I have been having some trouble coming up with an update about where I am and what I'm doing. I think this is mostly because I've been having too much fun doing it.
Thus the update of the day is that I am currently doing an ER rotation at the largest regional medical center in our area. It is so enjoyable that I hardly feel I am at school. My preceptor has an amazing amount of knowledge to share and has been pretty willing to have me experience new things first hand - like suturing. On my first day a patient came in needing a number of stitches... my preceptor said, essentially, "Go for it," and with the appropriate supervision (he looked over my shoulder the whole time) I closed the patient's wound with no trouble. It was a good experience. I have had many others already, and I've only worked 2.5 shifts (30 hours) so far.
One dilemma I have faced so far - and one that hit a little too close to home - was that of how far we as providers should go for patients in a permanent vegetative state. This came up in my last rotation as my preceptor and I listened to a radio news broadcast on the subject. We discussed this and the question that arises is this: should we do absolutely everything for everyone? Of course, if we say that we should not provide life support for people in permanent vegetative states then at what point will we draw the line? Will we begin to draw it further and further down the line? Will we start withholding medical care from the frail elderly or those who are simply so ill that they have no change of a meaningful recovery? Truth be told, this decision does not lie with us (the medical providers) but often times families ask us what we think - what we would do. It is their decision, but they seek affirmation of their choice and support for whatever they elect to do. The weight of the situation is such that it warrants a great deal of forethought.
One discussion point that I think helps me the most is this: perhaps we should draw the line between prolonging death and preserving quality of life. If a patient is in end stage lung cancer with multiple metastatic lesions to their bones and in excruciating pain all day, every day then perhaps we should not seek to blast them with all sorts of chemotherapy and make them endure their pain longer by only slowing the progression of their disease without hope of a cure (aside from a miracle direct from the hand of God). Perhaps in this situation we should simply help them be comfortable - not hastening or prolonging death, but providing comfort and care for the ill in their final days. And I think that most reasonable medical providers can see the logic and compassion in this situation.
But how does it change in a pediatric patient? Perhaps there is more hope for a cure and long years of a high quality of life, or perhaps a child is so ill that he cannot be saved. This is a huge dilemma for all of us, and the answers are not so clear cut. I have struggled with this recently and will no doubt revisit it. But my preliminary thought is that if, for example, a child has an injury that has left them without higher brain function such that they have a steady heartbeat and steady respiration we should do nothing to prolong their entrapment in that tomb made of flesh and bone. We should not hasten death, but I have to ask a question: what good does it do a person to be trapped without hope of recovery inside a body that itches, that hurts, that will become ill over the years? In this situation there is no expressive faculty left for the patient and no ability to move - in my opinion this would be more like torture than life.
So where should we come down on this issue as medical providers? Well, I have my opinion, and others will have their own. And, to be honest, it is unlikely that all of us will ever agree. But we should all give it a great deal of thought and we should all do it early in our careers so as to be ready for these situation because, as I have seen, they come up often.
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