Wow, John. This has the impact of a heavyweight prizefighter's roundhouse -- as poems about matters of life and death should have -- and it achieves its effect with such finely calibrated understatement.
I could debate for hours over the question of "and" vs. "but" in the final line. I'm pretty sure you made the right choice there.
Do doctors actually give ironclad guarantees that a patient isn't going to die in surgery? Would it be better to reword that line so he's hedging his bet a bit? Would that even make the final line stronger? The thing he states as a sure thing (no pain) doesn't happen, while the thing he phrases merely as a likelihood (survival) does happen.
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