As I walked into the hospital bright and early in the morning, fall seemed to be coming in full swing. The sun had yet to awaken for the day and the overnight chill lingered in the air. I was on my cardiothoracic surgery rotation, and had developed the habit of arriving long before the first case of the day. I liked to take my time in the morning and prepare myself for whatever the day would bring. After changing into surgical scrubs and tucking my belongings into a locker, I walked to the OR where I wrote my name under the “student” section of the whiteboard on the wall and introduced myself to the RNs and scrub techs who were already setting up for the case. I spent the remaining time researching the patient, the diagnosis, and the details of the intended surgery in hopes of being prepared when the surgeon inevitably quizzed me. I learned that the first patient of the day was a 22-year-old woman with relapsed osteosarcoma. She was diagnosed at age 16 years, but she fought her way into a remission that lasted for several years. It wasn't until she presented to the ED with pain and shortness of breath that she was found to have a fast-growing metastasis of her previous cancer taking over her chest cavity.

This woman and her physicians soon discovered that the tumor would not respond to chemotherapy or radiation, and that the final Hail Mary would be surgical resection. This is how she and I found ourselves in the same cold, fluorescent-lit OR that Monday morning in November. In any other setting, we would be considered to be very similar, but the circumstances that led us each to that space at that very moment could not have been more different. As the RN wheeled the patient into the OR and I watched the anesthesiologist preparing to administer anesthesia, I had no idea of the effect this patient would have on me and the way that her story would take up residence in my memory for the next several months. Nothing could have prepared the cardiothoracic team for the 23-hour surgery that they were about to endure. Nothing could have prepared us for the level of infiltration this tumor had achieved. And, despite knowing that this was a last-ditch effort to extend her life, I don't think anything could have prepared the patient for the aftermath of such an extensive surgery.

Opening the chest and exposing the anatomy of interest felt just like it did in every cardiothoracic surgery I had seen before this. But as the case went on, the extent of disease became obvious. We expected a long case from the beginning, but with each passing hour, minimal progress was made in resecting the tumor from the mediastinal structures. Though I had been asked to help in various ways throughout the case, about 8 hours in I was tasked with holding the heart out of the way to provide visualization for the surgeon and the PA to resect parts of the tumor that lay in the posterior chest. Placing my hand directly onto a beating heart was exhilarating. But that feeling was short-lived. I began to feel her heart rate increase there in my hand. I looked up at the monitor on the wall where her vital signs were projected in large font. 110 ... 112 ... 120. I had so many thoughts running through my mind as her heart rate continued to climb. 145 ... 152 ... 168. I looked around the room in a silent plea for someone to tell me that everything was okay, but suddenly her heart began to fibrillate in my palm. Then it stopped. It wasn't the kind of stop where you watch the speedometer in your car decrease as you approach a red light or the heavy strides of a runner slowing down after crossing the finish line. It was sudden, and sucked every bit of noise from the room. After relaying what I felt to the surgeon, time sped back up. The surgeon quickly used the defibrillator to restore a regular rate. Cardiac surgeries have a defibrillator ready for this reason, but this successful resuscitation did not ease my mind. The emotions that flooded my brain as I realized what had happened were deafening. I had just felt a human's heart stop beating in my hand. But not just any human's heart. It was the heart of a 22-year-old woman who had a whole life that was changed by the return of this cancer. A young woman who was supposed to have a whole life left to live. It is so easy to watch an operation in the same way that one would watch a movie. It's easy to separate what we see during a surgery from real human life and tangible consequences. Up until this point, I had been looking forward to learning and helping during the case. I had been caught up in the idea that the surgeons were going to do what chemotherapy and radiation could not. I had been so focused on how interesting this case was that I forgot about the fragility of this young woman's health and the potential that this surgery could be too much for her body to bear.

Leaving the hospital that day, I was faced with the reality that this patient likely wouldn't make it. Even if the surgery provided her with more time, it was unlikely to be much. The age of this woman was the only thought I had. Twenty-two. Just three years younger than me, yet our futures were so different. Thoughts of who this patient was and who she wanted to be had consumed my whole drive home. I thought of all the things that I was looking forward to at 22: a concert to see my all-time-favorite artist, graduating from college, applying for jobs to gain clinical hours for my applications to PA school. Then I realized that it wasn't just about the things that she might have been excited about doing as a 22-year-old. It was also all the things that she wanted out of the long life that none of us ever think will be cut short. I couldn't help but wonder about the life she wanted for herself. Did she want to buy her own house? Did she want to get married and become a mom? Did she want to rent a car just to be able to say that she could?

These thoughts inspired the art accompanying this article. I drew 22 things that represent what this young woman could have been, could have done, or could have wanted. The little things that might make her who she is, like waking up with a cup of coffee every morning or singing in the shower, to the bigger things that she might have dreamed of, such as falling in love and starting a family. Maybe she never ran late to anything or maybe she loved to read. Maybe she had thick curly hair that was always tangled and endlessly frustrated her before the chemotherapy took it away. I will never know her answers to these questions, though this experience made me realize that I must always keep them in mind. It will remind me that anyone I help during my career is more than a professional success and more than a problem meant to be solved. Rather, each patient is a person with an entire life hiding behind a diagnosis that can so easily overshadow them. So many rewarding experiences come from being a PA, but I never want to forget the biggest reward of all—watching patients get to continue forward in their lives and read a book, relax on the beach, dress up for their wedding day, or travel the world.