Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Resilience in the face of setbacks


Treating aortic dissections has taught me the importance of staying positive, both in communicating with families and in my own approach. 

In my career as a vascular surgeon, I’ve found that in many cases of critical illness that evolve over days and weeks, there’s an evolution of the disease process that we can predict and potentially divert toward recovery. However, in the case of aortic dissection, the evolution of the disease process is exquisitely individualized, based on anatomy, physiology, and most importantly, time of detection. Every patient has their own chapter in the textbook. As Osler said, “There is no disease more conducive to clinical humility that that of aneurysm of the aorta.” Namely, aortic dissection is often detected when it’s already set loose a pantheon of severe complications. In this moment you care with immediacy, often in a tightly coordinated time frame. Care with immediacy isn’t the final shot with the clock running out, it’s more akin to heading into the last quarter well behind the lead. Care with immediacy is the full force of medicine and surgery, right now, right here.   


There are two lessons when you care with immediacy. First, the patient and their loved ones are petrifieddrilling down on the litany of complications that may or may not occur only wastes time and emotional energy.  They want to know that their physician is there for themcalm, knowledgeable, and most importantly, positive. Positivity is gas in the patient’s and their family’s engine, and when you care with immediacy, you will need gallons of it.   


Second, knowledge and technical algorithms for handling complex care scenarios are vitally important, but you don’t have time to see if each step down the decision tree evolves in your favor. Move quickly across the decision trees and don’t take a failure of a well-executed intervention personally. Positivity counts. Especially so when fighting a late diagnosis, it’s very likely you will follow the “NO” arrows repeatedly down the treatment algorithm. In many cases, the entire playbook will be used to save an immediately ill aortic dissection patient with multiple territories of their body each affected to varying degrees. So, care with immediacy viewed within the “art and science” of medicine is very much about the “science;” however, the “art” is seen in the symphony of teamwork to help our patients. 











This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.