Making a strong, plaintive case for preventive care

“Dear Doctor – Please don’t let my daddy die.” It was perhaps the most profoundly sorrowful moment of my early medical career.

I was a young intern, recently minted as a medical school graduate, and cutting my teeth in the challenging setting of the intensive-care unit.

Late one evening, tragedy struck when a man in his 40s entered the emergency room due to sudden and severe chest pain. The “tearing” character of the pain bespoke a serious problem.

He was suffering an acute aortic dissection, involving a tear within the wall of the largest artery in the body.

Once the man’s pain had been controlled, he was sent to the ICU for medical stabilization of his elevated blood pressure while a surgical team prepared for a possible intervention.

The location of his dissection was of the most serious type, and a conference was quickly convened with his wife and 8-year-old daughter to explain the circumstances of his care.

In a small ICU waiting room, the senior resident explained the dire circumstances while I attempted to console and give some hope to his young family. It was hard to hide the emotions evoked by the sense of impending doom reflected in the medical facts – this man could possibly die tonight.

Upon a return to the man’s ICU room as his family remained behind to wait, I reached into the pocket of my lab coat and found a note, torn from a pad of paper, written in the perfect penmanship of a third-grader: “Dear Doctor – Please don’t let my daddy die.” Words cannot explain my sorrow.

Within less than an hour the man suddenly went into a full cardiac arrest as the tear extended to one of his coronary arteries and he died. There was nothing that could be done to save him.

The man suffered from a relatively unusual genetic condition known as Marfan syndrome, which involves a defect in the connective tissues. Affected people tend to be very tall, with long thin arms and legs, a long narrow face and spider-like fingers. For the trained eye, the appearance is classic.

Marfan syndrome is associated with certain conditions affecting the skeletal system, eyes and lungs. But the relationship with a potentially life-threatening dilation of the aorta posing risk of acute aortic dissection is the most important.

This man was young, otherwise healthy, without physical complaints and as most of his gender and age-related peers, he probably did not seek routine preventive medical care. Yet his is one example of how a preventive medical visit may have saved his life.

An astute primary care physician could have diagnosed his condition and known to look for the commonly related problem with the aorta. Blood pressure control and monitoring may have preserved his life, as his daughter had asked.

Her message to me resounds in every preventive encounter I have as a primary-care physician as I hope it will for all of you who have not seen your doctor in a while.

Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.