[HSF] Nonagenarians and Cardiac Surgery - karma

[Nasser F. Abou'Seada]

kar·ma (kär“m…) n. 1. Hinduism. Buddhism. The total effect of a person's
actions and conduct during the successive phases of the person's existence,
regarded as determining the person's destiny. 2. Fate; destiny. 3. Informal.
A distinctive aura, atmosphere, or feeling: There's bad karma around the
house today. [Sanskrit, deed, karma. See kwer- below.] --kar“mic (-m¹k) adj.

apparently totally different from the context and perspective revealed .... 

NFA

> From: prasannasimha
> We have one word in Hindu philosophy for what Nasser said in many words
> "Karma"
> Prasanna
 
> Nasser F. Abou'Seada wrote:
> > I would agree to Prasanna's argument, from a different conceptual
framework.
> >
> > In my culture (different faiths and different religions) people do
believe
> > that the LENGTH of life is already predetermined -thought that might
> > conflict with some rhetorics - ..... in another word .... the time we as
> > humans are destined to materialize in this materialistic existence ...is
> > already pre-determined ..... meaning that life can't be prolonged ....
can
> > not be shortened .... when the time comes ... it comes .... -I got that
say
> > from an American Family, a doctor's family, I've been living with in
> > Cleveland-
> >
> > Still, surgical procedures -and medicine in general- is meant to be a
REASON
> > to IMPROVE the QUALITY of life .... that we'd never know when it ends
....
> > hence we have to work on to improve ITS EXISTENCE .. till the unknown
time
> > comes ..
> >
> > based on that ... my domain of thoughts would intersect with prasanna's
and
> > others' ....in that:  surgical care should be offered to others -for
> > whatever reason of belief- to provide for good life, to improve quality
of
> > life, to extend life ! ... yet the DETERMINANTS of the surgical decision
> > would count on many variables; age being one of them .... solely as a
number
> > .... among other important variables ..... -as Hal described-

> > we would arrive at the same destination at the end .... starting from a
> > different perspective ....
> > NFA

> >> From: prasannasimha
> >> I would put it in perspective -
> >> If the patient is active and desires surgery and seems an OK candidate
-
> >> who are we to deny surgery just based on age if we can give a
reasonable
> >> extension of life.
> >> If the patient is a frail old person who represents an inordinate risk
> >> and does not want it and is ready to make peace with his/ her maker
then
> >> why should we operate. The decision should be based on the patients
> >> condition and desires and not our prejudices.
> >> The oldest patient I have operated was a 94 year old man who underwent
> >> non cardiac surgery by me. He had a diabetes  and hypertension and a
> >> host of other medical problems and no urologist was ready to operate on
> >> his prostate. He told me Doctor life is becoming miserable as I cannot
> >> get one nights rest. I operated on him in a private hospital and he
> >> lived for another 4 years and was thankful for it till he died. When
his
> >> time was coming I told his Son's that I will not ventilate him etc etc
> >> and allowed him to die at home in peace. Was operating him wrong - in
> >> his view (which was good enough for me) No and he got to see his great
> >> great grandchild which was what his great desire. I do agree that
> >> cardiac surgery may be a different ball game but then who are we to
deny
> >> surgery based on our own belief systems and prejudices ? No. You must
> >> realize I come from a community where old people do not want to have
> >> interventions done on them and if any one asks for surgery  - he has a
> >> compelling desire to do so and I will not deny that to him /her if that
> >> person is ready to accept the risks and consequences.
> >> remember the holy grail of medicine is meaningful prolongation of life.
> >> If prolongation of life is meaningful for someone at 90 years so be it.
> >> I would think that the reverse - doing a Norwood for a child with a
> >> chromosomal anomaly is somehow found acceptable by some whereas it may
> >> equally reprehensible. Are we to judge ?
> >> Prasanna

> >> Salerno, Tomas wrote:
> >>> Sometimes it is important to pause and ask questions, such as
operations
> > in 90 year-old patients...
> >>> Tomas

> >>> From: Nasser F. Abou'Seada
> >>>> Age is a number to be considered, but I
> >>>>> feel obligated to evaluate the patient's cormorbidites, mental
> >>>>> acuity, mental outlook, etc, before categorically denying a patient
> >>>>> surgery just because they are in their 90's.<

> >>> Certainly Sounds Logic .... totally agree ........ though having no
such
> >>> patient in such age group ...
> >>> NFA

> >>>> From: Edward Bender
> >>>> I remember a 92 year old with disabling angina I did a CABG on a
> >>>> couple of years ago.  Discharged on post-op day 4, and then he went
> >>>> to Las Vegas to help set up an amusement park type train for a couple
> >>>> of the casinos.  There are 90 year olds and then there are 90 year
> >>>> olds.  Generalizations don't equate to universality.
> >>>>
> >>>> Ed Bender, MD
> >>>>
> >>>>
> >>>> On Nov 17, 2006, at 2:25 PM, hgrmd at aol.com wrote:
> >>>>
> >>>>
> >>>>
> >>>>> Tomas,
> >>>>>   I've done several patients in their 90's in my career.  Most of
> >>>>> them did reasonably and sometimes surprisingly well.  The key is
> >>>>> selection.  I generally won't operate on your average patient in
> >>>>> their 90's, but there are worthy exceptions.  Heck, I've turned
> >>>>> down some patients in their 30's or 40's because the cormorbidities
> >>>>> and the heart were so bad.  Age is a number to be considered, but I
> >>>>> feel obligated to evaluate the patient's cormorbidites, mental
> >>>>> acuity, mental outlook, etc, before categorically denying a patient
> >>>>> surgery just because they are in their 90's.  An example was the
> >>>>> sharp 93 yo grandmother of an internist who kept being admitted for
> >>>>> chest pain from severe 3vd.  I did her CABG, she did well, and was
> >>>>> living an active life at least 4 years later.  I'm sure plenty of
> >>>>> other members of HSF can relate similar experiences.
> >>>>> Hal
> >>>>>
> >>>>>
> >>>>> -----Original Message-----
> >>>>> From: TSalerno at med.miami.edu
> >>>>> To: OpenHeart-L at lists.hsforum.com
> >>>>> Sent: Fri, 17 Nov 2006 2:08 PM
> >>>>> Subject: RE: [HSF] Factor VII
> >>>>>
> >>>>>
> >>>>> Should a 90 year old be subjected to heart surgery? Anyone has seen
> >>>>> his/her grandmother at that age, and what she looks like?
> >>>>>
> >>>>> Tomas
> >>>>>
> >>>>> -----Original Message-----
> >>>>> From: openheart-l-bounces at lists.hsforum.com
> >>>>> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Ben
> >>>>> Bidstrup
> >>>>> Sent: Friday, November 17, 2006 1:49 PM
> >>>>> To: OpenHeart-L at lists.hsforum.com
> >>>>> Subject: Re: [HSF] Factor VII
> >>>>>
> >>>>>
> >>>>>
> >>>>>> Prasanna,
> >>>>>>   Basically, I wasn't thinking of the possible legal consequences
> >>>>>> when
> >>>>>>
> >>>>>>
> >>>>> I
> >>>>>
> >>>>>
> >>>>>> used VII, because I knew the potential for such was nil.  No South
> >>>>>>
> >>>>>>
> >>>>> Florida
> >>>>>
> >>>>>
> >>>>>> lawyer on contingency is going to take a case of a 90 yo cardiac
> >>>>>> surgical patient
> >>>>>> against a bare surgeon.  Now, if the patient had been in  her 50's
> >>>>>> with
> >>>>>>
> >>>>>>
> >>>>> a
> >>>>>
> >>>>>
> >>>>>> difficult family, then I might have had other thoughts.
> >>>>>> Hal
> >>>>>> _______________________________________________
> >>>>>>
> >>>>>>
> >>>>> Hal,
> >>>>> I am sure very few of us in a situation like this think of anything
> >>>>> but the benefits for the patient. It is easy to be 'wise' after the
> >>>>> event and that is what we are able to do here.
> >>>>>
> >>>>> --
> >>>>> Ben Bidstrup FRACS FRCSEd FEBCTS
> >>>>> Consultant Cardiothoracic Surgeon