Chapter 1: A Digital Handshake at the Virtual Front Door

A True Story

Bonnie Martin was preparing herself emotionally for widowhood. It was Sunday, August 2, 2015, and Bill, her husband of over 40 years, was going to die. That's not what his doctor said, but it was the truth. Bonnie knew it, and she thought Bill probably knew it, too, though, from the way he was talking and the questions he seemed to make a point of not asking, it was pretty clear to her that he wasn't quite ready to accept it yet, even if she was. Ready to accept the reality of the situation, that is. What she was not ready to accept, even as she was making her own private preparations, was that it had to happen now. And that's why she was on the Internet: she was looking for information, options, answers, and maybe, just maybe, a little hope …

On Cleveland Clinic's website, a little window popped up asking if she would like to "live chat" with a Heart and Vascular Institute nurse. Bonnie decided yes, that was exactly what she wanted to do. During that chat the Cleveland Clinic nurse said something that changed, quite literally, everything, first for her, and eventually for her husband. Even after Bonnie had spent quite a bit of time describing her husband's dire situation, with his many surgeries (including a triple heart bypass) and his extremely complicated medical history—a history that was so complex, in fact, that it had finally caused his doctors at home to say that he was too weak to survive any further interventions, so that all they could do was wait—the Cleveland Clinic nurse typed, "You know, you haven't scared me off yet."

And that, Bonnie remembers, was a very good thing for her to read.

What Bonnie's husband had was an abdominal aortic aneurism, or a "triple A," which meant that, deep inside his body, he had developed a dangerous enlargement in the portion of his aortic artery that extended through his abdomen.¹ The aorta, which is about a foot long and a little more than an inch in diameter,² is the human body's largest and most important single artery; it originates at the heart's left ventricle and runs down near the spine into the abdomen, where it splits into the two smaller common iliac arteries.³ Almost all of Bill's major organs receive their oxygenated blood through his aorta, which also distributes blood to the rest of his body through a process called systemic circulation, which is the constant cycle that pushes oxygen-rich blood out from his heart and returns oxygen-depleted blood back to his lungs.⁴ Like most arteries, Bill's aorta is elastic, which allows it to be filled with blood that is under high pressure. Over time, Bill's aorta had developed an aneurysm, which means that a portion of his arterial wall had become weak, distending ...