I knew it might be long day. 

We had twenty-three patients scheduled for cataract removal which was twice the usual number for our surgery center.  There are a few things you can count on with cataract surgery:  the procedure will be short, the time between patients brief, and the patients will be, well, older. 

I like these older patients which is probably why I’ve gravitated toward surgeries involving people who remember the attack on Pearl Harbor. Still, there are inherent challenges in a medical practice where the average patient is eighty years old, and that day, as I attempted to maneuver through the two pages of surgical cases, I was reminded what those challenges could be.

AJ:   Hi Mr. Larson, I’m your anesthesia doctor today. 

(I glance at his health information form)  

So when was your heart attack?

MR L: What heart attack?

AJ: You checked the heart attack box.   

MR L: Not me.

AJ: So you didn’t have a heart attack?

MR L: Not so far as I know

AJ: No problem. I’ll just uncheck the box.

(Erroneous box-checking is common in this surgery center. The print is tiny and our patients, after all, are here for cataract removal.)

MR L: My wife might have checked the box.

AJ: Did your wife fill out the form? 

MR L: I don’t have time for all that nonsense.

AJ: Is she here?

MR L: I sent her home. You people are too slow.  She couldn’t wait around forever.

(I feel an argument hardening in my throat. For once we are ahead of schedule and until now I was feeling proud of our efficiency.)

AJ:   Does your wife think you had a heart attack?

(He looks up at the ceiling which effectively shuts me out - the nurse took his hearing aid thirty minutes ago.)

Mr. Larson? Sir?   

(I’m trying to speak louder without yelling.  It’s not easy. I tap his arm lightly, suppressing the urge to pinch him.) 

MR L: We’ve been married sixty-two years in August.

AJ: That’s a long time.

(He turns to face me.  His eyes look watery. I hope it’s a side effect of all the drops he’s had this morning.)

MR L: She’s a special lady. 

(It’s not the eye-drops. It’s tears. Pure, contagious emotion. The rock returns to my throat. I take a deep breath and look away. There's no time for sentimentality - we still have twelve patients waiting.

 The Operating Room nurse taps gently between my shoulder blades and clears her throat. The surgeon, she informs me, is tired of waiting. Although I want her to relay the message “go suck it, Mr. Surgeon,”  I opt for a more diplomatic approach which buys me five minutes.)

AJ: So you didn’t have a heart attack, Mr. Larson?

MR L: Maybe a little one.

AJ: A little heart attack. When was that?

MR L: A while ago.

AJ: A while as in 2007 or more like, say 1964?

MR L: More recent probably.

(I review his medications. They are extensive - I can’t imagine keeping track of all of these drugs and their dosages.  I read the name of his final medication and our conversation begins to make sense.

The medication is Aricept, a drug used to mitigate the symptoms of Alzheimer’s Disease.)

AJ: Mr. Larson, are you sure your wife went home?  

MR L: Home? She’s in the waiting room. Jesus Christ, you people keep asking the same questions.  

AJ: We’re going to fix your cataract today, Mr. Larson, but I need to check with your wife about a couple of things.  I’ll be right back, okay?

MR L: You’re the doctor.  (This is the octogenarian equivalent of “whatever”)

 In the lobby I am directed to Mrs. Larson, a blond, athletic seventy-ish woman who is sitting in a sunny corner of the waiting room reading an Andrew Weil book. She is used to talking to doctors on behalf of her husband and in less than a minute I have a working knowledge of Mr. Larson’s health history and some unexpected historical information. 

   Although the details of his 2006 heart attack are obscured by the disease that tangles his memory, he is remarkably clear about the 1970’s.  For the twenty minutes it takes to emulsify his cataract and replace it with a clear, synthetic lens, Mr. Larson engages the OR team with story after story of the decade when he was the CEO of a well-known record label.

   I don’t give him much sedation that day. He doesn’t need it. Instead I sit beside the operating table, hold his hand and witness the recounting of a remarkable life.