No Benign Procedure

A 20 year old considering a career in professional athletics has a benign congenital heart defect. It causes him no symptoms on a day-to-day basis but it's felt by his coaches and trainers that he should have it repaired. The procedure ought to be a simple one; in fact, the bypass time is only half an hour. He is young, and no one expects any complications. After all, we do open heart surgery on octogenarians. His surgery appears to be uneventful and he comes to my care in the CVICU post-operatively.

We extubate him and wean off his cardiovascular drips. He's meeting all our goals and parameters, but upon working with physical therapy, he notices something odd. He is slightly weak on one side. We rush to scan his head, and there's evidence of a completed stroke, likely from the OR. We are all devastated. In getting an elective heart surgery for a career, a complication makes it impossible for him to pursue that career. He will be fine for everyday activities; he's improved with physical therapy and he was quite strong to begin with. But he will never play professional sports again.

This was one of the saddest cases I had in the CVICU. We all know that complications are a risk of any surgery, but it's easy to assume they would never happen to a healthy young patient. To see someone with such potential lose so much hope - my eyes filled with tears in talking to him. It is a grave reminder that everything we do in medicine has risk, and we should never undertake any procedure lightly. I am glad I am not a surgeon, but as an anesthesiologist and intensivist, I will have similar circumstances and situations. Reminders like this make our responsibilities as a physician feel so much more raw and poignant.