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A Piece of My Mind
October 8, 2008


JAMA. 2008;300(14):1629. doi:10.1001/jama.300.14.1629

I wish I had operated on Saturday, not the next Tuesday.

He was only 3 months old, with an aortic aneurysm and failing kidneys. He didn't look sick: fat rosy cheeks, bright sparkling eyes, a tuft of brown hair, and two chubby hands that would hold your fingers tightly, wanting you to play with him. But his breathing was shallow and labored, his lungs were overloaded with fluid, and his smiles were often cut short, by things he certainly didn't understand.

Surgeons often have to judge the benefits of waiting, to prepare a patient for an operation: “Lose weight, Stop smoking, Let's get your blood pressure under better control” are common preoperative utterances, but not so in his case. He simply was retaining a little too much water, not much, perhaps a few hundred milliliters . . . a teacup full . . . but then again he weighed only 11 pounds.