A jarring experience with a gravely injured patient shattered this surgeon's assumption that she always knew best.
A jarring experience with a gravely injured patient shatteredthis surgeon's assumption that she always knew best.
I'd never thought of myself as an arrogant doctor in the habit of "playingGod." Then an unforgettable experience made me realize that every day,consciously or not, we form opinions and make decisions for patients asif we alone know what's best for them.
Mr. Andolino (I've changed his name) was a subway train conductor. Amiddle-aged, suburban family man, he probably never imagined himself asa hero. But he became one on a spring day about 10 years ago as he triedto save a passenger's life.
A young man was arguing with his girlfriend, and when the discussiongot loud and ugly, he pulled a gun. The girl ran the length of the subwaycar and pounded on the conductor's door for help. Mr. Andolino was pullingher into the safety of his compartment when a shot was fired. The bulletmissed the young woman, lodging instead in the middle of the conductor'sneck.
Mr. Andolino was rushed to the hospital where, on that day, I was thechief resident on call for the trauma service. Alerted to the patient'simminent arrival, our team quickly gathered, listening as sirens wailedlouder and louder.
Finally, the ambulance pulled into the bay. EMS workers rushed the patientinto the trauma room, announcing that he had lost vital signs en route.They described a devastating entry wound in the left neck, as well as neurologicsigns of quadriplegia at the scene.
Carefully adhering to the ABCs of trauma, we began the resuscitation.After a good deal of struggle and sweat by doctors and nurses, Mr. Andolino'spulse returned. But he coded again a minute or two later, and once morewe jumped in to restart his heart.
Despite the intense activity and concentration, I couldn't help thinkingin the back of my mind about the patient's ultimate outcome. I imagineda scenario in which we salvaged the man and he left the hospital--only toend up as a ventilator-dependent quadriplegic in a long-term care facility.Surgical residents, not always known for tact or compassion, had a namefor such people: "talking heads." Picturing myself in that condition,I believed it was better to die.
I snapped back to the reality of the moment as one of the nurses declared,"We got him back!" Without thinking, I murmured, "Oh, no."Later, as the patient was stabilized and taken for a full complement ofX-rays, that same nurse pulled me aside and gave me a brief, bitter rebuke:It was our job to heal the sick, not to make judgments about their qualityof life.
During the next several weeks, while my team and I took care of Mr. Andolino--gettinghim through various operations for spinal fixation, a feeding tube, anda tracheostomy--I resented the nurse's words. Such lofty sentiments werefine for her, I thought; she didn't have to see the reality every day. Thisman would never again be able to hold his wife or hug his children, wouldnever draw another breath without assistance. He would be totally dependenton others for the remainder of his life. I was tempted to give the nursea piece of my mind, but I decided it wasn't worth the argument.
Ultimately, Mr. Andolino was deemed stable enough to leave the hospital,and he was transferred to a rehabilitation facility in another state.
I often wondered about his long-term prognosis, and regretted for himhis bleak future. Then, about a year after he'd left our hospital, I wassurprised to see Mr. Andolino at a news conference televised from his home.He was able to speak in short bursts, with intervening puffs from a ventilator.
His words stopped me in my tracks: "I just want to thank God forthe folks at the hospital--they saved my life. I hope they know what itmeans to me to be here with my family."
Since then, I've had plenty of opportunities to deal with sick, injured,and dying patients, and I'm better prepared for the experience. At timesI still find myself contemplating the patient's future quality of life,but now I withhold judgment. I'm no longer certain that I know best.
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Ann Rogers. My hardest lesson: I'm just a doctor. Medical Economics 1999;18:74.