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Introduction

In 2004, I was a colorectal fellow at Cleveland Clinic, in my final year of medical training. The institution had one of the preeminent colorectal programs in the world—and still does. It had among the highest case volumes in the world, as well as several leading colorectal surgeons, including department chairman Victor W. Fazio, a world-renowned, pioneering colorectal surgeon considered by many to be one of the grand masters in the field. Training under Fazio would not only mold me into a great surgeon; it would virtually guarantee an exceptional career. The day I was accepted into the fellowship program, I was ecstatic, knowing that I was joining one of the best programs in the world, if not the best. All of my hard work and sacrifice from years of training had paid off.

Six months into my fellowship, my 77-year-old father noticed blood in his urine. He was quite healthy, save for minor high blood pressure. He had an office cystoscopy, which confirmed multiple lesions in his bladder. At first, Dad did not want to come to Cleveland Clinic, preferring to be treated at a community hospital closer to home. I was insistent that he be treated at Cleveland Clinic, for several reasons. We had a world reputation as a top hospital and had the number two–ranked U.S. urology program. More important, consistent with Cleveland Clinic’s reputation for clinical innovation, we were providing minimally invasive urological surgery, clearly preferable for a 77-year-old.

Dad was admitted to the hospital on December 15 for a biopsy, to be discharged later the same day. His biopsy evolved into the removal of the lesions, as they were thought to be superficial—good news, because this would prevent a more invasive bladder resection. The procedure generally went as planned; however, Dad’s abdomen was distended afterward, necessitating a small incision in it to ensure that his bladder had not been perforated. This complication required him to stay in the hospital for observation. I went to the postanesthesia care unit shortly after his surgery. He was still not quite recovered, but he opened his eyes when I touched him. He was having some difficulty breathing and still had an oxygen mask on his face. He pulled the mask down, and I reassured him that everything was OK. He looked at me and asked, “Am I going to die?”

My father’s stay in the hospital was rocky. He was admitted to one of the surgery floors and suffered continuous respiratory problems, requiring supplemental oxygen and respiratory treatments. He developed an ileus, where his bowels were not functioning, and required a nasogastric tube, which is placed through the nose into the stomach to decompress air and remove fluid. I walked into my father’s room as one of the staff colorectal surgeons was placing the nasogastric tube. I had performed this procedure hundreds of times on patients, but I had never seen it ...

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