Waco Tribune-Herald (TX) - Tuesday, April 17, 2012
Author: MICHAEL ATTAS
was a young man who owned a successful family business. He had a wonderful wife
and four beautiful children and without a doubt was at what we would consider
the prime of life.
During a family picnic, he collapsed without warning. CPR was administrated at the scene and when the Emergency Medical Service arrived, he was in full-blown cardiac arrest.
Drugs were given to attempt to stabilize his cardiac rhythm, but they were unsuccessful. He was intubated and placed on life support at the scene, and CPR was continued in the ambulance on the way to the hospital.
Finally, just as the ambulance arrived at the hospital he regained a semblance of a cardiac rhythm that could sustain life.
Upon arrival in the CCU, he was comatose. His pupils were fixed and dilated, a clinical sign of irreversible brain damage and often considered the equivalent of brain death.
Just as I arrived, his rhythm deteriorated again and we again initiated CPR.
For more than an hour, we struggled with a pulse that came and went. We gave him every drug in our pharmacological war chest, but we simply could not sustain his life.
We finally began to acknowledge the apparent futility of our endeavors.
The nurses, who often have infinite wisdom in these matters, looked at me with pleading eyes to stop. “Let this man die in peace” were the unspoken words I heard.
When he finally was “flat line” and unresponsive, I told the nurses to stop CPR. I glanced at the clock and noted the time of death and prepared to go to the chart and make the appropriate documentation in the medical records.
There was stillness in the room, a solemn honoring of the all-too-familiar process of death and dying. It never is easy for all of us in the field, but it is a part of our daily reality.
And then something happened that to this day is simply unexplainable. As I began to make my way out of his room, I was flooded with a sense that this man’s life and destiny were not yet completed.
The story wasn’t over. There still was work for him to do.
I quickly walked back into the room and instructed the nurses to begin CPR again and give him one more round of cardiac stimulant drugs. I injected adrenaline directly into his heart muscle instead of his IV.
The nurses looked me in a questioning, pleading way. “Please, not again,” their eyes spoke in no uncertain terms.
But just as we were about ready to once again terminate our efforts, his heart resumed pumping. It stabilized.
His blood pressure started climbing and his skin started to warm up and turn from ashen blue to red.
We were astonished for none of us held one ounce of faith that we could save him. He was placed on a ventilator overnight, and despite apparent “brain death,” he woke up the next day.
He walked out of the hospital two weeks later. He returned to work running his business for another 25 years and saw his teenage children grow up to become successful adults and lived to see his grandchildren born.
It defied everything I know and believe to be true about the human body and science. It is, in medical parlance, an “outlier” — something outside the statistical norm. So what do we do with that information is the question I struggle with routinely.
At what point can we trust intuition and not science? At what point do we rely on computer simulation and therapeutic algorithms to define what is referred to as “best-practice patterns”?
We live in an era when both private industry and federal policy are going to define what are the “norms” of how we treat patients.
Hospitals and physicians are going to be held accountable for their decisions, and scorecards will be generated for the public to review and decide who is “the best doctor” based on how we comply with well-documented science.
Physicians who are “outliers” will be fined or not reimbursed for practices that fall outside the realm of the standards. If charges exceed the predicted for the given diagnosis, a hospital will be penalized or payment simply withheld.
While I don’t necessarily have a problem with these noble attempts to rein in costs, I will say this: I could be in a similar clinical situation again another 1,000 times and I would never see that particular outcome in 999 of them. It defies all knowledge and all odds.
But if I felt like I did then, I would do it all the same, even if I lost the next 999 patients. Even if I found my name on a list of doctors who do not practice by “acceptable” standards.
What is the value of one human life?
I am not sure.
Ask this man’s family and have them tell you what it meant to have him in their midst another 25 years.
Then place yourself in the position of deciding who lives and who dies.
Dr. Michael Attas is a Waco-based physician, a medical humanities professor and an Episcopal priest. His column appears biweekly. Send email to Michael_Attas@baylor.edu.
Record Number: 18477741
(c) 2012 Robinson Media Co. LLC - Waco Tribune-Herald
To bookmark this article, right-click on the link below, and copy the link location: