Surviving Aortic Dissection Redefines a Surgeon’s Perspective

It was 2:00 am when jet lag finally loosened its grip on my body and tightened its hold on my mind.

The house was still, wrapped in the peculiar hush that settles just before dawn. My family slept. Yet in the silence, memory refused rest.

The past month replayed itself in fragments—images, sounds, and sensations that still felt borrowed from another life. A family vacation had quietly transformed into a lesson on vulnerability, surrender, faith, and grace.

As surgeons, we live in timelines measured by minutes and margins. We calculate ischemia times, blood loss, operative windows. We speak in probabilities and contingencies. Rarely do we examine the fragility of the body we inhabit ourselves. When that illusion fractures, it does so without ceremony.

Memorial Day, May 26, 2025, was only the second morning of our stay in Seattle, Washington. The night before had been unremarkable in the way vacations often begin: brief shopping for necessities, an early dinner to recover from travel fatigue, a walk through a nearby park while the light lingered longer than it did back home. Nothing about the evening carried omen or warning. It was a perfectly forgettable happiness.

In the early hours, my wife woke to find me sitting quietly at the edge of the bed. She would later tell me that something in the way I held myself felt wrong—too deliberate, too contained, as though I were bracing against something unseen.

About an hour earlier, she had woken from a vivid, unsettling dream that something terrible had happened to me. Dreams often dissolve in daylight; this one did not.

“Masakit dibdib,” I said simply. My chest hurts.

Like many surgeons, I defaulted to restraint. Observe first. Wait. Do not escalate without proof. I had taken my medications.

However, my Apple Watch could only offer a heart rate, and we did not have a separate blood pressure apparatus where we were staying. My wife woke her brother to drive to the nearest retail pharmacy. While waiting, I retched violently in the bathroom—another warning that my mind acknowledged but did not yet obey.

When the blood pressure apparatus finally arrived, the numbers hovered around 100 to 110 over 70. To most people, this would have been reassuring. To two physicians far from home, it was not. My baseline systolic pressure typically lived in the 130s. Relative hypotension is often how catastrophe introduces itself quietly, before it announces its presence aloud.

Still, I hesitated.

It was only when my wife told me about her dream—when I saw the unguarded fear in her eyes—that something shifted. We locked eyes in a brief, wordless exchange that required no medical vocabulary. I nodded. We agreed to go.

Downstairs, the children were already gathering for breakfast. We kept our voices light. No prolonged explanations. No dramatic embraces. We did not ask them to hug me goodbye. That small omission would later ache with unexpected gravity.

Race Against Time

Urgent care moved quickly. This was not benign chest pain. Coronary angiography at the community hospital showed clean vessels. And then, a transesophageal echocardiogram revealed the real diagnosis: an acute ascending aortic dissection (Stanford Type A). The hospital was not equipped to manage it. I was to be airlifted to a tertiary center.

The choreography of emergency medicine unfolded with both precision and fragility. The helicopter landed on a grassy field. The stretcher could not roll on grass. It had to be exchanged. The replacement stretcher was incompatible with the aircraft. It, too, had to be exchanged.

Somewhere in that urgent ballet of logistics and human hands, my heart ceased to generate a pulse. Pulseless electrical activity. There were 6 to 12 minutes of resuscitation before circulation returned.

I have no memory of that moment. My wife does.

She remembers the convergence of flashing lights and rushing bodies. She remembers recognizing the gravity of the scene without needing anyone to articulate it. She remembers introducing herself as a physician and watching colleagues measure their words carefully—truthful but merciful, precise but gentle. She remembers waiting, hour after suspended hour, as the world narrowed to a single unanswered question.

She also remembers something else: an almost irrational voice inside her that whispered, persistently, He will be okay. Against everything her training had taught her about probabilities and physiologic reserve, that voice refused to recede. It became her anchor.

At the receiving hospital, I underwent an emergency Bio-Bentall procedure. The hospital staff later told my wife we were fortunate that the appropriate surgeon was on call—this pathology was his specialty. A fellow would later describe the operative field to me: blood everywhere, the aorta held together by little more than its outermost layer. A few more minutes, perhaps, and there would have been nothing left to repair.

Seventeen hours after I had first sat silently on the edge of the bed, I emerged from surgery alive.

The Moment I Opened My Eyes

Survival, however, is not synonymous with recovery. I remained intubated and unconscious.

Days passed without discernable milestones. My kidneys failed; creatinine climbed into the double digits. Dialysis was discussed. Instead, aggressive diuresis was attempted. Over the course of 10 hours, nearly 12 liters of urine poured forth—a physiologic reprieve that felt less like science and more like mercy. Rehabilitation began early. Filipino nurses recognized my accent and offered small pieces of home in a foreign hospital.

Yet, the hardest stretch belonged not to me, but to my wife. For 5 days, she did not know whether I would awaken, when I might awaken, or who I might be if I did. Would she need to remain abroad indefinitely? How would she bring me home? What if I never opened my eyes? Each day, she leaned close and whispered for me to come back—to her, to our children—without knowing whether her words reached anything beyond silence.

When I finally opened my eyes, her relief was indescribable.

Recovery outside the ICU carried its own quieter humiliations. Within a day of discharge, I developed urinary retention. We briefly joked about inserting a Foley catheter ourselves—two physicians navigating foreign healthcare—until we remembered that prescriptions still governed improvisation. At 3:00 am, my brother-in-law drove us back to urgent care. Mid-interview, the attending paused.

“Aren’t you the Filipino transplant surgeon who was here weeks ago?” she asked. Turning to my wife, “And you’re the plastic surgeon?”

We smiled, surprised by the recognition.

She asked permission to tell her colleagues outside that I was alive.

Professional Solidarity

Medicine contains these small, luminous moments of kinship—fleeting acknowledgments that beneath credentials and specialties, we are simply human beings caring for one another in moments of vulnerability.

Constipation followed. Abdominal pain. Recurrent ER visits. Readmission coincided with my wife’s 50th birthday, quietly spent under hospital lights.

Eventually, equilibrium returned. My surgeon asked only two things when we parted: to send periodic surveillance scans and a photograph when I returned to the OR. I later sent him images from my first kidney and liver transplants after recovery. His reply was brief and generous: welcome back.

On the day of our flight home, one final irony arrived. A dull ache emerged in my right lower abdomen. I recalled a small renal stone incidentally noted on imaging. While waiting for lunch, the urge to urinate came suddenly. In the restroom, I felt the unmistakable scrape of stone against urethra until it audibly bounced into the urinal. Relief was immediate. Timing, impeccable.

Only medicine permits such endings.

Surgeons inhabit a culture of control. We make irreversible decisions under pressure. We accept responsibility for outcomes that echo long after the OR lights dim. We rarely occupy the opposite side of the bed. Becoming a patient dismantles illusion quickly. The body does not defer to expertise. Time stretches and contracts unpredictably. Systems reveal themselves not as abstractions, but as lifelines. Family becomes the true intensive care unit.

More than anything, this experience reshaped my understanding of professional solidarity. At every threshold, I was carried by colleagues whose names I may never fully know, but whose hands preserved my life: urgent care physicians recognized danger, cardiologists excluded one diagnosis while uncovering another, anesthesiologists stabilized chaos, cardiothoracic surgeons repaired what minutes earlier had nearly ruptured, intensivists navigated organ failure, nurses measured outputs through long nights, therapists coaxed motion back into stiffened limbs.

A surgeon survived because other surgeons, and the systems they sustain functioned when seconds mattered.

Returning to the OR weeks later felt different. The instruments were the same. The choreography was familiar. Yet something inside me had softened and sharpened simultaneously. Every pulse felt less theoretical. Every consent conversation carried new gravity. Every family waiting outside a recovery room felt closer than before. The distance between physician and patient had narrowed permanently.

My wife still speaks of the voice that sustained her during the darkest hours: He will be okay. Against every algorithm and probability, that voice proved correct. Faith, she says, was not denial of risk—it was endurance inside uncertainty. It was choosing to stand steady while the future remained unreadable.

Two months later, scars remain. Surveillance continues. Fatigue lingers. Yet gratitude now accompanies routine. Perspective now shadows confidence. Humility now steadies ambition.

We spend our lives trying to save others. Occasionally, we are granted the rare education of learning what it means to be saved ourselves.

Disclaimer

The thoughts and opinions expressed in this article are solely those of the author and do not necessarily reflect those of the ACS.

Dr. Siegfredo Paloyo is an associate professor at the University of the Philippines College of Medicine in Manila and a transplant surgeon with clinical and academic involvement in liver and kidney transplantation, surgical education, and health systems development. He is actively engaged in building multidisciplinary transplant programs and mentoring surgical trainees.