Since I'm a physician, I wonder about the distress of the doctors, nurses, paramedics, and other health care workers. How are they doing? I've heard about first-responders who have committed suicide after seeing what they saw. Have there been doctors who felt the same way?
Throughout my medical training, I have been taught to distance myself, emotionally, from patients. I should not let my own personal views and feelings get in the way of taking care of the patient. I must always remain objective and not get too involved in the patient's medical treatment regimen. Interestingly, many doctors fail to do this. According to a recent survey by the University of Chicago, 55% of doctors said their religious beliefs influence how they practice medicine. Leaving aside my own disquiet about this finding, I do believe it important to remain objective whenever I take care of patients, especially if they are critically ill.
When one is objective, he or she is able to step back and "see the forest" and avoid being emotionally "lost in the trees." When one is objective, he or she can leave aside the fact that the 55-year-old man with a massive brain hemorrhage is a father with two children and a devastated wife. When one is objective, he or she can compartmentalize the tragedy that surrounds the critical illness, and focus on helping the patient heal and get better. This practice is extremely important because, frequently in critical care, one has to make decisions on his or her toes, and being an emotional wreck could cost the patient his or her life.
Yet this learned emotional disengagement comes with a price: the risk of becoming too callous, too cold, too hard-hearted. When I distance myself from my patients too much, they become "patients" and cease being human beings. In fact, many patients are referred to by their respective diagnoses: a "chronic lunger," or "the CVA in room 240," or "the septic shock in room 1150." This is especially true with the critically ill, who are frequently connected to tubes and catheters that can rob them of not only their dignity, but also their humanity. Add to this the common occurrence of massive swelling as a result of systemic inflammation, and they barely resemble their former selves. In fact, I am frequently shocked when I see the pictures of my patients posted in their hospital rooms, because the patient rarely looks like they did when they were not sick.
Yet I always try to make it a point to look at the pictures to remind myself that the "patient" is another human being--a creation of God shaped by His very hands--with a life, and a story, and a spirit, and a family. It helps me feel for the patient and try to understand the pain and anguish that the patient and his or her family must be feeling. In fact, it helps keep me human and helps keep my heart soft. It helps me connect to my patients and be a truly caring physician, as opposed to a rational scientist who feigns human concern out of public pressure and economic necessity. I admit, it is a very delicate balance that must be walked each and every day, but it is part and parcel of the whole doctor gig.
He claimed to do so out of "compassion" for the patients: "They would have been dead within hours, if not days," the doctor said. "We did not put people down. What we did was give comfort to the end." The report was corroborated by other witnesses, and emergency worker William 'Forest' McQueen supported the move: "Those who had no chance of making it were given a lot of morphine and lain down in a dark place to die."
Indeed, I myself have started continuous intravenous morphine infusions if patients--or their families acting on their behalf--have specifically requested to be taken off life-support machines. I do this because the morphine can eliminate any pain the patient may be feeling, and--if taken off a breathing machine--can reduce the feeling of impending doom and suffocation. I was not there in New Orleans and did not see what that doctor saw, so I am reluctant to criticize his or her actions, if the claims are even true.
I have never given--and don't think I ever will give--a one-time lethal dose of morphine to a dying patient. Although I have no problem with stopping life support for a patient who does not want to be kept alive, I could never intentionally hasten someone's death, even if their death is imminent and inevitable. If someone ever asked me to do something like that, I would respectfully decline. He or she would have to talk to someone else.
Even though the treatment decisions I make can prevent people from dying; even though I have intervened on a patient whose heart has stopped and, as a result, his heart started beating again; even though I have placed breathing tubes down people's tracheas and prevented them from dying from respiratory arrest--I know it is not my actions that determine their life and death.
God is the Healer. It is God who determines who lives and who dies. In fact, just the other day I had a patient who, despite speding two and a half hours at his bedside and throwing at him everything I had, died from an overwhelming systemic reaction to infection. I am not God. If I ever start to think otherwise, then it will be time for me to stop practicing medicine for good.
