The One Percent

 

As physicians, we have always been taught to follow guidelines. Weigh the risks against the benefits. Always be evidence-based. We are told that the complication rate is low. One percent. Sometimes even lower. It’s the kind of number that helps us sleep at night. We tell ourselves, “Most patients do fine. Most bounce back.” And they usually do.

Until one of them doesn’t.

And suddenly, that 1% stops being a statistic. It becomes a person. A patient whose name you remember. A woman who was stable, pain-free, and smiling when you last saw her. A patient you had tried to prepare for a procedure meant to help her, not take her away from this world forever. 

She had an NSTEMI five days ago. Her troponin shot up from 500 to over 40,000. Her ECG showed dynamic changes. We stabilized her. Started guideline-directed therapy. She improved. We recommended PCI early on, but consent took time. So did logistics. And money. The usual constraints. She was finally sent to the cath lab yesterday. The interventional cardiologist's hands were competent and steady and I know I can trust her with even my own life.

Her coronary angiogram showed three-vessel disease. Diffuse atherosclerosis, with eight separate lesions that looked amenable to stenting. CABG would have been ideal, but the patient had made it very clear from the start: no open-heart surgery. It wasn’t an option she would ever consider. So when the family saw the angiogram, they agreed to proceed with PCI.

But even before the first balloon could be inflated, she suddenly went into ventricular tachycardia. It rapidly degenerated to asystole. They tried to revive her. They couldn’t bring her back.

I wasn’t there when it happened. I was in clinic, seeing other patients. So when the resident called me that she arrested and they were currently in the middle of ACLS that has extended for almost an hour already, I was stunned. What did I do wrong? I followed the guidelines. Why did she die instead?

That’s the thought that keeps looping in my head. She was stable. Pain-free. Talking. Breathing better. Eating. She asked when she could go home.

You think of all the things you could have done differently, even when you know, clinically, you did the right thing. You followed the guidelines. You prepared her as best as you could. You didn’t delay, although the system did. But it doesn’t stop the ache.

Because we live in probabilities, but we grieve in absolutes. And no matter how rare the complication is, 1%, 0.1%, 0.01%, someone still ends up being that one. And this time, it was her.

Right after clinic, I went straight to her family. What I saw broke my heart. Her two granddaughters were sprawled on the hospital floor, crying like children in the middle of a tantrum. One of them was pounding her fists. The other couldn’t catch her breath. Her son just sat there, staring into space, stunned, unmoving.The first word he asked me was: “Why?”

And I told him, as honestly as I could: “I’m so sorry. I thought she would be fine too.” I stood there quietly. Sometimes answering their questions. But mostly, just quietly. Because sometimes there are no explanations, no right words. Just presence. Just grief, shared in silence.

Sometimes I wonder if God picks His 1% with care. Not randomly, not to punish, but for a reason we won’t understand just yet. I have to believe that. Otherwise, this would all feel unbearable.

Because here’s what no one really prepares you for: Medicine will teach you guidelines and protocols. But it will also confront you with mystery, with things you can’t predict, can’t control, can’t fix. And somewhere in that tension, between evidence and surrender, we do our best to carry on.

We do what we can. We show up. We care. We remember their names.

And we try again the next day, knowing full well we’ll never know who the next 1% will be.

Doctors are not gods. And while I do my very best for every patient, I know I have a God who knows better than I do. Whose plans I may not always understand, but whose grace I choose to trust anyway.