“I Feel Great at 98” When is too old—too old for surgery?

“Wisdom is with the aged, and understanding in length of days” (Job 12:12)

Ms. AC is an elderly lady who says to me at her last office visit one week before I retire from practicing medicine, “I Feel Great at 98.” These words describe her journey from being in a wheel chair with excruciating hip pain to being symptom free and walking with minimal support of a cane.  It had been eleven months since she had her right hip replaced because of severe arthritis.  

When I met Ms. AC, one year before her surgery, she had just moved to Atlanta from Florida to be with her daughters. Although she had asthma and hypertension, she was a vibrant 97-year-old who walked on a treadmill 2 to 3 times a week!  However, after a few months in Atlanta, she began having pain in the right hip. The severity of the pain stopped her from exercising and even walking.  Before long, her visits to the office were made in a wheelchair. The vivid expressions of pain and duress on her face were not eased with neither pain medication or anti-inflammatory pills.

Then, Ms. AC sees an orthopedic specialist who recommends surgery to replace the hip. She accepts this option without hesitation. I explained to her that (at her age) there was more of a chance that surgery could impair her memory, cause a heart attack, stroke, or even death.  None of this mattered to her—explaining that the pain was too much for her to bear. 

So, she was referred to cardiology and pulmonary specialists for surgical clearance. Then, she was admitted to the hospital to have the right hip replaced. She had an uncomplicated two-day hospital stay and was then discharged to a rehabilitation center for physical therapy. After being there only one day, she developed right arm weakness and garbled speech.  Hearing this outcome, I imagined that things were happening just as I had expected. However, further testing and evaluation by the neurologist did not confirm a stroke. Her symptoms were caused by too much pain medications. When the medication was discontinued her symptoms resolved. She continued to recover and receive physical therapy with complete resolution of the hip pain.

Before surgery, Ms. AC was in severe pain. She made a courageous decision to proceed with hip surgery notwithstanding the evidence that surgery at her age is more likely to result in complications including death.  To my astonishment, Ms. AC had a complete recovery exceeding my expectations.

When is too old—too old for surgery? I’m not sure but when there is a willing patient, skillful surgeon, optimal physical therapy, and advanced medical technology, age was not the deterring factor for this patient. 

As I walked with Ms. AC to the waiting room area, I thanked her for the privilege of caring for her.  Since I would be retiring in one week, I felt extra privileged to hear her say, “I feel great at 98!” Indeed, she is experiencing value-based living.