What Dr. Luke has to Say About Evaluation Before Surgery

Zhang Hua Xia was 56 years old and was scheduled to have surgery next week.  He was to have his gall bladder removed as it was causing him a lot of pain and not working well.  He had agreed with the surgeon that he needed to have the surgery.  Today he was to go to the hospital to discuss with the doctor the surgery and any complications he might have from the surgery. While at the hospital the doctor asked him many questions about his past medical history.  The doctor asked him if he had ever had heart or lung problems. Zhang Hua Xia told him that he did smoke and had done so for 20 or years.  He also told the doctor that occasionally when he walked he had some mild chest discomfort and shortness of breath. The doctor ordered an EKG and the results showed that there were some very small abnormalities on the EKG.  The doctor asked Zhang Hua Xia to go and see a cardiologist that day.

The cardiologist ordered some other tests after talking with and examining the patient.  Then the cardiologist talked to Zhang Hua Xia about the operation.  He told him that it would be important to cancel the operation as he might have some heart problems, which could cause serious problems while in the operation.  The cardiologist called the surgeon and relayed the information to him and the surgery was canceled.

The next day Zhang Hua Xia had another test, which showed that he indeed did have very serious heart disease.  The cardiologist told Zhang Hua Xia that he was very glad the surgery was postponed as he could have died within the surgery from his heart disease.  A surgery was done to fix the heart problem and then one month later the gall bladder surgery was done, this time with very little risk to the heart.  The gall bladder surgery went very well.

After the gall bladder surgery Zhang Hua Xia returned to the cardiologist for a follow up.  There he asked the cardiologist many questions about evaluating a patient before surgery.  He was certainly glad he did not have the surgery until he was fully evaluated.  He asked the cardiologist how he knew to test him for any heart problems.  The cardiologist told him those women under 50 years of age and men under 40 years of age generally have very little risk of having heart problems during surgery. However, those women over 50 years of age and men over 40 years of age more often that not can have heart problems during surgery.  The cardiologist also told him that people who smoke a lot or have a history of a lot of bleeding are at risk of having complications during surgery.  These patients should have special evaluation before surgery to fully understand their problems.

Men over 40 years of age and women over 50 years of age should have an EKG done before surgery.  If these are normal and the history of the patient and the physical exam of the patient are normal then further testing of the patient will not be helpful to find out if the patient has underlying heart problems.

Zhang Hua Xia wanted to know how common it was for patients to have heart problems while in surgery.  The cardiologist told him that probably millions of patients in surgery each year have some type of heart complication.  However, probably only a 100,000 to a few hundred thousand have a heart attack during surgery.  If a patient has no underlying heart disease, then the chance of them having a heart attack is less than 0.5%.

Then Zhang Hua Xia asked how you could know if a patient had heart problems before surgery so they would not go to surgery?  What gave the doctor a clue, like on his test result to halt the surgery?  The cardiologist told Zhang Hua Xia the following points were important:  1. A prior history of having a heart attack would require special investigation; 2. An EKG which was abnormal; like Zhang Hua Xia's; 3. Other heart tests which were abnormal; 4. Chest Pain, like Zhang Hua Xia had and 5. Obstruction of arteries in the legs.  If a person has any of these five then they should not have surgery until they have been fully evaluated to see the extent of the underlying heart disease.

The cardiologist emphasized that it is important to realize that during surgery a patient's heart is put under more stress and that is why more patients have heart problems during surgery.  Thus the need for more careful evaluation before surgery to pick up problems early.

The cardiologist told Zhang Hua Xia the story of a man who went to surgery without proper evaluation of his heart.  The man was 62 years old.  During the surgery the man had a heart attack and died.  The cardiologist told Zhang Hua Xia that more than likely the problem was completely preventable.

The doctor told Zhang Hua Xia about another type of heart sickness, that is one, which is caused, by another type of heart sickness not due to heart disease but due to sin.  This causes a permanent type of death towards God.  This interested Zhang Hua Xia and he asked more questions.  How is this type of heart sickness caused?  The doctor showed him in the Bible the following, 'See to it brothers, that none of you has a sinful, unbelieving heart that turns away from the living God.  But encourage one another daily as long as it is called Today, so that none of you may be hardened by sin's deceitfulness.  We have some to share in Christ if we hold firmly till the end the confidence we had at first.  As has just been said:  'Today, if you hear his voice, do not harden your hearts, as you did in the rebellion (Hebrews 3.12-15).'

The doctor told Zhang Hua Xia that this showed that if we have sinful unbelieving hearts we would turn away from the living God.  Zhang Hua Xia was interested that God was called a living God.  Also that unbelief would turn him away from God.  He asked the doctor what sin was and the doctor told him that sin was simply going against what God had for us to do.  That is we miss the mark of God's purposes and plans for us.

The doctor went onto to show Zhang Hua Xia that all people did this, that is went against God.  He showed him the following place in the Bible written about 65AD to the people in the city of Rome.  This verse said, 'For all have sinned and fallen short of the glory of God (Romans 3.23).'  Then the doctor showed Zhang Hua Xia the results of the sin or going against God.  Those results were also mentioned in the same book written to the people in Rome.  It said, 'for the wages of sin is death but the gift of God is eternal life through Jesus Christ our Lord (Romans 6.23).'  The doctor went explained to Zhang Hua Xia that when we sin we get a wage or payment just like anyone does for their work.  However, the payment for sin is death.  Spiritual death now and eternal death after we die.  The doctor also showed that God gives us a gift, which is eternal life through Jesus Christ.  Thus there is an option.

Zhang Hua Xia wanted to know how he could have this eternal life through Jesus Christ?  The doctor told him that to have this eternal life we must come to have a personal relationship with Jesus Christ by putting our trust in him.  However, before talking about this Dr. Luke would like to finish talking about other aspects of evaluating a patient before surgery.

Not only heart patients but also other types of patients need evaluation before surgery to avoid complications during surgery.  Such patients include patients with lung problems, diabetic patients, patients with liver problems, patients with hypertension, kidney and even very old patients who have memory problems.  These patients all should have careful evaluation before surgery to make sure they do not have problems, which can cause them to have complications within surgery.

The doctor mentioned two examples of patients to Zhang Hua Xia. The first is a patient with diabetes.  If the person's blood sugar is too high before, during and/or after the surgery the patient can have problems with the surgery and it or the results of the surgery may not go well.  The same with high blood pressure.  Those patients if their blood pressure is too high can have problems with strokes and heart attacks during surgery.  Thus, if the blood sugar is too high or the blood pressure is too high then the patient's surgery should be canceled until either is under control.  It is better to be safe than the patient have some side effects during surgery and the surgery not go well or worse yet the patient would die in surgery from a complication of the blood sugar being too high or the blood pressure being too high.

The doctor told Zhang Hua Xia of a patient whose blood pressure became too high during surgery and they had a stroke and died several days later.  This is certainly a preventable tragedy. Thus it is important for any patient going to surgery to have careful evaluation before going to surgery. In the same way it is important it is for each of us to evaluate ourselves carefully before God in regards to our sins.  The doctor showed Zhang Hua Xia another place in the Bible which said, 'for God so loved the world that he gave his only begotten Son, that whoever believed in him should not perish but have everlasting life.  For God did not send his Son into the world to condemn the world but that through him the world would be saved.  He that believes is not condemned but he that does not believe is condemned already (John 3.16,17).'  This verse shows us that God loves us a lot.   So much that he sent his only Son to die for us so that we could have everlasting life.  However, if we do not believe in Jesus Christ we are condemned for this lack of belief.

However, as Zhang Hua Xia had asked before, how can we come to know this person Jesus Christ?  The doctor mentioned that it is through believing in Jesus Christ as our personal savior.  We must first believe that we have done wrong before God, which is called sin.  It is this sin which separates us from God.  We must also realize that we are powerless to save ourselves.  The Bible states it like this, 'as for you, you were dead in your transgressions and sins in which you used to live when you followed the ways of this world and of the ruler of the kingdom of the air, the spirit who is now at work in those who are disobedient (Ephesians 2.1-2).'  We must come to see that our 'sins' leave us dead before God.  That is we are totally incapable of responding to him.  The Bible goes on to say, 'like the rest we were by nature objects of wrath (Ephesians 2.3b).'  The results of our sin is not only deadness before God but God's wrath to us because he is right and true and we have defiled that rightness and truth and thus are deserving of God's wrath.

God's solution to our sin and his wrath to us is mentioned in the following place in the Bible, 'But because of his great love for us, God, who is rich in mercy, made us alive with Christ even when we were dead in transgressions-it is by grace you have been saved (Ephesians 2.4,5).' God showed us his love and made us alive with Christ, even when we were dead.  Grace is the reason God loves us. Grace is God's unmerited favor towards us.  We did not deserve it but God gave it to us.  Who took God's wrath for our sins?  Jesus Christ did when he died on the Cross.

The Bible again in the book to Rome says, 'if you confess with your mouth the Lord Jesus and believe in your heart that God raised him from the dead you will be saved, for it is with the heart that you confess and are saved and it is with the heart that you believe and are justified (Romans 10.9,10).'  This is how we have God's eternal life.  That is if we say with our mouths that Jesus Christ is Lord, that is we believe he created and is Lord over the world and everything in it and also that because he died on the Cross for our sins, he is our Lord.  Then if we say that we believe that after he died on the Cross-he was buried and three days later he rose from the dead, we will be saved from our sins and be allowed to have eternal life with Jesus Christ.

The doctor asked Zhang Hua Xia if he wanted to have this life which can change his heart forever.  Zhang Hua Xia did want this new life.  They prayed the following prayer.  'Dear Lord, I know that I am a sinner and have sinned before you.  I know that this sin has separated me from you.  I believe that you died on the Cross-to take my sin so I would not have to bear it and its consequences.  I believe that after you died on the Cross-for me you were buried and three days later rose from the dead and are alive today.  I ask you to come into my life and give me a new life.'  Zhang Hua Xia prayed this prayer and gained new life in Jesus Christ.  If you pray this prayer and believe it you too will have new life in Jesus Christ.