My brother Michael was 42 when he died from an undiagnosed dissecting aortic aneurysm. Prior to his sudden death, Michael was an executive for Wells Fargo overseeing 30 people and had recently returned from a golf vacation in Ireland.
When many people think back to August 2005, they will remember it as the time when New Orleans was battered by Hurricane Katrina. For me, it is the month that my 42-year-old brother Michael died unexpectedly from a dissecting aortic aneurysm. Five years later, I still struggle as a grieving sister — and as a health care researcher — to understand why his death wasn’t prevented.
Googling “dissecting aortic aneurysm” will take you to the Wikipedia definition of an aortic dissection. It is a tear in the wall of the aorta that causes blood to flow between the layers of the wall of the aorta and force the layers apart. If the dissection tears the aorta completely open (through all three layers), massive and rapid blood loss occurs. The mortality rate for patients who do not receive treatment for aortic dissection within two weeks is greater than 75 percent. This is what happened to my brother sometime on the afternoon of Aug. 13, 2005, when he died alone in his house, despite seeking medical treatment.
Aortic dissection strikes approximately 10,000 Americans a year. Although this number seems relatively low compared to the annual number of heart attacks, the condition is common enough that many people have heard of someone who has died from an aortic dissection, including comedian John Ritter. When I returned to work after Michael’s funeral, a colleague told me of his nephew who died of an aortic dissection. He was in the hospital with chest pain for several days before a physician diagnosed him, and, by then, surgery was not able to save him.
Was there anything the health care system could have done to save my brother? Two weeks prior to his death, Michael traveled to Ireland for a golfing vacation with friends. None of these friends were extremely close, so they likely didn’t notice that Michael was experiencing swelling around his entire body. It was a fact that my father immediately spotted when someone showed him pictures from the vacation as we were waiting to hear the coroner’s report. The swelling was an early indicator that Michael’s circulatory system was failing to clear fluids from his body. After he came home, Michael started feeling extremely ill. His wife took him to a general practitioner in Beverly Hills, Calif., where he complained of swelling and excruciating chest pain that radiated to his back. The pain shooting to his back should have been the first warning sign. In fact, one of Michael’s two closest friends is a trained paramedic who would routinely rush patients to the emergency room for the same complaint.
From prior experience, Michael’s friend knew that chest pain radiating to the back is a common sign of aortic dissection. Yet the physician missed this. He took an X-ray of Michael’s chest and explained that he couldn’t see anything wrong. But the doctor couldn’t quite get a clear picture, because Michael’s heart was in a different position from normal. The physician told Michael that his swelling was likely due to an allergic reaction from take-out food he ate earlier that day. He recommended some antihistamines, and then suggested that Michael see a cardiologist at some point to have the heart condition checked on. The physician decided that the heart condition was unrelated to Michael’s current pain and didn’t necessarily require same-day treatment.
After Michael’s funeral, I met with a colleague and close friend who is a nationally known cardiovascular researcher and physician at Baylor College of Medicine and the Houston VA. When I told her what had transpired during Michael’s doctor visit, her eyes widened in shock. My colleague told me that the heart’s position was yet another clear indicator that Michael was in trouble. The heart had been pushed out of position by Michael’s deteriorating aorta. My colleague might not have diagnosed Michael correctly on the spot, but she would certainly have sent him to an emergency room for immediate testing.
The questions still haunt me. Why didn’t the physician recognize that chest pain radiating to the back is an indicator for aortic dissection? With the additional evidence from the X-ray, why didn’t the physician recommend that Michael go to a hospital immediately? Why didn’t my brother notice that the swelling had begun much earlier, so that it was not likely due to an allergic reaction? Given that my brother was still on vacation from work, why didn’t he take the extra time to go to a hospital for further testing? If only he had been back from his vacation long enough to speak with his close friend with paramedic experience, or to visit with my parents, who would have noticed the marked change in his appearance.
Other than better luck and improved physician awareness of the symptoms of this condition, what might help people with an aortic dissection avoid my brother’s fate in the future?
If Michael had checked his symptoms on the Internet first, perhaps he would have been alerted to the mortal danger that he faced. To this day, if one enters “chest pain and swelling” or “chest pain to the back” on Google, one does not find immediate information on aortic dissection. With a bit of clicking, one can get to a symptom checker on the Mayo Clinic website that tells you that “tearing or ripping” chest pain is a potential indicator of aortic dissection. This symptom checker has improved since 2005, but Internet resources need further improvement in accessibility, thoroughness and accuracy before they can be of help to people like my brother.
The lesson that I learned from this sad experience is that my own previous inclination to seek care from physicians affiliated with a medical school is correct. In my experience, physicians at medical schools are by nature more interested in research. Their teaching pushes them to maintain a broad knowledge of patient care, and they follow current research more closely than community doctors.
In general, I am surprised that the American public maintains such high trust in our health care system, despite widely publicized information on the wide rate of medical errors that persist in health care. The federal government is taking some steps in the right direction to improve the quality of health care, but much stronger demands for improvement by consumers are necessary to transform the system.
Not a day goes by when I don’t think about Michael. Sometimes it’s a song that I hear, or a gift I received from him in my home or office, or the sight of someone with his appearance in a crowd that reminds me of my brother. Even though Michael has been gone for five years, I still expect him to walk through the door at any moment. My family and I miss him dearly. It is my hope that someone who reads this story may be able to warn a friend or relative if they are unfortunate enough to experience the same symptoms as Michael. That is the best memorial that I can offer to my much-loved brother.
Vivian Ho is the James A. Baker III Institute Chair in Health Economics, and she is an associate professor in the department of medicine at Baylor College of Medicine. She is also a professor in the department of economics at Rice University. Ho’s research examines the effects of economic incentives and regulations on the quality and costs of healthcare.