Friday, February 17, 2006

The First Time

I'm between rotations at the moment, so here is a little story from not too far back. It was the end of the second week of my cardiac surgery rotation, and I was at the point where I felt I should be a little more competent and useful to the team. An adolescent patient was being admitted to our service and was there with his mother. This patient had a rare autoimmune disorder known as RPC that caused his own body to digest certain types of his own tissue. The patient was being forced onto our service -- essentially against our will (yes, ours) -- for a possible valve replacement surgery or two.

But why didn't our team want him admitted? Why didn't we want to operate on him? Because based on the little we had learned of his obscure disease from the "experts" (the rheumatology consultants), chances were good that within a few years of a valve replacement operation, his body would just eat away the new valve and necessitate yet another replacement surgery.

Things did not look good for this patient. This poor patient -- mentally disabled, partially deaf, and often staring into space with a blank look on his face -- was, for now, being denied a surgery that could have improved his quality of life immediately, since his heart condition was so severe now that he couldn't stand up for more than few minutes without fainting and collapsing.

The eager med student that I am, I sought to see if anything helpful could be done. I searched the literature and found case report after case report of patients similar to ours that had valve replacement surgeries ... and all ended up with the same poor outcome: repeat valve replacement surgeries within a few years. But I then found one short, obscure article recommending a certain type of procedure that eliminated the need for future surgeries. Before bringing up this news with my team, I went and talked with the patient's mother to see what sort of life her son used to lead. She related that while he might appear sluggish and debilitated now, this was only a recent development and that until a few weeks ago, he lead a fairly normal life -- he was affectionate, he could communicate with others, and he loved to play basketball. In short, offering him the surgery would return him to a life that he enjoyed and where he was loved by others.

I presented the results of my search and interview to my fellow, and together we made a brief yet impassioned plea to our attending, convincing him how this patient wasn't simply some gomer sent to us to have a surgery only to be sent back to a gome home, unnoticed and left to die, but rather a young patient who had much of his life left and whose presence would be appreciated by a close family. Our attending agreed to do the recommended surgery, the patient did well, and for the first time in my brief medical career I felt I had made the proverbial "difference in someone's life".

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