Like most doctors, I have seen a great many deaths. Those in intensive care epitomise the undignified nature of death in modern Western society, but one becomes used to, inured to, fully monitored deaths, where coloured lines chart final dysfunction.

While working in Samoa, I helped to treat a middle aged patient. Two days after his admission to hospital with back pain, a diagnosis of dissecting thoracic aortic aneurysm was made, and he underwent surgery. The procedure was difficult and prolonged, with a large false lumen, no identifiable re-entry site, and probable carotid artery damage.

Within hours of arriving on the intensive care unit, he required an emergency thoracotomy for cardiac …