

“He’s probably right out there at the cutting edge of a whole generation of people in their 90s who are going to survive” after such medical ordeals, one of his doctors, Dr. James L. Pool, said.

But beyond the medical advances, Dr. DeBakey’s story is emblematic of the difficulties that often accompany care at the end of life. It is a story of debates over how far to go in treating someone so old, late-night disputes among specialists about what the patient would want, and risky decisions that, while still being argued over, clearly saved Dr. DeBakey’s life.

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The last paragraph in the above quote is a pretty serious issue. How far one must go in treating elderly patients with invasive procedures is something the medical profession is still grappling with. At its simplest, it's about cold economic calculations: as one gets older, the procedures get fancier and more expensive (for example, Dr. DeBakey's treatment cost more than a million dollars), so affordability is an issue. And then there's the expected pay-off (e.g., the number of years of survival) which keeps getting smaller with one's age. At another level, there's the problem of the patients' decreasing ability to take these procedures in stride; complications may reduce the quality of life during the remaining years.

Do read the rest of the NYTimes story for a great discussion of the ethical issues that doctors weighed before before choosing to go with that complex surgery.

* * *

But there's also a different problem. In many cases, similar symptoms in elderly people need treatments that could be quite different from those for younger people. Experts in Geriatrics who would know these key differences are in short supply -- even in rich countries. [Geriatrics, as a field, is both young and and unpopular!]. This NYTimes story from two months ago looked at this problem:

Even as the population ages and more people like Mrs. Foley need them, geriatricians are in short supply. It is a specialty of little interest to medical students because geriatricians are paid relatively poorly and are not considered superstars in an era of high-tech medicine. In fact, the credo of geriatric medicine is “less is more.” [...]

Caring for frail older people is about managing, not curing, a collection of overlapping chronic conditions, like osteoporosis, diabetes and dementia. It is about balancing the risks and benefits of multiple medications, which often cause more problems than they solve. And it is about trying nonmedical solutions, like timed trips to the bathroom to improve bladder control.

But these are common-sense remedies in a health care system that rewards the heroics of specialists, in both compensation and prestige.

1 Comments:

  1. Jeff said...

    At least DeBakey was smart enough to avoid heart surgery, particularly a CABG, as long as possible. If cardiologists had their ways, I would have received a quintuple bypass almost three years ago becaue I was a "walking time bomb." To find out why I didn't explode despite avoiding getting my chest cracked open.

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