El amor en los tiempos del colera

On a Friday afternoon, on call, I received a call from another hospital: A 42 year old asylum seeker from Africa. Wife and two pre school children left behind. A symptomatic subacute Type A dissection in the context of previous kidney transplant, immunosuppression and acute pneumonia. A virus pandemic framing everything. The perfect storm? Not quite.

He came over for assessment and by the time he arrived to the ward I had just finished removing a self-inflicted kitchen knife from another patient’s neck in theatre under very crescendo-dramatic but decrescendo-undramatic conditions: We prepared for major hemorrhage but I pulled it out and nothing happened.

I went to see the dissection man and explained the risks/benefits with and without an operation. Either way his life was at significant risk and his precious kidney transplant even more so. He chose to have it. He wanted his wife to be part of the conversation and so I called her because he had no credit on his phone.

We agreed to do the operation next day, Saturday. The silver lining: I had a great team to help me. We started 12:00 finished 21:00. All went as planned. That night I sent a message to his wife. She was grateful but very worried and asked me to help her write a letter to the home office supporting her coming over to look after him (this of course was unrealistic and probably impossible under the current restrictions). I said I would try but I knew there was not much I could do.

His first night in ICU was uneventful. I sent her a message with the good news Sunday morning but I also explained I would not contact her any more unless there was some big change in his condition and that I could not help in the other matter. I blocked the number (she did not try to contact me anyway) so I unblocked it to update her on his good progress after a few days.

The hospital liaison team updated her the next couple of days. The man woke up with intact brain and kidney. He called and spoke to his wife. A few days later on the ward close to discharge, he expressed his gratitude to me and the team that looked after him. He asked me to write a letter outlining the medical events for him to submit with the asylum application. I will certainly help with that. I am glad he reached the stage where he has big (but not life or kidney threatening) problems to deal with. This was intended to be the ‘happy end’ of this story.

He was discharged two weeks after the operation to the kidney unit for further tweaking of his meds. The same night was found unresponsive in his bed at 02:30 and resuscitation was unsuccessful. They called his wife and told her. I found out in the morning (Saturday) via a text from her: ‘Doctor, good morning, my husband is dead’

Welcome to cardiac surgery.

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