When I had a little time to indulge in pob for a while, the word of the week caught my attention, do not hesitate to look for it to remember its definition, although I had heard it, it is not so common, I have tried for a long time to practice various aspects of the meaning of it.
I stopped to recall a conversation I had with a childhood friend who became my colleague, after years without communication he shared with me that he is doing the postgraduate degree in Neurosurgery.
Among the shared experiences I never forget, the words my brother always used to joke with us both (you are in a military career, there is always and there will always be a hierarchy).
What I still find unforgettable is the story told by my friend while in R3 (second-year graduate resident), where he is delegated more responsibility, such as preparing patients for the operating room and being present in surgical interventions, as well as being attentive to R2, R1, plus emergency and ward patients, one of those days on call, in which he was in the operating room, he told me that he carried out a routine intervention with success, after about 3 hours of work, then he went down to emergency to supervise your Residents and the emergency ...
It is achieved with the unique scene where her R1 is giving cardiopulmonary resuscitation to a young woman of approximately 21 years of age, who had fallen into post-arrest after multiple repetitions of clonic tonic seizures, product of a malignant end-stage brain tumor, which it manifested itself with the seizure clinic. The cardiopulmonary resuscitation being satisfactory, managing to connect the young woman to mechanical ventilation.
When my friend evaluates the Glasgow scale (it is a scale that quickly assesses eye opening, verbal and motor response), obtaining a score of approximately 3 in the patient (the normal value being 15 points) and then performing other maneuvers complementary, my dear friend realizes that the patient is brain dead (it was literally a corpse connected to an artificial respirator)
Upon realizing this, he called his residents to tell them that the behavior taken was not right. On the contrary to his point of view, it was to prolong the suffering of the patient and also of the relatives, although the fact had already occurred, he made his point of view clear.
To his surprise, the young woman's relatives were of very limited resources and her residence was also far from the capital, where we were, who had been referred so far due to the complexity of the pathology.
It is with sadness that I think and analyze the reality of this family, which they did not even have to eat, they fed on the solidarity of the relatives of other patients, they did not have anywhere to rest, and the agony lasted for 15 days, that was the time in which this patient was connected to the mechanical ventilator.
Observing both scenarios, how would you judge this reported fact with equanimity?
Observing the panorama from the point of view of the R1 who were alone, in the face of an imminent emergency that threatened to take the life of a young patient, and as the duty of a doctor to act "to save her life, for an instant"
Or do you prefer to see the perspective of a family which suffered in many ways and for a long time?, Without any resources that they risked even what they did not have to seek help and save the life of their young daughter
Wait a minute, the medical terms just got complicated
Please break it down for me
Did you mean the patient was already dead but the medical personnel in charge connected her to the artificial respirator in order to extort money from her relatives?
Damn, if that is what it was about, then that was a terrible act, and I am glad your friend was against it
Medically the patient was already dead, although she had signs after resuscitating her, her ability to respond to different stimuli, such as vision, hearing, or reaction to pain, and other factors, was completely null.
At that point is where we declare what is called brain death, it is a state from which very, very little has been able to return.
And to be honest of the cases in which I have had brain dead patients, none have been able to return!
Oh it is such a pity
May I ask how you normally deal with such losses or cases where you can not do anything to save a life?
Being level headed in the face of adversity is the key to equanimity. Calm, cool and collected.
I did not get enough of a factual basis though to respond to the question you posed. I presume, however, your friend had the presence of mind based upon experience and familiarity of the situation to make a fair and proper medical decision under the circumstances.
Good luck in the contest.
In effect, to date, he maintains a position which makes clear the fact that he did not agree with the resuscitation of the patient.
Thank you for your comment!
I think it is because of these cases that in other countries euthanasia is considered as an option.
It is evident that both the relatives and the patient suffered much more than expected.
It is here where in my opinion, the divine will enters, everything that happens in our lives has a purpose and we cannot go against it!
If there are complex cases which anyone could believe is the best option.
I share the thought that we do not have the right to take life. It must and must be something that only a supreme being must decide, we are simply an instrument!
A great story and paradigm here. Despite being a sad story.
This is the kind of situation that nobody or I believe that almost nobody wants to choose to go through.
A point well raised for you. Many people will want to respond to your views here, calmly, well relaxed in their homes and in a rational way. But this is invalid.
The real answer is the one that will happen for those who are experiencing this tense and complicated moment. With emotions difficult to control. Perhaps the doctor who is already used to this type of situation throughout life is more calm and rational. But a mother with her child has no equanimity to help. Only if she came from a family with strong roots and an understanding of these difficult situations and about "life after death".
He has hit a good point, it is not pleasant for a person to be in that situation.
On the other hand, as a doctor, I have to see situations that in general would surprise other people a lot, I think that is why we are being prepared from the second year of the degree, but something will always happen that will not be so easy to forget. Like a sudden rise in pressure, which literally causes a brain to cook, they are things that no matter how much you have seen, the complexity of the body does not cease to amaze!
And this is really encouraging when you have hope after death, I have seen relatives of patients who die in total peace, it is something that when it happens, I am more convinced that there is a supreme being.
Just reading the story brought to my mind a moment of pain and sadness, but being a mother the loss of a child is strong. A mother who is equanimyti at that time like this, have a very strong mind, because the pains of loss of relatives are very painful moments and some little recoverable before that pain.
Yes and it is that the perception that all or most of us have, is that a mother should not see a child die, although the reality in a hospital does not respect that norm.
As time passes I will share with you experiences that you may not have heard, which happen in a hospital, where it has nothing to do with whether or not you are someone with power or someone in common, when death knocks at the door, we can do nothing!