Not long ago a 24-year-old woman named Grace Lopat registered for assignment as a substitute teacher in the elementary school system of a small town outside New Haven, Connecticut. Although Grace walks nowadays with a barely perceptible shuffle, in all other ways she presents the perfect image of vibrant good health. It comes as no surprise, for example, to learn that she placed third in a county beauty pageant a few years ago.
Even forewarned with the knowledge that since the age of eight she has required twice-daily insulin injections to control her diabetes, anyone meeting Grace would have good reason to see in her the personification of that idealized image of a past generation’s sketchers and artists, the American Girl. Certainly it is a great deal easier to think of her as a wholesome, smiling beauty contestant than it is to imagine her mottled and swollen, in a delirium of fever and near death, being rapidly wheeled toward an operating room one spring afternoon four years ago. She had been assessed a Class 5 risk for anesthesia, in the opinion of every physician who saw her. To this day, she’s not sure whether to credit her survival to the flabbergasting marvels of modern scientific medicine or the spiritual intervention of her long-dead father, and even a few of her doctors sometimes wonder. Either way, it took a miracle to save her life.
The American Society of Anesthesiologists describes a person in Class 5 as “a moribund patient who is not expected to survive without operation.” No one, doctor or otherwise, seeing Grace Lopat just before those preoperative moments had reason to dispute that description, and most observers would have projected her survival period to be hours rather than days. I was her surgeon, and I’ve now had four years to think about it. I’m absolutely convinced that I have never taken a sicker patient to the operating room, even if I include in my recollections those few who didn’t leave it alive.
