Saturday, February 13, 2010
In my whirlwind tour of all specialties that makes up the third year of medical school, I spent the last two weeks working in Labor and Delivery. There have been many moments over those two weeks that were, by themselves, blog-worthy. But when babies are popping out, there's no time to blog. So here are some of the more notable moments on L&D. Some were joyous, some were sad, all were miraculous and humbling.
On my second day, I still didn't really have any idea how things worked. I was at a new hospital, on a new rotation, and pretty lost. My first day had been pretty uneventful. I'd written some notes (all the laboring ladies need notes every 2 hours), and seen twins delivered from across the OR, but not seen any normal deliveries. About 8 hours into my second shift, one of the residents wanderd into the room I was writing notes in and said someone had just come in and would probably deliver pretty quickly. So I scampered off to her room, and when I got to the door, one of the residents said, "do you want to deliver a baby?". Duuuuhhhhhhh. So I put on my plastic booties and gown and jumped right in! About five minutes later (these things happen fast when it's the fourth vaginal delivery a woman has had...), the resident was coaching me as I delivered the baby boy. There was much screaming (from un-medicated mom, not me!), some crying (from the baby, not me!), and a very firm grasp on a slimy baby (yeah, that was me). Those suckers are SLIPPERY!!! Moral of the story: I delivered a baby. It was pretty awesome.
A friend of mine was following a patient. She was a 19 year old girl, 24 weeks pregnant with her first baby. I never asked, but I don't think the baby's father was even as old as she was. When we came in that day, the plan was to stop her labor and send her to the antepartum unit for a long stay until her baby was old enough to deliver (probably around 34 weeks). Suddenly, my friend ran off because the girl was fully dilated and going to deliver. 24 weeks old is on the limit of viability. Sometimes they try to save them at 23. But at 24 weeks, the likelyhood of the baby living, let alone being normal and healthy, is slim. And we don't think the mother had a clue how serious the situation was. She was excited, anxious, and happy. She had no clue about the challenging journey her daughter was about to embark on. She was born weighing 1.5lbs. When my friend and I went to see her in the NICU, she was intubated, had two lines in her unbilical cord to deliver medicine and draw blood, her face was bruised from trauma, and you could see through her skin. When I left the service a week later, she was still hanging on. I don't know what the outcome will be, but I have spent a lot of time thinking about that little girl, and how far we push the limits.
Speaking of pushing limits, this last patient was probably more memorable than any. She was also 19 years old, and came to triage (pregnant lady ER as I like to call it) because she'd had fluid leaking for the last couple days. Her doctor told her he was worried her water had broken, so she was sent to see us. She was 22 weeks pregnant when she came in. After ultrasounding her belly, we found that she had virtually no fluid around her baby. Her water had broken 18 weeks early, and she was devastated. This was very much an intentional pregnancy. She wanted this baby. But rupturing at 22 weeks meant that not only was the survival of her baby in question, but whether or not they could even try to save it was unsure. Before 23 weeks, no one will attempt to resuscitate. So before she could even absorb what was going on, conversations about when to give steroids, when she wanted to set a cut off for resuscitation, whether she wanted a DNR, what to do if she got an infection were all happening.
A 23 week old baby is a remarkable, devastating miracle of modern medicine. I honestly don't know of any of them make it. They are million dollar babies, attended to continuously for the first months of their lives. Many don't survive. Most aren't "normal". But when you look at it, less than a pound, but with fingers and toes and a nose, how many parents would say, "no, don't try". Some do, and it takes strength and courage and understanding to be willing not to put their little one through what they go through. But some can't, because they know there is a chance that their little baby will be the one to turn out ok.
In the hallways of the NICU, there are pictures of many of the kids that have made it out. My favorite is of an 11 month old boy named grant, who is little for his age, but otherwise a normal baby. He was a 23 weeker. As I walked past that picture with one of the high risk maternal-fetal medicine fellows, he said "that is why we do what we do. He is why we keep pushing the limits."
So we push the limits of what we know is possible, hoping that the ones that make it can somehow live for the ones who couldn't.
On my second day, I still didn't really have any idea how things worked. I was at a new hospital, on a new rotation, and pretty lost. My first day had been pretty uneventful. I'd written some notes (all the laboring ladies need notes every 2 hours), and seen twins delivered from across the OR, but not seen any normal deliveries. About 8 hours into my second shift, one of the residents wanderd into the room I was writing notes in and said someone had just come in and would probably deliver pretty quickly. So I scampered off to her room, and when I got to the door, one of the residents said, "do you want to deliver a baby?". Duuuuhhhhhhh. So I put on my plastic booties and gown and jumped right in! About five minutes later (these things happen fast when it's the fourth vaginal delivery a woman has had...), the resident was coaching me as I delivered the baby boy. There was much screaming (from un-medicated mom, not me!), some crying (from the baby, not me!), and a very firm grasp on a slimy baby (yeah, that was me). Those suckers are SLIPPERY!!! Moral of the story: I delivered a baby. It was pretty awesome.
A friend of mine was following a patient. She was a 19 year old girl, 24 weeks pregnant with her first baby. I never asked, but I don't think the baby's father was even as old as she was. When we came in that day, the plan was to stop her labor and send her to the antepartum unit for a long stay until her baby was old enough to deliver (probably around 34 weeks). Suddenly, my friend ran off because the girl was fully dilated and going to deliver. 24 weeks old is on the limit of viability. Sometimes they try to save them at 23. But at 24 weeks, the likelyhood of the baby living, let alone being normal and healthy, is slim. And we don't think the mother had a clue how serious the situation was. She was excited, anxious, and happy. She had no clue about the challenging journey her daughter was about to embark on. She was born weighing 1.5lbs. When my friend and I went to see her in the NICU, she was intubated, had two lines in her unbilical cord to deliver medicine and draw blood, her face was bruised from trauma, and you could see through her skin. When I left the service a week later, she was still hanging on. I don't know what the outcome will be, but I have spent a lot of time thinking about that little girl, and how far we push the limits.
Speaking of pushing limits, this last patient was probably more memorable than any. She was also 19 years old, and came to triage (pregnant lady ER as I like to call it) because she'd had fluid leaking for the last couple days. Her doctor told her he was worried her water had broken, so she was sent to see us. She was 22 weeks pregnant when she came in. After ultrasounding her belly, we found that she had virtually no fluid around her baby. Her water had broken 18 weeks early, and she was devastated. This was very much an intentional pregnancy. She wanted this baby. But rupturing at 22 weeks meant that not only was the survival of her baby in question, but whether or not they could even try to save it was unsure. Before 23 weeks, no one will attempt to resuscitate. So before she could even absorb what was going on, conversations about when to give steroids, when she wanted to set a cut off for resuscitation, whether she wanted a DNR, what to do if she got an infection were all happening.
A 23 week old baby is a remarkable, devastating miracle of modern medicine. I honestly don't know of any of them make it. They are million dollar babies, attended to continuously for the first months of their lives. Many don't survive. Most aren't "normal". But when you look at it, less than a pound, but with fingers and toes and a nose, how many parents would say, "no, don't try". Some do, and it takes strength and courage and understanding to be willing not to put their little one through what they go through. But some can't, because they know there is a chance that their little baby will be the one to turn out ok.
In the hallways of the NICU, there are pictures of many of the kids that have made it out. My favorite is of an 11 month old boy named grant, who is little for his age, but otherwise a normal baby. He was a 23 weeker. As I walked past that picture with one of the high risk maternal-fetal medicine fellows, he said "that is why we do what we do. He is why we keep pushing the limits."
So we push the limits of what we know is possible, hoping that the ones that make it can somehow live for the ones who couldn't.
Wednesday, February 3, 2010
So the idea for this blog came about after giving a sermon at a friends wedding. One of the things I've struggled with in medical school is coming to terms with the fact that I don't come up with all the answers, and there are consequences. I think the best way to kick off the blog is to post the sermon that prompted me to start it. Sorry for the length! The next post will be MUCH shorter... and there will be pictures. Enjoy!
Kari
____________________________________________________________________
When Sarah asked if I would be interested in preaching after her wedding, I was honored. I would have the opportunity to give Mr. and Mrs. Weaver their first sermon as a married couple. I could tell them about how marriage is great, or how it’s hard, or how it’s the start of a new life, or how it’s the continuation of the great life they already had. I could find oodles of scripture to support any of these statements, sculpt a perfect sermon straight out of a preaching class, and feel really great about the job I did. But, instead, I made the mistake of asking Sarah, “So, what should I preach about?” Her response: well, you’ve been in medical school for two years now. How about faith and medicine?
Hmmm. Faith and medicine. But I barely know anything about medicine. How am I supposed to integrate something as complicated and important as faith into it? So I started looking for scripture to base my sermon on. Something that says, “Being a doctor is important. Modern medicine is important. You are doing good. Keep it up.” Unfortunately, scripture like that doesn’t exist. Bummer. So I thought about all the ways I have experienced “faith and medicine”. I could talk about being the person who has to tell a mourning wife that the miracle she is hoping for isn’t going to come, while secretly praying that it will. Or about the constant struggle of questioning why bad things happen to good people, why the father of four dies while the person driving drunk that hit his car walks away. But these are experiences that we all have, in some way, at some point in our lives. Faith, driven in these moments by a solid religious background, or by dispair, desperation, frustration, or complete surrender, is more personal and intense than during times of calm. I am no more qualified to talk about faith in medicine, simply because I know the medicine, than the person sitting across from me, searching for faith. So, I feel under-qualified to talk about faith in medicine. Maybe I could talk about how being a Christian makes medicine so much easier because there is a guiding moral compass that tells me what the right decision is all the time. But the truth is, being a doctor (or, in my case, almost a doctor) and a Christian at the same time is often like playing twister with your little sister “spinning the arrow”. Somehow, it always seem like your right hand and left foot need to be on red, your left hand and right foot need to be on green, and just as you get comfortable in that spot, you need to switch them all at the same time. While wearing socks. And mittens.
During our first two years of school, we had a class called “Being a Physician”, otherwise known as BAP. The purpose of BAP was to expose us to the non-science side of medicine, the ethical, moral, and spiritual issues. The hope is to produce physicians who care about these sorts of things, to send forth into the world of medicine “good physicians” who are invested not only in treating disease, but also in healing people. And naturally, I want to be one of those doctors; one of the “good” physicians who always connects with their patients, makes ethical and moral decisions, and comes out the other side looking nothing short of stellar. I think Jesus was a pretty decent role model of how to be a good doctor. It would be an easier road if I could bestow miracles upon people, but alas, I cannot. So I’ll shoot for this. Love completely, recognize pain, minimize suffering, listen attentively, counsel honestly, study passionately, try harder. Not so different from what I aim for as a person… Now by no means do I think that to be a good physician you have to be a Christian, nor do I expect to ever nail this perfectly. But it’s something to shoot for.
Unfortunately, what I’ve learned during my two years of extensive medical training is this. The hard part of becoming a physician is not cramming thousands of pages of information into my head. For me, the hard part of becoming a “good” physician is feeling like I’ve failed at least on a weekly basis. When I walk into the hospital, I don’t walk in looking like Joe Shmo off the street. I walk in looking like a doctor, people assume I’m a doctor, and I am supposed to play the role of doctor. Patients don’t know that the short coat means I am inadequately prepared to answer their questions. They place their faith in me, and I constantly search for somewhere else to dump it. Because the questions that they ask and the decisions that need to be made are not about what antibiotic to take, or about what test to run next. They are questions like, “Am I going to die?”, “Why did this happen to me?”, “What would you do if this were your father?”, “What do I do now?“. They are questions that make that Christian moral compass spin like I’m are standing on the north pole. They are questions that make the twister board just a little bigger than my 5’6 frame can span. They are questions with more than one right answer, or more than one wrong answer, or just simply no good answer at all. And at the end of those conversations, I feel completely unsatisfied. I feel like I have failed my patient, and I feel like a bad doctor. But I think that in order to become a good doctor, sometimes I have to be a bad doctor.
Last summer, I worked at a sports academy not far from here, in Great Barrington, MA. The job I signed up for was to work in the infirmary, four or five shifts a week, with a doctor there every day to send the really sick kids to. The job I ended up with was working in the infirmary nearly 24 hours a day, with a physician there only the first 2 weeks out of 7. But I got into the groove of things pretty fast, and was running the place like a pro in no time. About the middle of the summer, I had a kid come in complaining of cramps in his calf at night. No big deal, it’s hot, the kids run around all day, he probably just needed fluid. So I told him to drink lots of water. A day later, he said he was drinking lots of water, the cramps were better, but his throat was sore. No shock there, EVERYONE at camp had a sore throat, including me. So I gave him some Tylenol, and told him to come back if it didn’t get better. Later that day, he came back. It wasn’t better. So he spent the night in the infirmary, and still wasn’t better the next day. His mom was worried, and came to came to take him to a doctor. His strep test was negative, but his mom decided to take him home for a few days anyway. The plan was for him to be back by Friday for the mid-session trip. On Thursday, we hadn’t heard from him so I called his mother to make sure he was still planning to come to Boston. When she answered, I could tell something was wrong. She told me that on the way home, her child had become unresponsive, and she had taken him straight to Yale Children’s Hospital. The previously healthy 14 year old was in diabetic shock and close to death. At the time I talked to his mother, he was still in the ICU at Yale, and she was distraught. How could this happen, she asked? How could he have gotten so sick in my care? How did I not notice he had lost weight? How did he get diabetes? What did we do to him? And I had no idea how to answer her questions. I listened for a good half an hour, and tried to explain the course of his care while he was in the infirmary. When she hung up, I was pretty convinced I was going to be kicked out of medical school and never become a doctor. I felt like a failure, like I had narrowly missed killing my first patient. How did I miss it? It made so much sense! Cramps from dehydration due to polyuria. Strep infection either as a physiologic stress that perpetuated the diabetes, or as a result of an immunocompromised state. Same with the oral thrush. Altered mental status, fatigue, all due to diabetic ketoacidosis. If I had only asked if he was peeing a lot, I totally would have diagnosed this new onset type 1 diabetes! But, I didn’t. In a panic, I called the physician who had worked in the infirmary with me for two weeks. I told Lance the whole story and asked him what I had missed, how I could have messed up so badly! And he told me I hadn’t missed anything. He told me that everything I did was perfectly reasonable and appropriate for what the kid was presenting with. He told me I did nothing wrong, and I would probably NOT be kicked out of medical school. That was somewhat of a relief. But I still felt like I had failed this kid. How could the outcome have been so close to tragedy if I did nothing wrong? How can I make reasonable decisions, and have bad outcomes??
This paradigm is one that I find most challenging in the Christian faith. Not the part of being a Christian where you read the bible and talk about old times and old people. Not even the part where you read about Jesus and the things he did, and get all sorts of good suggestions about how to live a Christian life. The hard part is where you leave church on Sunday morning, and have seven full days of living to get through. Seven days of rushing to the grocery store, and waiting in lines, and talking to inlaws, and going to work even when you don’t want to, and watching your favorite sports team lose. You have seven days of living to reflect who you are and what you believe. You show the world your character and your Christianity by the decisions you make and the actions your take. And in general, most of us get the basics. We don’t always do them, but we at least know when we’ve messed up. But then there are those situations where you just don’t know what to do. There’s an insurance commercial on right now. The tag line is, “I think most people want to do the right thing. They just don’t always know what that is.” And I think it’s those situations that challenge your faith and make you question, really really question, what kind of Christian you are. At least, I think those situations should make you question. Not because we are all bad people and need to be reminded of that. But because we need to be reminded that being a Christian should be a challenge. We should, at least every once in a while, wonder if we are doing it right. Because, it’s out the back end of those struggles that we figure out how to do it better. And it’s those situations that make the people around us better also.
Let’s take the story of the Good Samaritan. You’ve all heard it before. Many times, I am sure. In summary, a guy gets beat up and left in a ditch. A priest walks by, and passes without helping. A Levite walks by, and passes without helping. Then, a Samaritan comes along and helps the man. He takes him to safety on his animal, and the Samaritan makes sure he is taken care of. The moral of the story: Take care of those in need, don’t pass by someone in need, treat your neighbor as you would like to be treated. We know all that. There are any number of other theological interpretations about this parable, but I am a medical student, so we will leave those to the theologians. What I want to do is make the story of the good Samaritan a little more complicated.
We’ll keep the beginning the same, but we’ll fast forward to modern times. Someone in need is on the side of the road. The priest and the Levite drive by without helping, too busy to stop, too consumed in their iPhone’s and Blackberries to notice something is wrong, afraid they will get goo on their new shoes, afraid they won’t know what to do. Then the samaritan comes along. He, being the attentive person that he is, notices trouble in the ditch. He approaches the person, and finds it to be a woman. In labor. Holy crap, he thinks. I am just an accountant. I have NO idea what to do about this. The woman is screaming. No one else drives this particular road at this particular time. It’s just him and the lady. In labor. Still screaming. OK, he says to himself. I have two options. I can throw her in my car and drive the 15 minutes to the hospital, or I can try to deliver this baby right here. I have no idea how to deliver a baby. He asks the woman, “Is the baby coming soon?” She screams. Not helpful. He decides to deliver the baby. He gets a blanket from his car, the first aid kit he always carries, and thinks back to Doogie Houser. Within minutes, the woman delivers the baby. She stops screaming and starts crying. Thanks you, she says to the man, thank you for saving me and my baby boy. She names the boy after him. She names him Sam. The good Samaritan loads the woman and baby Sam into the car and rushes off to the hospital. When they arrive, baby Sam is crying, and mom is resting in the back seat. The ER staff whisks them away, and the good Samaritan waits for news. A man comes into the waiting room, asking about his wife. His wife, the woman who delivered a baby on the side of the road. The good Samaritan interrupts the man and says he was there, he delivered the baby, they were both ok when he last saw them. And the two men sit together and wait for news. Eventually, a doctor comes out. He takes a deep breath. “Your son, Sam, is doing well. He’s very lucky this good Samaritan delivered him when he did. Your wife was bleeding, and he wouldn’t have survived another few minutes.” “Ok” the husband says, “and how is my wife?” The doctor takes another, deeper breath. “Like I said, there was some bleeding. We tried to stop it, but she’d lost too much blood already. I’m so sorry, your wife died.” The husband broke down, sobbing. He was taken to see his wife and his son. The good Samaritan turns to the doctor and asks, “If I’d brought the woman here right away, if I hadn’t waited to deliver the baby, would she have survived?” The doctor looks at him and says, “She very well may have. We have no way of knowing for sure. But her baby boy most certainly would have died. You saved his life.”
So did the Samaritan make the right choice? It’s pretty clear that the priest and the Levite made the wrong choice. No one argues otherwise. But what about the Samaritan? He made a reasonable choice. The husband may argue the other would have been better. He may not. The fact of the matter is, it was a bad situation with a bad outcome, irrespective of the choice the good Samaritan made. In the end, he made a decision under pressure that he truly felt was the best one. The quality of our faith, the character displayed in our choices, isn’t necessarily best measured by outcomes. The good Samaritan would struggle after this incident. He would question if he made the right decision. He would blame himself for Sam not having a mother. He would ask God why this happened, why he had to be the one driving down the road at that particular moment. He would regret not staying at the hospital to talk to the now-single father. He would tell the story to his friend, who would tell other friends, and they would all wonder if they would have even stopped, would have even noticed. They don’t know what decision they would have made, but they were proud of their friend for making one. Even though the good Samaritan felt like a failure, others would hope to be as good a Christian as he was to that little baby boy on the side of the road.
In December, the Samaritan got a Christmas card from an address he didn’t recognize. He opened it and read the following message. “Friend, I don’t know if you remember me from months ago. I am the man whose son you saved on the side of the road. Sam is doing very well. He looks like his mother, who we miss terribly. But I thank God, and I thank you, for every day Sam and I have together. I hope Sam someday becomes as good a man as you are. God Bless.”
So maybe, in the end, this faith and medicine thing isn’t so hard. As a physician, I will time and time again make decisions with major repercussions. Sometimes, the outcome will be good. Sometimes it will be devastating. Sometimes, it will just be less than ideal. You all will also make decisions with major repercussions. They may be related to the health of you or your loved one. But challenges are clearly not isolated to the medical world. They are one of God’s little gifts to humanity. They are opportunities to figure out how you can do better at this being a Christian thing. Sometimes, you will feel like you’ve failed. But don’t give up. Love completely. Recognize pain. Minimize suffering. Listen attentively. Counsel honestly. Study passionately. Try harder.
Kari
____________________________________________________________________
When Sarah asked if I would be interested in preaching after her wedding, I was honored. I would have the opportunity to give Mr. and Mrs. Weaver their first sermon as a married couple. I could tell them about how marriage is great, or how it’s hard, or how it’s the start of a new life, or how it’s the continuation of the great life they already had. I could find oodles of scripture to support any of these statements, sculpt a perfect sermon straight out of a preaching class, and feel really great about the job I did. But, instead, I made the mistake of asking Sarah, “So, what should I preach about?” Her response: well, you’ve been in medical school for two years now. How about faith and medicine?
Hmmm. Faith and medicine. But I barely know anything about medicine. How am I supposed to integrate something as complicated and important as faith into it? So I started looking for scripture to base my sermon on. Something that says, “Being a doctor is important. Modern medicine is important. You are doing good. Keep it up.” Unfortunately, scripture like that doesn’t exist. Bummer. So I thought about all the ways I have experienced “faith and medicine”. I could talk about being the person who has to tell a mourning wife that the miracle she is hoping for isn’t going to come, while secretly praying that it will. Or about the constant struggle of questioning why bad things happen to good people, why the father of four dies while the person driving drunk that hit his car walks away. But these are experiences that we all have, in some way, at some point in our lives. Faith, driven in these moments by a solid religious background, or by dispair, desperation, frustration, or complete surrender, is more personal and intense than during times of calm. I am no more qualified to talk about faith in medicine, simply because I know the medicine, than the person sitting across from me, searching for faith. So, I feel under-qualified to talk about faith in medicine. Maybe I could talk about how being a Christian makes medicine so much easier because there is a guiding moral compass that tells me what the right decision is all the time. But the truth is, being a doctor (or, in my case, almost a doctor) and a Christian at the same time is often like playing twister with your little sister “spinning the arrow”. Somehow, it always seem like your right hand and left foot need to be on red, your left hand and right foot need to be on green, and just as you get comfortable in that spot, you need to switch them all at the same time. While wearing socks. And mittens.
During our first two years of school, we had a class called “Being a Physician”, otherwise known as BAP. The purpose of BAP was to expose us to the non-science side of medicine, the ethical, moral, and spiritual issues. The hope is to produce physicians who care about these sorts of things, to send forth into the world of medicine “good physicians” who are invested not only in treating disease, but also in healing people. And naturally, I want to be one of those doctors; one of the “good” physicians who always connects with their patients, makes ethical and moral decisions, and comes out the other side looking nothing short of stellar. I think Jesus was a pretty decent role model of how to be a good doctor. It would be an easier road if I could bestow miracles upon people, but alas, I cannot. So I’ll shoot for this. Love completely, recognize pain, minimize suffering, listen attentively, counsel honestly, study passionately, try harder. Not so different from what I aim for as a person… Now by no means do I think that to be a good physician you have to be a Christian, nor do I expect to ever nail this perfectly. But it’s something to shoot for.
Unfortunately, what I’ve learned during my two years of extensive medical training is this. The hard part of becoming a physician is not cramming thousands of pages of information into my head. For me, the hard part of becoming a “good” physician is feeling like I’ve failed at least on a weekly basis. When I walk into the hospital, I don’t walk in looking like Joe Shmo off the street. I walk in looking like a doctor, people assume I’m a doctor, and I am supposed to play the role of doctor. Patients don’t know that the short coat means I am inadequately prepared to answer their questions. They place their faith in me, and I constantly search for somewhere else to dump it. Because the questions that they ask and the decisions that need to be made are not about what antibiotic to take, or about what test to run next. They are questions like, “Am I going to die?”, “Why did this happen to me?”, “What would you do if this were your father?”, “What do I do now?“. They are questions that make that Christian moral compass spin like I’m are standing on the north pole. They are questions that make the twister board just a little bigger than my 5’6 frame can span. They are questions with more than one right answer, or more than one wrong answer, or just simply no good answer at all. And at the end of those conversations, I feel completely unsatisfied. I feel like I have failed my patient, and I feel like a bad doctor. But I think that in order to become a good doctor, sometimes I have to be a bad doctor.
Last summer, I worked at a sports academy not far from here, in Great Barrington, MA. The job I signed up for was to work in the infirmary, four or five shifts a week, with a doctor there every day to send the really sick kids to. The job I ended up with was working in the infirmary nearly 24 hours a day, with a physician there only the first 2 weeks out of 7. But I got into the groove of things pretty fast, and was running the place like a pro in no time. About the middle of the summer, I had a kid come in complaining of cramps in his calf at night. No big deal, it’s hot, the kids run around all day, he probably just needed fluid. So I told him to drink lots of water. A day later, he said he was drinking lots of water, the cramps were better, but his throat was sore. No shock there, EVERYONE at camp had a sore throat, including me. So I gave him some Tylenol, and told him to come back if it didn’t get better. Later that day, he came back. It wasn’t better. So he spent the night in the infirmary, and still wasn’t better the next day. His mom was worried, and came to came to take him to a doctor. His strep test was negative, but his mom decided to take him home for a few days anyway. The plan was for him to be back by Friday for the mid-session trip. On Thursday, we hadn’t heard from him so I called his mother to make sure he was still planning to come to Boston. When she answered, I could tell something was wrong. She told me that on the way home, her child had become unresponsive, and she had taken him straight to Yale Children’s Hospital. The previously healthy 14 year old was in diabetic shock and close to death. At the time I talked to his mother, he was still in the ICU at Yale, and she was distraught. How could this happen, she asked? How could he have gotten so sick in my care? How did I not notice he had lost weight? How did he get diabetes? What did we do to him? And I had no idea how to answer her questions. I listened for a good half an hour, and tried to explain the course of his care while he was in the infirmary. When she hung up, I was pretty convinced I was going to be kicked out of medical school and never become a doctor. I felt like a failure, like I had narrowly missed killing my first patient. How did I miss it? It made so much sense! Cramps from dehydration due to polyuria. Strep infection either as a physiologic stress that perpetuated the diabetes, or as a result of an immunocompromised state. Same with the oral thrush. Altered mental status, fatigue, all due to diabetic ketoacidosis. If I had only asked if he was peeing a lot, I totally would have diagnosed this new onset type 1 diabetes! But, I didn’t. In a panic, I called the physician who had worked in the infirmary with me for two weeks. I told Lance the whole story and asked him what I had missed, how I could have messed up so badly! And he told me I hadn’t missed anything. He told me that everything I did was perfectly reasonable and appropriate for what the kid was presenting with. He told me I did nothing wrong, and I would probably NOT be kicked out of medical school. That was somewhat of a relief. But I still felt like I had failed this kid. How could the outcome have been so close to tragedy if I did nothing wrong? How can I make reasonable decisions, and have bad outcomes??
This paradigm is one that I find most challenging in the Christian faith. Not the part of being a Christian where you read the bible and talk about old times and old people. Not even the part where you read about Jesus and the things he did, and get all sorts of good suggestions about how to live a Christian life. The hard part is where you leave church on Sunday morning, and have seven full days of living to get through. Seven days of rushing to the grocery store, and waiting in lines, and talking to inlaws, and going to work even when you don’t want to, and watching your favorite sports team lose. You have seven days of living to reflect who you are and what you believe. You show the world your character and your Christianity by the decisions you make and the actions your take. And in general, most of us get the basics. We don’t always do them, but we at least know when we’ve messed up. But then there are those situations where you just don’t know what to do. There’s an insurance commercial on right now. The tag line is, “I think most people want to do the right thing. They just don’t always know what that is.” And I think it’s those situations that challenge your faith and make you question, really really question, what kind of Christian you are. At least, I think those situations should make you question. Not because we are all bad people and need to be reminded of that. But because we need to be reminded that being a Christian should be a challenge. We should, at least every once in a while, wonder if we are doing it right. Because, it’s out the back end of those struggles that we figure out how to do it better. And it’s those situations that make the people around us better also.
Let’s take the story of the Good Samaritan. You’ve all heard it before. Many times, I am sure. In summary, a guy gets beat up and left in a ditch. A priest walks by, and passes without helping. A Levite walks by, and passes without helping. Then, a Samaritan comes along and helps the man. He takes him to safety on his animal, and the Samaritan makes sure he is taken care of. The moral of the story: Take care of those in need, don’t pass by someone in need, treat your neighbor as you would like to be treated. We know all that. There are any number of other theological interpretations about this parable, but I am a medical student, so we will leave those to the theologians. What I want to do is make the story of the good Samaritan a little more complicated.
We’ll keep the beginning the same, but we’ll fast forward to modern times. Someone in need is on the side of the road. The priest and the Levite drive by without helping, too busy to stop, too consumed in their iPhone’s and Blackberries to notice something is wrong, afraid they will get goo on their new shoes, afraid they won’t know what to do. Then the samaritan comes along. He, being the attentive person that he is, notices trouble in the ditch. He approaches the person, and finds it to be a woman. In labor. Holy crap, he thinks. I am just an accountant. I have NO idea what to do about this. The woman is screaming. No one else drives this particular road at this particular time. It’s just him and the lady. In labor. Still screaming. OK, he says to himself. I have two options. I can throw her in my car and drive the 15 minutes to the hospital, or I can try to deliver this baby right here. I have no idea how to deliver a baby. He asks the woman, “Is the baby coming soon?” She screams. Not helpful. He decides to deliver the baby. He gets a blanket from his car, the first aid kit he always carries, and thinks back to Doogie Houser. Within minutes, the woman delivers the baby. She stops screaming and starts crying. Thanks you, she says to the man, thank you for saving me and my baby boy. She names the boy after him. She names him Sam. The good Samaritan loads the woman and baby Sam into the car and rushes off to the hospital. When they arrive, baby Sam is crying, and mom is resting in the back seat. The ER staff whisks them away, and the good Samaritan waits for news. A man comes into the waiting room, asking about his wife. His wife, the woman who delivered a baby on the side of the road. The good Samaritan interrupts the man and says he was there, he delivered the baby, they were both ok when he last saw them. And the two men sit together and wait for news. Eventually, a doctor comes out. He takes a deep breath. “Your son, Sam, is doing well. He’s very lucky this good Samaritan delivered him when he did. Your wife was bleeding, and he wouldn’t have survived another few minutes.” “Ok” the husband says, “and how is my wife?” The doctor takes another, deeper breath. “Like I said, there was some bleeding. We tried to stop it, but she’d lost too much blood already. I’m so sorry, your wife died.” The husband broke down, sobbing. He was taken to see his wife and his son. The good Samaritan turns to the doctor and asks, “If I’d brought the woman here right away, if I hadn’t waited to deliver the baby, would she have survived?” The doctor looks at him and says, “She very well may have. We have no way of knowing for sure. But her baby boy most certainly would have died. You saved his life.”
So did the Samaritan make the right choice? It’s pretty clear that the priest and the Levite made the wrong choice. No one argues otherwise. But what about the Samaritan? He made a reasonable choice. The husband may argue the other would have been better. He may not. The fact of the matter is, it was a bad situation with a bad outcome, irrespective of the choice the good Samaritan made. In the end, he made a decision under pressure that he truly felt was the best one. The quality of our faith, the character displayed in our choices, isn’t necessarily best measured by outcomes. The good Samaritan would struggle after this incident. He would question if he made the right decision. He would blame himself for Sam not having a mother. He would ask God why this happened, why he had to be the one driving down the road at that particular moment. He would regret not staying at the hospital to talk to the now-single father. He would tell the story to his friend, who would tell other friends, and they would all wonder if they would have even stopped, would have even noticed. They don’t know what decision they would have made, but they were proud of their friend for making one. Even though the good Samaritan felt like a failure, others would hope to be as good a Christian as he was to that little baby boy on the side of the road.
In December, the Samaritan got a Christmas card from an address he didn’t recognize. He opened it and read the following message. “Friend, I don’t know if you remember me from months ago. I am the man whose son you saved on the side of the road. Sam is doing very well. He looks like his mother, who we miss terribly. But I thank God, and I thank you, for every day Sam and I have together. I hope Sam someday becomes as good a man as you are. God Bless.”
So maybe, in the end, this faith and medicine thing isn’t so hard. As a physician, I will time and time again make decisions with major repercussions. Sometimes, the outcome will be good. Sometimes it will be devastating. Sometimes, it will just be less than ideal. You all will also make decisions with major repercussions. They may be related to the health of you or your loved one. But challenges are clearly not isolated to the medical world. They are one of God’s little gifts to humanity. They are opportunities to figure out how you can do better at this being a Christian thing. Sometimes, you will feel like you’ve failed. But don’t give up. Love completely. Recognize pain. Minimize suffering. Listen attentively. Counsel honestly. Study passionately. Try harder.
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