Over a span of several years, Roger Bone, MD, a pulmonologist, gave us a running commentary on his fight with Cancer in his “As I lay Dying” articles. Now another world renowned pulmonologist, Thomas Petty, MD, gives us an account of his personal brush with death. I met Professor Petty as a fellow in 1969 when I attended his innovative respiratory care course in Denver. (He was one of the pioneers who established that it was safe for trained respiratory therapists and nurses to do radial artery punctures, a procedure we implemented the following year in this community.) Twenty years later when he gave the respiration seminar in Monterey, he was still the picture of health. Then, in 1992, he had an emergent coronary bypass. In a recent issue of Internal Medicine, he tells of his experience in 1998 with mitral valve surgery; he was developing pulmonary hypertension (PAP 75/35) with reversal of blood flow. He elicited a promise from his pulmonologist not to use paralytic or sedating agents as he was adjusting to the mechanical ventilator postoperatively. “If I get into trouble, I want to know what’s going on. If I’m dying, I want to experience it.” He had taken a powerful antioxidant preoperatively, against doctor’s orders, as a defense against acute lung injury or respiratory distress syndrome (ARDS). Postoperatively, he was extubated, felt nauseated, had emesis, with a blood pressure drop to 50/palp. When he saw the 20 second run of ventricular tachycardia, with the defibrillator being rolled in, he felt like he was in a whirlpool going down a drain feet first. By morning, after circulatory resuscitation, his pressure was restored. He never fully lost consciousness. He also had a 27-pound weight gain. Louise, his respiratory nurse clinical specialist in Denver in 1969, was at his bedside. The following morning he walked. By the fourth day his oxygen saturation was up to 85% off oxygen (normal 97%). Although he had to recover from multi-organ damage, he did not experience ARDS. In a month he was back at work full time; in two months he was on his annual fishing holiday. Petty wonders why his life was spared. “Maybe God was trying to give me a wake-up call. Confronting one’s mortality is not a pleasant experience…. I was lucky enough to be sent back from the brink–and I plan to do something very special in the new time granted me.”

The Bulletin of the San Bernardino Medical Society devoted a recent issue to “Live & Then Give,” encouraging members to become involved in organ and tissue donation. Every 16 minutes a name is added to the 64,500 people on the National Organ Transplant waiting list. Each day, 11 people die while waiting for an organ that didn’t come through. President Victor Ching, MD, suggests that the solution begins with you and me. To be a donor, it is essential to let your wishes be known, preferably to a family member. It is a simple matter — Share Your Life, Share Your Decision. If you haven’t told your family that you are an organ and tissue donor, then you are not.

William Olson, MD, President of the Kern County Medical Society, tells us in his presidential message that some physicians have always believed they practice quality medicine. Few are convinced that the HMO efforts to measure immunization rates, mammograms and Pap smears are equivalent to quality. “We all know [physicians] who may do well on one or several of these statistical measurements, yet can’t diagnose or treat his/her way out of a wet paper bag!” But he warns his society members that only the ostriches among us expect that these measurements will soon disappear. “Quality measurement” is an industry coming of age and will continue during our professional lives. The health of an individual will continue to be the single most important factor and the prime source of satisfaction to us as physicians. Although we may laugh at Dilbert and his view of “organization” and “process,” understanding organization and process is the key to improving quality. Olson feels that lamenting how a health plan is “making my life miserable with inaccurate data” or “beating me with their miserable requirements” is victimhood and an effort to point the finger at someone else. As we resume leadership in medicine, physicians must define quality with data. We must be responsible for legitimate versus illegitimate data. For a taste of the future, log on to “healthcarereportcards.com.”