A training exercise, I am handed this scenario.
I'm a colonel. I drank heavily the night before, and returned to my office instead of trying to drive home. On the way up, I fell down a flight of stairs, badly. Being a tough old bird, I manage to get back to my desk, where I now sit at six in the morning, where I am found by my aide, who assumes I only just arrived.
I have damage to my aorta, which is being tamponaded by my position. I am embarrassed, and although truthful when I am asked a direct question, I am to offer no information. They may ask questions about how I look from the judge, covered with bruises, and reeking of alcohol, but only told if they ask. If they lay me down, I pass out, and the judge will start a timer. If they get the mast pants on me quickly enough, I live. If not, they fail, because I have bled out.
None of the teams figure out what happened in this scenario, only one didn't kill me.
Health care, especially in emergencies, is a two ended rope. Embarrassed silence kills. Lies kill. More often, it's simply not speaking the same language, or having the same objective. It's a miracle anyone survives anything. Failures of imagination, failures of interest and rigor. Failures of training.
It's not science. True scientific, double blind studies are unethical. Take ethics out, and science does not flow in, only torture. Most of what we do is best-guess-work, practitioner dependent, skill, luck. Doctor confidence would have a salutary placebo effect, so quacks are often enough, successful, at least once in a while.
And yet, I would have the people I work with work on me, were I injured or ill. Because it's the best available choice. Because I know they care, and they know a lot of stuff not to do, and they will tell me the truth, as I will be forthcoming in telling them all the truth I can.
Not even close to perfect. But miracles happen all the time.
13 comments:
Hi Zhoen, there was a fun article in the NYer about checklists that made me think of you...
This month? I will take a look at the liberrrry. Thanks.
Oh! No need for that!
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
I especially liked where the nurses were given authority to correct erring doctors...
(o)
Oh, and what I really like about this post is the thoroughly dirty, negative charge you give the title word "miracle", that is too well developed to be labeled sarcastic. I, myself have a tendency to be precious so I like shaking hands with this effigy of failure and mortality.
Perhaps death is the miracle, and it is life itself which is tedious and ordinary.
My thought was, "poor guy." Death before indignity.
lj,
It was a strange experience, and very frustrating, not to tell them what was going on, only too willing to answer if asked. But they didn't ask. I wonder if Mast pants are even used outside the military, or anymore anywhere.
Bill, I'll read that later this week. Looks very interesting, thanks. I don't know that I overshot sarcasm, although I am very cynical and resigned to life as it is. I am in part responding to another blogger's rant against hospitals and modern western medicine, and medical mistakes. It's the worst, except for all the others. And an old friend is dealing with an old surgical error. And I work in surgery everyday, with people I respect. With a bad back, and studies that show back surgery is useless, and all that suggests. I live inside the conundrum.
Whaddya know, Mast Pants.
"I don't know that I overshot sarcasm"
No, I don't think you did either. I am an overactive reader.
excellent post z; sentence "when ethics taken out" is perfect
(o)
A strangely comforting post. Thanks.
It sounds like a kind of grisly black-humour party game.
I can imagine how something as apparently trivial as embarrassment could be fatal.
Yet, like Dave, I find your conclusion reassuring; we're harder to kill than it seems, perhaps.
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