Friday, April 17, 2015

Statistical Semaphores Semantics

Full disclosure disclaimer: in more than eleven years of my career as a college student, the closest I had come to staring at the prospect of a failing grade was in Mathematical Statistics.  Ergo, with the benefit of twenty-twenty hindsight, my disquisition involving matters statistical should be taken with a generous dose of the proverbial grain of salt.
When I was first diagnosed with an acute Abdominal Aortic Aneurysm (AAA, 3A) my reflexive reaction was, “we all got to go sometime, what quicker way to check out of this mortal coil than a ruptured aneurysm?”  But my vascular surgeon had convinced the restless demons of my hubris that passive resignation violated human nature and the instinct to leverage the outcome in the face of uncertainty would be more consistent with the essence of the human soul endowed with a free will.
I of course supplied the metaphysical arguments as an afterthought to justify my willingness to sojourn in the shifting sands of statistical reality that only a pro-active intervention can influence statistical outcomes.  It was sort of the ultimate delicious irony to feel comfortable in the certitude of Heisenberg’s Uncertainty Principle.
Escapade into statistical jargon started with the routine monitoring of the aneurysm’s growth.  It seems axiomatic in the realm of vascular surgery that when the size of the aneurysm is larger than 5.5 cm, the risks of not doing anything far outweighs the risk of intervention.  It is sort of rubbing in the truism that everything in life manifests itself as a calculated risk.
Thus it came to pass that on 8-Jul-2013 through nearly eight hours under general anesthesia, the procedure for Endovascular Aneurysm Repair (EVAR) was successfully completed and I was pronounced safely in the lower-risk zone of the statistical divide.  I remained there for all of three weeks until another roll of the statistical dice mandated otherwise.
On 29-Jul-2013 the Catholic Home Health Care visiting nurse assigned to my case sent me to Stony Brook University Hospital Emergency Room with a body temperature north of 102ºF.  I was forthwith admitted to the ICU (Intensive Care Unit) and stayed there for all of seven weeks, in continuous intravenous antibiotic regimen for an indeterminate acute blood infection  The regimen was punctuated with nocturnal incubation when my body temperature registered in the 104~105 ºF range.
I was then on the cusp of the statistical divide where nobody was certain what was going on.  The floor attending physician pronounced me to have high grade MRSA (Methicillin-Resistant Staphylococcus Aureus), a bacterium that is resistant to many antibiotics.  On the other hand, the consulting infectious diseases specialist insisted I had the Methichillin-Sensitive (MSSA) variant.  Otherwise, there would have been no point in administering any antibiotic regimen.
Eventually, my condition stabilized enough for me to be transferred to St. James Rehabilitation Center with a peripherally inserted central catheter (PICC) line to continue the intravenous antibiotic regimen for another twenty-six more days.  Although being connected to an intravenous line was not my idea of a grand time, I was relieved to be back on the safer-zone side of the statistical divide.
Shortly after being released from the rehab center, I consulted with the vascular surgeon for a comprehensive evaluation and definitive prognosis on the disposition of the EVAR stents.  On 18-Oct-13 the verdict was unqualified success.  A follow-up look was tentatively scheduled for 16-May-14.
Meanwhile, I got engrossed on more esoteric pursuits such as a membership to the community of aspiring poets.  The tentatively scheduled follow-up assessment did not take place until 23~27-Mar-15.
After an ultra sound and a follow-up CT-scan, it has been established that I am showing a type 2 endovascular leak and the aneurysm has continued to grow to put me back on the critical side of the statistical divide.
Reverting to statistical parlance, the literature reveals that 20 to 25% of successful EVAR cases develop endovascular leaks for a variety of causes.  In my case, the vascular surgeon explained, because my liver is only south of 10% functional, I grow collateral vessels enabling retrograde flow into the aneurysm sac to compensate for what the liver cannot adequately supply.
Ergo, since the body attempts to compensate itself, there is no telling how many other collateral vessels would develop to compensate for a successful embolization closure of the extant leaks.  So we are back at the mercy of Heisenberg’s Uncertainty Principle, to wit, in layman’s parlance, we only know that we are moving but not whether we are coming or going.
Or, alternatively, for a more colorful version, we settle for Uncle Omar’s formulation in the Rubaiyat:
The Moving Finger writes; and, having writ, 
Moves on: nor all your Piety nor Wit 
Shall lure it back to cancel half a Line, 
Nor all your Tears wash out a Word of it.

And that inverted Bowl they call the Sky, 
Whereunder crawling coop'd we live and die, 
Lift not your hands to It for help--for It 
As impotently moves as you or I.

1 comment:

  1. Having conceded that much, the coil embolization of the type 2 endovascular leak is firmly scheduled for 23-Apr-2015 at the Mt. Sinai-St. Luke-Roosevelt Hospital in Manhattan. Dr. James McKinsey who is the Vice Chairman and systems Chief of Complex Aortic Intervention is the specialist performing the procedure this facility.