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Education  |   April 2015
The ASA 4 Patient at the VA Hospital
Author Affiliations & Notes
  • Audrey Shafer, M.D.
    From the Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, Palo Alto, California. ashafer@stanford.edu
  • Accepted for publication May 30, 2014.
    Accepted for publication May 30, 2014.×
Article Information
Education / Mind to Mind / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Gastrointestinal and Hepatic Systems / Geriatric Anesthesia / Respiratory System
Education   |   April 2015
The ASA 4 Patient at the VA Hospital
Anesthesiology 4 2015, Vol.122, 950-951. doi:10.1097/ALN.0000000000000347
Anesthesiology 4 2015, Vol.122, 950-951. doi:10.1097/ALN.0000000000000347
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Dread is the pile of stones I carry in my chest

each diseased organ, each hardened vessel

a stone in the sepulcher

his heart sags large and tired

tar flecks his lungs

his gangrenous toe a granite shim

wedged into the growing pyramid

numbers thump like a mason’s hammer

91, 2.1, 29, 30

the cairn demands more stones

hepatitis, stroke

early dementia seeps

like concrete poured into crevices

dread: the pile of stones I carry in my chest

his aging wife, a tiny bird, flutters about him

she primps his pillow, knows to not ask questions

my patient cracks a joke

he’s made me smile

I push him on his gurney

and for a brief shining moment

before we enter the operating room

we disappear at the turn

into the glare of the morning sun

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