A Cardiologist's View of Modern Cardiovascular Surgery

¹ Professor of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota

Several centuries ago, a cynical Gregory said of doctors: "Old men let their patients die, young men kill them," and there are times when the first part could be paraphrased: "Physicians let their patients die," the second part you can complete as you will. It is important to point out that the availability and acceptable risk of some surgical procedures may not be known to some physicians and the term "too ill for surgery" may be in grievous error. The remarkable resurrection of some patients with gross acute mitral or aortic regurgitation are cases in point. Be kindly to the physician as you continue to render him out of date; join with the physician in the support of basic research which may make much of the joint present labors unneeded. Remember that at the end of life, it may be more courageous to be accused of "doing nothing" (except relief of pain) than to forge ahead with dramatic surgical effort. In some instances, too, it is well to recall the old adage, "in the dying, surgeons need not hurry the hand of God." I thus return to Ecclesiastes' dictum "there is a time to be born and a time to die"—undoubtedly, then, when written, a reflection of passive fatalism, but in this age it would imply an active, sometimes agonizing human desicion. I ask your indulgence for the chauvinistic and pejorative touches in my remarks and hope that the yoking together of many heterogeneous ideas will not cause immediate rejection and that such ideas may be better tolerogens than antigens for productive thoughts.