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facts & arguments

sophie casson

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Would a second bypass operation help or harm my dad? The surgeon paused, and then replied that there was no way to know.

It was what I was expecting. My father had undergone his first cardiac bypass more than 20 years earlier, when I was a teenager. Those events seemed unreal, a distant memory.

How had things come to this point? My father had maintained a regimen of exercise and a healthy diet. Ultimately, though, genetics are a tough thing to overcome.

My father was outwardly well. Now in his 60s, he could be found most summer days on the golf course. Never once had he experienced chest pain walking his 18 holes. The stress test told a different story. The grafts that maintained blood flow to his heart were almost completely blocked. They could go at any time, or he might continue feeling well for the foreseeable future. Repeat bypass would restore blood flow to his heart, but open-heart surgery carries risk.

As the physician in the family, I had gone over the literature before meeting the surgeon. I had discussed things with colleagues in cardiology. What I found was that it was not possible to know the best course of action.

When I went to medical school, I had the false impression that all would be revealed. But the reality is that a physician's only certainty is doubt.

One of my first clinical rotations as a student was nephrology. A middle-aged man recently started on dialysis was admitted after becoming confused. Each day on rounds, the thought as to why he was confused changed. Initially it was felt he was experiencing fluid shifts from the dialysis. Then it was decided the confusion related to a recent intake of benzodiazepines. As the confusion steadily worsened, it was realized that something more serious was to blame. The true cause was an atypical case of meningitis.

The practice of medicine is based on science, but it is definitely an art.

As a doctor, I had become used to friends and relatives asking me about this or that. This was different. What advice would I give my dad? What if it were the wrong advice? I had thought a lot about this, but at that moment sitting in the consultation room I did not know what to say.

At a certain point in life, you think you really know your parents. Mine had instilled in me the importance of education and hard work – values rooted in the immigrant dream of a better life for one's children.

My parents had left apartheid-era South Africa with little money but a lot of determination. South Africa was a country where my father, a pharmacist of East Indian origin, was not permitted to serve white customers; where if you were in an accident, you'd be taken to the hospital designated for your race, even if it was further away; where whites discriminated against Indians, and all discriminated against blacks.

Canada offered the opportunity for their children to advance on merit, regardless of colour. More than that, it promised acceptance and social integration.

My father was a kind and patient man when I was growing up. I cannot recall him speaking to me with anger. On the occasions I did something wrong, he would talk to me rather than raise his voice. What a rare gift for a child to receive. I always knew his love was beyond question. My father had given me everything. He had left behind his country of birth, and his brothers and sister.

After the surgeon finished speaking, I started to open my mouth. Before I could say a thing, I heard my father. In his matter-of-fact way, he said, "Best we go ahead with the surgery then."

I was surprised, but glad I was not responsible for the decision.

The day of the surgery came quickly. As we waited for him to go into the operating room, he was at ease. He told us of the time he let in 17 goals on his high-school soccer team. They shot it this way. In it went. They shot it that way. In it went. My father laughed at his own recounting of the tale.

Hearing him laugh was the best thing one could ask for at that moment. As they wheeled him away, though, I felt hollow inside. Would this be my last moment with my father?

Hours later, the surgeon came down to talk to us. All had gone well. It was as if I could suddenly breathe again. Still, there was long way to go to recovery. My father lay unconscious, a ventilator responsible for the rise and fall of his cracked chest. Lines and tubes ran everywhere.

Though I had rotated through intensive care as a medical resident, and cared for critically ill patients, it is much different when it is someone you love in that bed.

Slowly, the days passed and he improved. In the days I sat by his side, he never complained. He tried to make us feel better rather than the other way around. The day that we took my dad home from the hospital remains one of the best days of my life.

I had thought I knew my father, but with his grace and quiet courage, he had more to teach me. Years later, I walk with my dad on the golf course and consider how lucky I am.

Navaaz Saloojee lives in Orleans, Ont.