Ethics in Medicine

Last night, while I was shadowing in the ICU, I saw a patient who is in a vegetative state for years now due to the brain surgery she had to relieve swelling from an aneurysm. The doctor stopped right in front of her doorway and started telling me her case: she can breathe on her own without the need for a ventilator, she has some simple neurological function like retracting from pain, but she can’tcommunicate. Since everyone in the ICU appeared to be sedated, I was at first concerned that the patient would be uncomfortable because we were talking about her. Even though I knew that she was in a vegetative state, I was aware of her stare,and felt like she was staring at me. However, when I voiced my concerns to the doctor, he said that she couldn’t track anything with her eyes. I still felt aware of her stare, and all I wanted to do was give her a smile or hold her hand, do something small that might ease ten seconds of her existence.

Existence is what it has come to be for her. The life that she led before the surgery is long gone, and there isn’t much waiting for her except death. This was an interesting case to see because it brings up the question of ethics in medicine. Although she’s in this state, there are still some neurological functions that prevent the doctors and family members from “pulling the plug.” The measures for resuscitation have been reduced, so if she were going into cardiac arrest, the doctors would not do multiple tries to bring her back to life. Nonetheless, knowing that she will return to the ICU for another infection is heartbreaking. We do not know what she is thinking or what she wants in this situation, all we know is that we have to keep waiting.

The Joy of Medicine

By the middle of the second morning shadowing a doctor, I thought I was getting used to the pace of the hospital, the types of patients that were coming in, and the illnesses they were trying to fight. I started to see how an experienced doctor can get worn down by the cycle of patient treatment because there is a routine. When we entered the room of a patient to discuss discharging him, I, however, was at first surprised by the case, and then humbled by this encounter. Entering the room, I did not know the patient’s history or health status, and once I saw him, I could not believe he was being discharged. This patient was breathing through a ventilator, could not speak, and had a bunch of IVs attached to him. Then, I heard his history. He was admitted to the hospital three months ago, had coronary artery disease, a coronary artery bypass graft and even coded once. I was amazed that he was alive, and I was even more amazed that he was well enough to leave. What struck me the most was how grateful the patient was towards the Attending and residents who take care of him. Even though he couldn’t speak, he signaled “thank you” a couple of times and held their hands. As the Attending was leaving the room, he told me, “That’s why you become a doctor.”

I couldn’t agree more. This attending who has been practicing medicine for so long stated it so clearly: this is why he’s a doctor, and this is why I want to be one. I have heard from those who I have shadowed, that medical school is not easy, and I have witnessed that being a resident can be challenging. There is a constant effort being put in to help these patients and learn more about medicine, but this moment encapsulates the joy of it all. These types of moments define why medicine is so wonderful, how every bit of studying and work is worth it when you can change someone’s life.

This encounter with the patient was very short, but a lot was felt in that length of time. When we walked out of the room, I took a deep breath and said, “Wow.” Before rounds, I started to think that every patient didn’t have great chances. Just yesterday, I saw a patient who doesn’t have great odds of living unless he gets a liver transplant. Seeing all of these patients with heart failures led me to think cynically and forget my previous encounters with doctors. I forgot that doctors help cure patients, and I forgot that patients have lives and loved ones that they miss while at the hospital. Discharging this patient today reminded me that medicine does work. I realized that there is more than just a patient with symptoms; there is a person who feels and struggles through the illness. I hope that, eventually, I can understand how doctors not only diagnose, but also how they manage the strong emotions of sadness or joy that come with the job.