Agraphia Medical Tragicomedy

19Oct/05Off

Today was huge... I doubt I'll touch on even half of what we went through.

First, we went over child abuse in our social/behavioral sciences class. It was a difficult session- lots of pictures that you wish you hadn't seen (some of the worst, actually, were just the X-rays of kids that had "fallen from a couch", with multiple broken bones, healing ribs, head fractures, and hematomas- blatant, ongoing physical abuse). Amazing, too, the gamut that "abuse" runs. Physical abuse, mental abuse, emotional abuse, sexual abuse. The number of things that we humans can do to our offspring is so varied, and being presented with a quick and dirty litany of awful stuff was pretty emotional at times.

Funny, too, that I started to look somewhat dispassionately at it. Not because I didn't care, but because I realized that if I were the physician taking care of this child, the most important thing I could do would to get the child help- and help probably means CPS, and that means that a forensics examiner needs to talk to the kid. If you're talking to a little boy about how his daddy hits him all the time, you can't say "well, that's TERRIBLE" and get totally upset. If you do, when the forensics examiner asks him, he won't say what happened, because you judged him on it- so, as the doctor with the first-pass exam, you have to be totally unemotional. That's not to say that you can't be boiling with rage inside... and some of the stuff we saw and heard today was just vile. You just have to be able to outwardly be dispassionate. Turn it on, turn it off, with the flick of a switch. Interesting, as I keep finding out the implications of this career that I've chosen. There's a lot of nasty stuff in this world that I'll be dealing
with.

Then we had our bioethics conference. The one gaping flaw with U of A's curriculum is that they don't give us much ethics- and there are a LOT of ethics in medicine. The current solution is that one of the student groups organized this bioethics conference, which was really incredible. It was a 5-hour thing, and was extremely well run and VERY thought provoking. I wasn't bored for a minute.

The first issue we talked about was very similar to My Sister's Keeper. The watered down version of our case is that a 5 year old girl needs a blood transfusion. Her mother is pregnant, and the baby has a 25% chance of being a match for the transfusion (and if it is, the transfusion would be much more likely to succeed than from someone else). The test, though, is dangerous to the fetus- so what do you do? Endanger the fetus' life for the sister's? Go for the unmatched donor and hope for the best?

Worst case scenario, mind you, is that the fetus dies from the testing, and the sister dies when the transfusion fails. Then the patient is left with no children. As the physician you have to discuss all of this... and then you walk the road with the patient. You're the one who has to tell the mother that her daughter's transfusion didn't work and she's dying (much like I did yesterday). You're the one who has to tell her that the testing caused a miscarraige. So, you can't sit on the sidelines and wait for someone else to take charge.

Then there were a whole other host of issues. What if the parents test the fetus, find out that it isn't compatible, and decide to abort and then get pregnant again in the hopes of getting a match? I mean, I'm very pro-choice and I'm still reviled by the idea of trading one life for another so flippantly. Obviously a lot would go into that decision- maybe flippant is the wrong word- but still. The idea that these issues are constantly going to be popping up throughout my life is pretty awesome.

It was good to sit around and talk about these things. There were two other things we did (one was somewhat related to the Schiavo case) and it was fascinating to hear what some people had to say. Even people that I would have figured to be completely set in their opinions seemed to have their foundations rocked when there was no clear right answer. I suppose this is what hospital ethics boards are for- letting doctors pass difficult decisions by a group of people who will mull it around for hours.

Also interesting is the fact that though it was emphasized several times that there were "no right answers" to these questions... but in the end, a choice will still be made. "I don't know what I'd do" is no longer a viable answer. Chew on that for a while .

God I love medical school. This is what it feels like when you know you've made the right decision.

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