On Monday, the first patient that I met was a 13 year-old boy. He was unresponsive. He had been in the car with his dad when their tire blew out and they flipped upside-down into the frozen waters of a nearby creek. His father died that night. The boy was taken to our hospital, and several tests had shown that there was no brain activity. His mother, who had not been in the car that night, made the tough decision to stop all medical interventions, including fluids and nutrition. As he was seizing uncontrollably, there was little hope of him regaining any function. Over the weekend, one of the nurses had an issue with fluids being withdrawn, and decided to restart his IV without having an order to do so. I don't know how that issue was handled, but this is what I walked into. I briefly met the mother, examined the patient, and continued on with my list of patients. Fluids were again withdrawn. Tuesday I had off, and Wednesday was a conference day so I was excused.
Today, as I walked in, I was told that the patient had just died. I think that I have never been so thankful to be running late in my life. By the time I got there, he had already been pronounced, and the poor overnight resident had to stay late finishing up the paperwork. I don't know exactly what I'm learning about medicine this month, but I am certainly getting a crash course in ethics.
My next patient was the opposite end of the spectrum. The resident from last night had been taking care of her so I hadn't really known much about her case. She was doing well enough after her surgery to be transferred to the rehab floor, so getting that accomplished was my goal for the morning. As I sat down to read her chart, I was surprised by what I found: this girl was from Iraq. She had been a very sickly child, who was having fainting spells that were getting worse. It turned out that she had a large defect in the wall of her heart that separates the two ventricles. Her oxygenated blood was mixing with her deoxygenated blood to the point that her body wasn't getting the oxygen that it needed. She had seen doctors in Baghdad for this, but after keeping her on medication for a year, they had stopped all treatment and told her family that the condition was inoperable.
And that's when the miracle took place. Somehow her path was crossed by a U.S. soldier who brought her here. To sum the story up, last month she got a patch placed over the defect in heart. She developed a fatal arrhythmia in the operating room, and a pacemaker was immediately inserted. Her left side is weak, and the head CT I ordered this morning explains the weakness as there is evidence of an old stroke. However, today she has a chance. Her life will never be that of a normal 9 year-old, but with therapy and some medications, she should do well. I tend to not make political comments because in general I have nothing nice to say, but today I was proud of my country.
It kind of reminded me of that tale about the starfish, where the old man is on the beach throwing the starfish he finds back into the ocean. A young man points out how they will keep washing ashore and there's no way to save them all. The old man keeps at his work, and says something like "well, it makes a difference to this one."