I hear you. And I feel the weight of your question in my chest, because I asked the same thing when I was 50 in 2015 and told I had a dissecting aorta and needed emergency open-heart surgery.

I had no warning. It was about 42 minutes between the first pain that I had and being cracked open. I had just finished teaching on my feet for 13 hours and was alone in a hotel room in San Diego when my Type A dissection happened. I didn’t think, “this might be dangerous” before that day. I didn’t feel fragile. But I was. Frankly, it was a ticking time bomb that I knew nothing about.

You’re in a unique position right now because you know you have a 4.2 cm ascending thoracic aortic aneurysm (ATAA). Surgeries typically not implicated until you get to 5.0. That means you have the gift of foresight—something I didn’t get. And that gives you power.

The short answer is: no, you probably shouldn’t be doing that job without serious modifications. Anything that involves intense straining, lifting, or spikes of stress—especially if you’re holding your breath while pushing or lifting (what’s called a Valsalva maneuver)—can increase intrathoracic pressure and put dangerous strain on your aorta. That’s not a scare tactic. That’s physics and physiology. It’s possible that the kind of work you do exacerbated or even caused the condition that you have. It’s really hard to say and I’ve spent the past 10 years racking my brain trying to figure out what caused mine and I’ve concluded that being overweight, hypertensive, and stressed out as a trial lawyer all were huge contributors to my condition.

We both know that life doesn’t always make it easy to walk away from a job. I did not walk away from mine, but I have made very serious modifications to how I live in my life. No more 13 hour teaching stints two days in a row. this is about survival and quality of life. You need to take this seriously and talk to your cardiologist and thoracic aortic surgeon—not just your primary care doc. Show them exactly what your workday looks like. Be very specific about the kinds of lifting, postures, stressors, and rest you get. Get their recommendation in writing if you can. That may help with your work.

You may need restrictions. You may need a new role. But what you don’t need is to go through what I did—the pain, the surgery, the risk of death—just to find out the hard way that your body had been trying to warn you all along.

You’re not weak. You’re informed. You’re strong enough to advocate for yourself and choose a safer path. And I’ll tell you from one patient to another: knowing is a gift because you can do something about it.

Let me leave you with this. I spent the entire day yesterday staining my cedar fence here in St. Paul. The sun was out. It was clear and dry and I just went to town on the fence. It was lots of repetitive, but not particularly heavy work to hold the paint sprayer. I try to avoid anything which involves grunting or straining. If it’s more than 30 pounds, I’ll leave leave it to the folks at Home Depot to load and unload. It’s not that I can’t do it. It’s that the hidden strain on a Dacron aorta is nothing I want to risk. Peace.

PS. Here’s what my morning looks like today and I’m thankful every day for every one I get.