My Uncle Almost Died

On February 10, my paternal uncle called my mother. I didn’t hear the conversation, but I imagine it went something like this:

UNCLE: Is my brother there?
MOTHER: No, but he’ll be home soon, you can call back.
UNCLE: Actually, I can’t because I’m going to have surgery.
MOTHER: ???
UNCLE: I have a dissection.
MOTHER: What’s that?
UNCLE: Tell my brother what’s happening. [hands phone to hospital worker]
MOTHER: What is happening?
HOSPITAL WORKER: Ma’am, he just entered the operating room.
MOTHER: Who are you?

The hospital worker told my mother the name of the hospital and the surgeon who was about to operate on my uncle and explained how to get updates on my uncle’s condition.

My uncle had an aortic dissection. I had never heard of ‘aortic dissections’ before Wednesday. My understanding (courtesy of Mayo Clinic) is this: an aortic dissection is when the inner lining of the aorta (the largest artery connected to the heart) tears. Once the inner lining is torn, it’s usually a matter of hours or days until the aorta itself breaks open, hemorrhaging lots of blood and causing the circulatory system to fail. It’s almost always fatal. The only way to stop this is to surgically repair the aorta before it breaks.

40% of people with aortic dissections die before they reach a surgeon, and 5-20% of surgeries end in death.

My uncle survived the surgery. He was kept under sedation all night so nobody knew, at first, whether he suffered neurological damage. On Thursday morning, they took my uncle off the ventilator. Just now (at the time I’m writing this) he was awake and briefly talked to my father. There are no signs of paralysis.

My uncle told my father that, on Wednesday morning, he felt chest pain while drinking coffee, so he drove to an urgent care clinic. The people at the clinic put him on an ambulance and sent him to a hospital. The people at the hospital put him on a helicopter and sent him to a hospital that specializes in cardiac care. I don’t know who diagnosed my uncle with aortal dissection, but they saved his life. Because aortal dissections are rare, they are often misdiagnosed as heart attacks.

After the 7+ hour surgery, the surgeon confirmed that the dissection happened on Wednesday, not earlier. He also found an aortal aneurysm and another heart problem I don’t understand. The aneurysm and other problem must have been around for a while (aortal aneurysms greatly increase the risk of aortal dissection). Did my uncle not know about his heart problems, or did he just not tell us? My dad did not ask my uncle about this yet.

A few years ago, one of my uncle’s friends warned us that he was in denial about his health problems, and that we had to encourage him to take better care of himself. But what could we do? Nag him to eat less salt and more vegetables? We did nothing.

According to the hospital bureaucracy, while my uncle is incapacitated, only my father can legally consent on my uncle’s behalf. So far the decisions have been easy (Hospital Bureaucrat: Do you consent to us giving your brother routine medical care? Father: Yes). Though my uncle can now talk, for reasons which don’t make sense to us, my father is still the one who has to consent, not my uncle. Our best guesses are that a) the hospital bureaucracy is confused or b) the doctors/nurses want my uncle to rest, not make legal/financial/medical decisions.

For a while, there was the possibility that my father might have to decide what to do if my uncle sustained too much neurological damage to ever talk again. Now that my uncle can talk and express his own wishes we can probably stop worrying about that, but things can still become worse.

I’m my uncle’s closest younger relative. I figured that, at some vague time in the future, my uncle would have a dramatic medical emergency and I’d have to do something about it. But my father did not expect to be in this position. He’s ten years older than my uncle; he reckoned that by the time my uncle had dramatic health problems he would either be dead or too incapacitated to be responsible.

Now, for the first time, it looks like my father might outlive my uncle. Though my uncle seems to be doing about as well as possible given the circumstances, his heart will remain fragile and the surgery, no matter how well performed, is an invasive procedure that damages the body permanently. Despite being ten years older, my father has never had a medical event like this.

On top of everything else, there’s the pandemic. My uncle tested negative for covid, but it’s not impossible that he could get infected in the hospital. The hospital bureaucrats also explained to my mother that the pandemic has messed up hospital operations in many ways (for example, the bureaucrat is not allowed to visit the ICU in person to find out what’s going on). It’s lucky that there was an ICU bed available for my uncle; during all these surges in covid hospitalizations across the United States that is not something to be taken for granted. He has to stay there for at least five days. We’re in different states, but even if we were in the same geographic region we would not be allowed to visit him.

In the contemporary United States, we’re conditioned to the idea that we might have chronic health problems get worse over time, or we could get hit by a motor vehicle, and now we’re even conditioned to covid deaths (nowadays, whenever anyone dies, the first question I hear is ‘was it covid?’) but we aren’t conditioned to ‘this medical problem you’ve never heard of can kill you with only a few hours of warning.’ If it can happen to my uncle, it can happen to my father, or to me.

Perhaps I have not cherished my uncle enough. Perhaps I have not cherished my own life enough.