April 13, 2008

Emotions and the Way

"This commercial actually made me cry a little bit.
I wish I had a family."

I was chatting with my friend tonight and he sent me a youtube link with that message on AIM. I'll let you take a chance to watch it before I continue.


Done? Good. The part at the end translates as "Thai Life Insurance."
So it's a totally fake commercial, but it made me tear up anyway. Decisions that don't make sense to doctors AREN'T bad decisions per se. Patients might have a completely different perpective that is totally valid.

If you open your eyes and listen, you might even be touched.
Oh my. Sometimes I worry that my emotions will get in the way. Other times, well... allow me take the scenic route towards another conclusion.

This commercial reminded me of a class I had last year.

A guest lecturer came for a "blood banking lab" which turned out to be a confusing session on making checkboxes in the appropriate columns to "type and crossmatch" blood so we don't inadvertently kill patients in the future. While this isn't the job of a doctor typically, Dr. R wanted to impress upon us the difficulty of this task.

"Blood banking isn't as easy as 'giving them O blood.' There's a lot that goes on," he stressed. "As a matter of fact, a lot of difficult decisions are made every day. How many of you know about rationing? No? Basically, each unit of blood that is ordered for a patient is a unit of blood that CANNOT be given to another patient. If everyone demands Type O blood and we only have a dozen units, it gets used up very quickly."

"Let me tell you a story. I was called to see a patient who was delivering a baby and ran into some complications. She had Disseminated Intravascular Coagulation (DIC) and started to bleed out of almost every orifice. She was rushed into the Intensive Care Unit with nurses literally squeezing bags of blood, but she was losing blood faster than we could put it in. We might as well have opened up the bags and spilled them directly onto the floor."

"The blood wasn't enough. Platelets and Fresh Frozen Plasma too. But there was something else we could try. The magic blue juju vial."

Ok, so I made that name up. Keep in mind, that I'm recalling a story from a year ago and I haven't actually PRACTICED medicine in any hospital situation so I don't know what the indications are for using FFP vs platelets vs the magic blue juju vial (MBJJV). What matters to me is the story and the lesson I got from it.

"The only thing is, MBJJV would cost the hospital ten-thousand dollars. On top of that, she would only live for fifteen or twenty minutes, tops, even if we gave it to her."

There was a quaver in his voice and a gleam of anger in his eyes. Dr. R's voice rose to a shout.

"What would YOU do?" He challenged a few people in the class who had no idea what answer would appease this boiling man.

"What if I told you that those 15-20 minutes would give her enough time to spend with her daughter. An occasion that the husband could recall, at best bittersweetly rather than traumatically." (Ah yes, this is the connection with the Youtube clip.)

"What if I told you that the hospital had only one MBJJV and it would take months until another one came -- and another patient who could have otherwise been saved -- died because it had already been used."

"What would you do..." he trailed off, taking the time to remove his glasses and wipe his tears away.

I mustered up the courage to speak up, my own voice wobbling and wavering as I imagined the situation before me. "There's two sides to this -- payment and resources on one side and the needs of the patient on the other. When we talk about futile care, resources should not... hm, ought not to be expended if they can save a life. But in this case, we aren't talking about what best benefits the patient, are we? It's about what will be best for the husband and her daughter. Is the hospital willing to pay the money that insurance surely won't cover?"

So what happened?
She held her baby for the first and last time. She held on two hours. (Or my memory is adding in this detail for the sake of the story.)


Afterwards, I learned that some of my classmates completely misinterpreted Dr. R's position. "That guy got really pissed off about ten-thousand dollars," someone told me. Wha? I thought his anguish over the ethical dilemma was obvious.

Do emotions get in the way? Do they cloud our judgement on what is right and wrong?
Perhaps, it's wrong to distance ourselves.
Maybe mmotions should guide us along the Way. They can reorient us to what actually matters.


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  2. I think that despite the fact that emotions can complicate a relationship between doctor and patient (or in my case both the patient and the client) I think that it is better to involve them. I hate working with the dogtor who has a sing-songy voice and is honestly terrible about breaking bad news to clients. My favorite dogtor to work with is one where the client can tell simply by her body language and tone of voice that she palpates something that she suspects may be life-threatening. It's rare that I cry when an animal is put down, and it seems the same for the doctors, and I feel unprofessional, but I think it makes a difference to the clients. I can not imagine doing those same things, having to make such a critical decision for a human being. Even the idea of it, is like a punch to the gut.

  3. Dogtor? hehe, that's cute.

    I'm worried about how my "bedside manner" will be. I want to be open and honest with my patients -- sometimes that might lead to disagreements, sometimes it might mean admitting to a mistake and sometimes, it might make me vulnerable.

    Perhaps that's what people who go into a profession with death (soldier, nurse, vet, mortician) want to avoid. I hope you don't have to choose between building walls around your emotions to protect yourself and getting burned out emotionally.

    I hope to find a way to keep my humanity in these sort of situations.