Ready to go

I recently had a patient come in for belly pain. He was elderly and very sweet. I'm asking him all the routine belly pain assessment questions, asking if he has any sort of medical history that could help me out - do you still have your gallbladder, history of ulcers, GERD, diverticulitis, does your pain radiate to your back? Anything? He thinks for a minute, and then says, "well, I do have an aneurysm." I ask him to show me where, and he points right to his chest. And then to his belly. "I've got two of 'em," he says. In my head I'm thinking that this is it, his aneurysm is seconds from exploding and he'll be dead before the end of my shift. On the bright side, everything is stable. No pulsations, normal BP, good color. Nothing but the persistent pain.

I move him to a room closer to the nursing station, and we quickly order a CT. When it comes back, the doc and I huddle around the monitor to look.

It turns out that his aneurysm had expanded since his last CT, but was stable. His AAA was, I kid you not, more than TEN centimeters in diameter. And the aortic arch wasn't much smaller. The doctor went in to speak with him to explain that the pain he was experiencing was most likely related to his aneurysms, but that due to multiple factors surgery was not an option. He was okayed for discharge with the knowledge that his aorta is a ticking bomb, but that today wasn't his day to die.

He took the information remarkably well, but I couldn't quite figure out why. As I was getting him into his wheelchair to leave the department, he started talking with me about his life.

"You know, I've tried to be a good person both inside and out. I took care of myself, I tried to give back to other people. I tried to be a good person, and my wife was much better than I am. She and I were married for over six decades. My wife died earlier this year. She was the better half of me, and when this artery goes, I hope she is the first one I see."

He knows his aneurysm is going to rupture one day. He knows he will feel fine one moment, then feel ripping pain for a few. He knows that within a minute or two he'll be dead. And he's not only ready to go; he's looking forward to his reunion with open arms and open heart.