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.

Writer’s Block

Okay, okay! Maybe laziness isn’t quite the same as writer’s block. I’m home in beautiful North Carolina, struggling to pick up my thesis books.

The senior thesis is a capstone project that allows seniors to pursue an original research project under the guidance of a faculty advisor. While it is a semester-long or year-long process, many students use research or coursework from previous summers/semesters. My own essay, on the ethics of resentment, grew out of a short essay from a course with Professor Jill Stauffer.

I sometimes work in Magill Library with a friend who has been translating interviews from Spanish to English for use in her work on street children. Another friend and I chatted over lunch about whether he could secure funding for expensive software for a thesis on the correlation between GPA and physical attractiveness. Another friend finished her thesis on Ghanaian music in December. Me. Jealous? Never.

Here are some things I’ve enjoyed about thesis:

  • I’m re-reading a work for the third time, and I’ve taken something new from it each time. It’s nice to (re)read a work closely.
  • Meeting individually with my advisor reminds me of Oxford’s tutorial system, which I really enjoyed.
  • It’s nice to be self-directed.
  • I’m glad I’ve been forced to write a little each week, because I’m further along than I thought.
  • Subject librarians are INVALUABLE! (Shout out to James Gulick!) He has found more resources in an hour than I could find in a week. He raised questions that I’ll need to grapple with in my work, and also pointed me to sources that may help me tackle them.

The following things are not so great:

  • I don’t usually have the time to read things as closely as I’d like.
  • I hate to write a little each week, because…well, it’s work.
  • I hate to present rushed writing to my thesis advisor each week!

Let’s hope this “writer’s block” let’s up soon!

 

 

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.

 

As a Haverford Economics Major

As an economics major, math and statistical analysis both have strong applications to my greater academic experience. I began my day by attending my Real Analysis class and learned how to rigorously prove integration. Although it may come across as nerdy and strange, this process brought much excitement to my morning, demonstrating my ability to not only comprehend but, also, reproduce the proof of an advanced mathematical concept. The next class was Econometrics, a course that attempts to test hypothesis about the relationship between two variables. That morning, we derived the appropriate test for a sample of data that an economist would not have the necessary statistics for. The conclusion was that by manipulating results, economists may understand their data relative to confidence levels. Finally, my day ended with a class on Differential Equations, a course on the manipulation of functions that detail the movement of higher order relationships. An example of this would be looking at population growth; economists may create a formula to find population levels by observing the growth rates in population.

What I most valued from this day was learning the dynamic nature of learning at Haverford. When people hear me say that I am an economics major, the usual reaction is always surprise. I think that there definitely exists a negative connotation associated with economics, viewed as something that promotes self-interest, money-making and the antithesis of liberal arts. I think that this snapshot at my day demonstrates that these assumptions are far from the truth. What becomes clear is that my education has been enhanced by my major, combining all of my interests into one direction. I have always been good at mathematical and social analysis. I see economics as the cross roads of these skills, quantifying social phenomena through the observation of markets and services. I truly look forward to the next two years in order to find myself in this field of study.

Leadership Retreat Reflections

The Pendle Hill staff was happy to have hosted Haverford’s leadership retreat because they witnessed the rare occurrence of a group of students smiling as they entered their halls, genuinely asking “how are you” to the hosts and residents. This was one of many reminders throughout the day of what it meant to be a Haverford student. One of the most often repeated ones at the retreat was that only Haverford students would spend their last day of break at a series of workshops on restorative justice, that we would engage with a panel of mediators in order to learn from them and that we would continue the conversations started at Pendle Hill even when we settled into our dorms.

One of the first activities we engaged in was to write about ourselves on strips of paper and link everyone’s strips into a chain. The finished chain was laid down in the middle of the room, serving as the physical manifestation of our thoughts at the beginning of the retreat. Following this brief moment, we transitioned into a panel discussion, concerning the history, challenges and prospects of the fields of restorative justice and mediation. Following a lunch break, we began to discuss conflict mediation techniques and closed the day off with a final question-answer discussion. Throughout this entire process, the chain still lay on the floor, forcing students to reflect on who they were several hours earlier and what condition they were leaving in.

Restorative justice was described as a perspective that looks at crime through an uncommon lens. Instead of categorizing people as victims and offenders, the restorative justice process attempts to engage parties involved in an incident to meet each others needs. Instead of valuing laws and technicalities, restorative justice values trust, community and respect. I soon began to realize why Haverford chose this subject as the topic of its retreat.

I couldn’t help but relate some of the material we were learning about new forms of mediation to what I had been taught about the criminal justice system. I couldn’t help but reflect on how frustrating it must be for reform advocates to have to deal with an apathetic and complacent society. While flaws in our criminal justice system appear well publicized throughout the media, the lack of an advertised alternative seems to pull people towards pessimism. Moreover, I believe the process for getting reform through bureaucracy is not well known; the height of people’s known political action is a vote on a ballot. I can only hope that people stop feeling obliged to simplified and inefficient systems of justice and begin to move towards more effective ones.

 

“Where else could a young man who grew up in an impoverished, low-caste fundamentalist Christian family in India get a degree in computer science and discover dance?”

Throughout the afternoon, I’ve been working on a grant application for the Kessinger Family Fund for Asian Performing Arts to support a performance that we hope to have in the spring by the Dakshina (Sanskrit for “offering”) dance troupe, which is an emerging dance group founded by choreographer Daniel Phoenix Singh. Dakshina is based in DC, and has been attracting a lot of attention for Singh’s fusion of traditional Bharatanatyam and Modern dance vocabularies, and for their productions of work by avant-garde choreographers such as Anna Sokolow and Darla Stanley.

The Kessinger Family Fund “sponsors musical performances and lecture-demonstrations that enrich Haverford’s cross-cultural programs….the Fund supports performances and residencies dedicated to the rich artistic heritage of South Asia, East Asia, and Indonesia, and was started by former Haverford President Tom Kessinger and his wife, Varyam” which is an amazing legacy from which to draw. Singh and his troupe exemplify the vision of the Kessinger Family Fund in some extraordinary ways; in a September 12, 2010 article for the Washington Post about emerging artists in the DC dance world, reporter Sarah Kaufman wrote: “Only in America: Where else could a young man who grew up in an impoverished, low-caste fundamentalist Christian family in India get a degree in computer science and discover dance?”

We’re asking for $5,000 toward the artists’ fees for the performance; Ethan Pan, in his capacity as the OMA liaison to the Asian Arts Initiative in Philadelphia (where Nancy Chen has been an inspiring force and guiding light) has been working with Jari Rizvi of the South Asian Students affinity group to raise funds for a projected performance and workshop that would take place March 16-17, 2012. Jari and his compatriots in SAS are looking to this residency as an opportunity to connect with sister groups at BMC and Swat, as well as with the South Asian community in the region. James Weissinger from the HHC has been a key figure in bringing these pieces together…which included the key work of literally collaring me in the hallway in Stokes to make sure that I got the proposal in to the office in time for the committee to review it tomorrow. Yes even deans — particularly deans — need someone to keep them on the straight and narrow, particularly if it means that we have the opportunity to bring amazing queer artists to campus.

“A Collective Narrative of Diversity”

Customs week was a heavy experience to say the least. It was the first time that I came back to Haverford’s campus following summer break, which for usually involves a lot of family time, reading and thinking. Coming back after a long break and being hit with so many familiar faces at once was somewhat overwhelming. Being around freshmen also gave the campus a new vibe, shifting dynamics  around like clockwork. I felt my place at Haverford had changed, with new responsibilities and priorities because I knew that I would have a strong impact on my customs group during the upcoming school year, as both a PAF and a model of a Haverford student.

I felt this responsibility even more so through the training that PAF’s and customs folk received concerning diversity and religion. I believe that my cultural background is unique to the college, as a Muslim American who grew up in a ridiculously diverse area of Brooklyn and who’s parents are both from Pakistan. During a PAF training on diversity, I remember talking about my experiences in public school, which immersed me in a mix of Eastern European, Latino, East Asian and South Asian students. I think that because of my upbringing, the perspective that I have to add is meaningful and influential to the conversations that I will have with both my customs group and the Haverford community as a whole. I think that after this intense week of attending programs and meeting faculty for training on the topic of multiculturalism, I’ve learned that I have a responsibility to voice my perspective towards a collective narrative of diversity.

Taha Ahsin, ’14 – Peer Awareness Facilitator (PAF)

First Year Student Refelects on the Multicultural Leadership Institute

Diversity and related taboo issues have always captured my interest, and at Multicultural Leadership Institute we dug into these topics every day as whole group of 30 freshmen and also in smaller groups with a Student Resource Person (SRP) leader. We had about 3 workshops per day, and our topics included Socioeconomic Class, Privilege, Race, Gender & Sexuality, Spirituality & Religion, and Leadership. As we delved into these heavy topics, we really got to know one another on a concrete and fundamental level within only a few days—something I had not experienced with previous classmates I had known for years. It was freeing to be able to speak honestly with each other, without the fear of becoming an outcast or being labeled in a negative way.

My favorite workshop was the Spirituality and Religion Workshop. There were students who had grown up in one denomination or religion but had switched to another, those that were unsure about the religion that they had grown up with, and those who had followed the same religion their entire lives. As this was one of our final workshops, we had gotten to know each other well beforehand and were comfortable enough to go around the circle and share a statement about our religious background. Even being in a room of friends, sharing my Christian identity was still scary. However, openly discussing our faiths ended up being an empowering experience. I am less afraid of rejection. I know that if I discuss my faith with people who are close minded or rude, I won’t take derogatory comments as personally now because their intolerance is their problem, not mine. With this confidence, I can continue to love those who reject and belittle my beliefs without feeling insecure.

—Alexis Etzkorn ’15