Sunday, August 21, 2011

Less Person, More Intervention

A couple days ago I was at an advisor's apartment to welcome students of the incoming M1 class. His wife, who has acute myeloid leukemia, was also present. By any statistic you can quote she has beaten the odds more than once. She's a tough one and still fighting on.

Almost 3 years ago when she first greeted me and others as freshly minted M1s, she was lively, warm, and motherly. Now, bald and weak from chemo, tanned as if her skin had been baking under a desert sun, and also on dialysis, she appeared so frail and mortal. I've seen this before - the frailties of the body, broken by disease and worn from treatment and intervention. But also peering through are the embers of a once-strong soul. I could tell through her heavy-lidded eyes that she wanted to be healthy enough to interact and engage with all of us, instead of lying on the living room couch. I could tell that behind her wearied smiles that she's fighting off her own suffering.

I read a blog article the other day by a doctor who experienced what it was like to be a patient. What he wrote seems to mirror some of the patient's I've seen. Being a patient in the hospital must be one of the most frustrating things in the world. You rarely fully know what's going on with you, nurses are poking you every 15 minutes to 4 hours, and doctors order things to be done on/to you as you lay helplessly. We just need to remind ourselves that, at the end of the day, we can go home. Our patients often can't.

It's easy to correct an electrolyte imbalance. It's easy chase a blood culture. It's easy to track labs. But it gets harder and harder to see patients as people and not a "bag of symptoms." You look at someone and you don't see a mother, a sister, a father, a brother. You look at someone and you don't see a baker, a chef, a nurse's assistant, a student. No, instead you see an alcoholic, a morbidly obese individual, a body part, an organ, a pulmonary embolism, a cancer. All of which is true, one can't objectively deny any of it.

But in the ICU (intensive care unit), I've seen people become less and less person and more and more medical intervention until all that's left is a body on a ventilator with an NG tube, a Foley catheter, an arterial line, a central line, and a telemetry attached. In that state the soul has probably fled and all that's left is a shell of a person kept alive, not for the patient's sake, but for someone else's (whether it's the family or the medical personnel).

A woman was brought in to the ICU today. Full code, meaning CPR and the whole deal. She should have been left to die in peace. As my senior resident said, "This is a special place of Hell that people are forced to suffer through when someone calls the code."

That said . . . people occasionally do get well enough to regain their humanity and go home.


robert said...

Thank you for this. Its a beautifully rendered word painting.

Mind Of Mine said...

I think it is essential for doctors look at patients as they illness that inhabits their body. It ensures consistent medical assistance for everyone and also ensures doctors don't burn out or become to emotionally involved to the point where they over look something.

R said...

Good post and as a student myself, I've come across feeling the same way as you've expressed on your post. Sometimes I cross the line and want to just go home so bad and leave the hospital but have to stay just to clerk in a few more patients or finish off some paperwork, and then not remembering that these are real people that have to stay in the hospital overnight.

I've been in ICU as a patient myself many many many times, and it's dreadful. Even then, I was probably the most stable/non-critical patient in the ICU then. All others were little babies with like, respiratory issues and on CPAP or ECMO and tons of infusion pumps racked up behind their bed.

But I suppose it's just the fact that in clinical settings like the ICU, the medicine gets so complicated that all the staff members get so caught up with the little details and the science behind the treatment, and sorta forgetting that the patient is a real person, not just a collection of symptoms and signs, not just a tutorial for med students

Aek said...

Mind of Mine: I disagree. If we only look at the disease and not at the person beyond it, how can we truly help that person other than in an acute setting? It's easy to treat a disease, it's difficult to treat a person. One of our goals should be to ensure health rather than just "fixing" diseases. Then again, that's more of a primary care mentality . . .

Ron: Going home at the end of service is one of the best things ever. And I can only imagine how great it must be for a patient to finally go home! I'm not a fan of ICU medicine. In the ICU, patients are truly more pathology than person, and we must take care of the pathology first and foremost so that there's even person left in the end. I'd burn out so fast if I did critical care.