Sunday, November 30, 2014

Is There A Doctor In the Room?

 (practicing in the days of Ebola)

This Article is Published in a shorter version in The Olympian.  Click here to read that version.

A longer (more raw?) version is below:

“Is There a Doctor in The Room?”  The question was asked by the chief surgical resident soon after he entered the trauma bay, full of confidence and clearly in charge in the midst of chaos.  He asked it after he had been informed that the nurses had been trying in vain to get an IV.  He knew the answer already.  Several intern doctors and medical students (like myself) were trying to help: getting our gloves on, wondering what to do next.  Afraid of death, which was obviously knocking, but excited at the same time to be where the action was.  We all questioned what he was getting at.  What did he want?  Did he not know?  Was this a trick question?  Was he trying to teach us something?

After the appropriate pause for effect, but not so long as to delay anything, and while putting on his own gloves, the chief explained,  “If there were a doctor in the room, he or she would have been getting a cut-down.”  Of course!  A venous cut-down.  We all secretly kicked ourselves for not already reaching for the minor surgical kit.  We could get IV access.  We had been trained in how to “cut down” through the skin to a superficial vein and grab it, get an IV in it and tie it up so it would not come out.  That way we knew we could get some fluid in.  I grabbed the kit and the chief and I did my first cut-down.

I think today it is time again to ask this question:  “Is there a doctor in the room?”   The today I am talking about is the day of Ebola.  The disease on the headlines.  This fearsome outbreak that has killed thousands in Africa and has reared its ugly head here in America as well.   There are newspapers.  There are lawyers.  There are many people scared out of their wits.  But the question is,  “Is there a doctor in the room?"

If there were a doctor in the room, he would go and treat the patient.  He would stop looking around and even though he had never seen such a patient before in his life.  He would dig into his brain and remember his training and come up with a logical, determined, and reasonable plan to do something about the problem.  He would do it, even if it made him shake in his boots.  He would do something even if his friends did nothing.  He would do something even if there were risks.

If there were a doctor in the room, she would volunteer to go to Africa and help treat the epidemic at the source.  Some have gone.  But recruiting doctors for this job has been very difficult.  Many working at the Ebola Treatment Centers are on their second or third rotation.  When the President of the United States put out a call for doctors to rise up and go, there was a surprising silence.  Aid organizations have the money and the logistics personnel, but few doctors.  

Is there a doctor in the room?

If there were a doctor in the room, she would stand up for reason and science and compassion for those returning from overseas.  Instead, we have a fight between governors and lawyers as the people panic in the street.  Doctors trained in the current era of  “guidelines” and “protocols” cannot function without them.  So they bow to whoever comes up with the plan that carries the least amount of risk, no matter the harm it may do in the end, even in the fight against this disease.  A doctor, knowing history and literature and people, not merely science, would explain to the people that no life is without risk.  A doctor would help bring people to balance, realizing that those who insist on an absolute risk-free life need therapy.  She would realize that to send people overseas means they will come back and need support and help, and they themselves will be a risk.

Is there a doctor in the room?

If there were a doctor in the room, he would put his suit on to see the Ebola patient.  He would know from lessons learned from prior outbreaks that a full body suit is required, with every inch of skin covered.  If there were a doctor in the room, he would do his best to find out who had treated Ebola patients before him, and he would realize it was the Africans and the Aid workers.  He would contact them and read their reports and see what they did.  He would not stop at full body covering. Until there was a clear reason to change strategies, he would do exactly what they do in Africa:  not let the Ebola patients into the hospital, treat them in a separate facility or tent, give them good supportive treatment with IV fluids, use chlorine based decontamination, send them to specialized centers for care.

So the question remains in the air, as it did those years ago.  That day of the gunshot and the blood.  The question that made all of us very uncomfortable, but at the same time gave all of us a flag to carry and a rallying point:  “Is there a doctor in the room?”

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