By now, most of the world knows Neil Armstrong died of "complications of a cardiovascular procedure" but few know why. Death, especially sudden, unexpected death, leaves few tell-tale signs of "why."
For families who are grieving over the loss of their loved one, there is a certain futility in asking "why." But for the doctors who cared for Neil, the quest for knowing will haunt them.
No doctor wants to make a mistake. Teams of people work tirelessly to try to avoid every possible adverse outcome that could come to their patients: internists, surgeons, anesthesiologists, perfusionists, scrub techs, circulating nurses, intensivists, radiology and lab personnel, med students, residents, chaplains, and cleaning crews. Regulation on top of regulation, records on top of electronic records, meeting after meeting are structured to avoid the unexpected, the unwanted, the unnecessary. No one wants the patient to die. No one wants the "complication." No one.
And yet, they come.
From the most obvious culprit, a cardiac rhythm disturbance like heart block, Torsades, or ventricular fibrillation, to something as tiny as a stitch gone wrong, people die. Maybe it was a blood clot, unexpected in a time of dysfunctional platelets post-bypass, maybe not. Maybe it was the wrong drug, maybe not. Maybe the death could have been avoided, maybe not. Add a wordly icon to the mix and you can bet your bottom dollar, secretly everyone wants to know.
When we stop to explore what when wrong, we learn. For physicians, there is healing, too. To know that it wasn't the stitch, the medication, or the clot is just as important to the responsible doctor (maybe more so) as finding the ultimate cause of death. But increasingly, the pressures of the job leave little time or money for such self reflection. Time is precious these days and the pressure to produce immense. Still, for doctors of today and tomorrow, we must continue to make this retrospective exploration a priority.
I have no idea if the team that cared for Neil really knows why he died since I was not involved in his care. It doesn't take rocket science to assume someone who had recent heart surgery might have died of a "cardiovascular cause." But for one of the world's most iconic explorers (not to mention ourselves) we should never stop trying to find out why.