I had written earlier on surgery for a 79 year old gentleman. Now a true story about an 85 year remarkable old lady.
When I was coming to my clinic I saw an elderly lady in a wheel chair.
I thought to myself, whatever it is, I just have to counsel her that she would not be suitable for any major surgery and send her back home for some supportive care.
Her son is a Paediatrician in the US. He came in and I started saying, “How old is your mother? She is 85 and too old to undergo any surgery”.
Then he stopped me and said, “I also know that, but I just want you to talk to her once before making up your mind”.
I said, “Oh! Certainly, let me just talk to her”. So she came in and I said, “You see Maaji, you are 85 and surgery at your age would be problematic because of complications”. She had a colon cancer with obstruction.
She said, “I am Mrs. Dikshit,( she insisted that I use her real name). There are 15 doctors in our family. So I know what I am talking. Do you know that I never went to a hospital so far? I do not have any heart problem or any other issue and this is the first time I am getting surgery done. YOU ARE GOING TO OPERATE ON ME. I know that I will survive”.
I was amazed that this lady who is so certain about her outcome. I said, “ but…” and she cut me short and said, “ NO ‘BUT’, YOU ARE GOING TO OPERATE ON ME, IT IS FINAL, IT IS MY DECISION”.
I said, “Okay, things may go wrong”.
She said, “So what if things go wrong. I am 85 as you know and lived my life well. Even otherwise I am not going to have much of a chance, so I’d rather take a chance with your surgery”.
Reluctantly I said, “Okay, let me try”.
My team was looking at me as if to say ‘Don’t do this, you will operate and we are going to have a problem’. We carefully evaluated her and every single test was normal. There was no way we could refuse surgery and taking high risk consent we went ahead with surgery. Believe it or not, on the 8th post-op day she literally walked home. When she came for suture removal she was walking and insisted that she will not come on a wheel chair.
I was so happy that I hugged her and said, “You are really remarkable, bless us that we would be like you at your age, so positive and so full of life”.
More and more senior citizens are getting operated. As we know, longevity is increasing and we see more and more elderly patients. We are extending our boundaries of surgery with better assessment and anesthesia. Earlier I used to feel 65 is the limit, then 70, then 75 and now it is nearly becoming 85 which is really pushing the boundaries.
But more than anything else, I think it is not just the chronological age but physiological age as to the other co-morbid conditions, how active was their life and whether they had multiple other problems. I think all these factors have to be taken into consideration while planning surgery for elderly. The mental attitude is important There are many articles on surgery in elderly. Elderly patients have same outcomes for cancer if they don’t have postoperative complications says Dr Preston “ Geriatric surgery is about the disease and not the age”.
The most fascinating story is of Dr. Michael deBakey, the pioneer heart surgeon of Baylor college, Houston who was the father figure of cardiac surgery. In December 2006, at the age of 97, he had chest pain and was diagnosed with Dissecting aneurysm of Aorta. He had treated 10000 such patients. But as with many patients of his age, he was in denial and then refused surgery. After a month the chest pain was unbearable and he nearly collapsed. His partner for 40 years Dr. Noon said, ”Either surgery or death, what will you choose”. His wife then intervened and consented for surgery. Anaesthetists were not willing to put such an elderly and important person to sleep for a complex cardiac surgery and were literally forced. The surgery went on for 7 hours and with exceptional care of HIS OWN team, Dr Debakey was discharged from the hospital. He himself could not believe that he survived the surgery. The whole story is interesting NY Times article
It will be great if all of us can age without co-morbid conditions. Yes, at some point of time there will be some illness but at least if you are fit by that time you are more likely to come out fine.
The engine has to be kept running in good condition and then you can cover long distances.