Ignore

It happens all the time in the world of trauma – we take care of people that most would rather ignore. 

Somewhere in the depths of this city a cycle of gang-related violence led to the death of several innocent women and children.  The suspected murderer was the target of a police raid, and when that raid got violent his motionless body came into our trauma center.  His airway was controlled, his brain was scanned, his pressures were normalized…within a week he was finally talking, and within two weeks was read to leave. 

This patient was under police custody, and so there were guards outside his room.  Armed guards.  And it was always odd walking past them to see our patient.  It felt a little like we were crossing a picket-line.  The police exist to protect us, or so we’re told, and here we were trying to take care of someone they were trying to put away.  We literally had to ask them to step aside so we could see our patient.  They would always look at us as we entered his room, and if to ask us why we were taking the time.  One day the guard was looking down at the patient’s mug shot – the guard was smiling and shaking his head, saying how he’d “been looking for this one for years.”  I remember being struck by the word “years.”  The patient was only a teenager – how long could the police have been searching for him?  More recently when we exited his room and the door closed, the guard uttered “I don’t know how you all do it; this is a really bad guy – really bad.” 

If I told you what this patient had done, and why the police cared so much about it, I’m willing to bet that you would agree that he did something absolutely terrible.  The worst, repulsive thing imaginable.  But we had no choice.  He was our patient, and we’re under oath to take care of people, just as the police are under oath to protect and serve.  There’s just no other option.  Patients are patients, people in need are people in need.  It’s rather simple, really.    

And so there we found ourselves each day, police and doctors, looking at each other with vastly different motives.  I’m not certain if there was mutual respect or not. 

Our patient improved, and was discharged – to jail.  What his fate will be is uncertain – I suppose it’ll be in the news one day soon.  Or maybe it’ll just go ignored

Bloodless

At this point in my life and career, there’s really no reason for much of anything to surprise me.  Not that I’ve seen it all or anything – far from it – but I’ve seen enough to know that most anything is possible. 

But I guess I’m always somewhat disappointed to find that those of us in the medical world are genuinely surprised by matters of faith.  Men and women have been dying for their beliefs since, well, forever.  The whole point is that one’s faith is stronger than what is logical to those who don’t share that same faith.  That’s why wars are fought, and it’s why people – even the very young – dye happily when they don’t necessarily have to. 

And the other day that happened right here.  A young women – she was twenty – was mauled by her neighbors dogs.  Six of them, in fact – six dog she knew – somehow went crazy and attacked her.  As you can imagine they did a lot of damage.  Her scalp was nearly completely ripped off; her left breast was torn in two; there were slashes and puncture wounds that were too many to count scattered throughout her body.  Under normal circumstances these would be terrible injuries, but nothing that we likely couldn’t get you though.  However, this women posed a unique problem, because she was a Jehovah’s Witness. 

Jehovah’s Witnesses are a branch of Christianity – nearly 8 million strong – who, amongst other beliefs, refuse blood transfusions.  According to their official website (jw.org):

This is a religious issue rather than a medical one. Both the Old and New Testaments clearly command us to abstain from blood. (Genesis 9:4; Leviticus 17:10; Deuteronomy 12:23; Acts 15:28, 29) Also, God views blood as representing life. (Leviticus 17:14) So we avoid taking blood not only in obedience to God but also out of respect for him as the Giver of life.

While all denominations hold certain beliefs, I can say that, in my experience, this particular belief amongst Jehovah’s Witnesses is unwavering. 

And so our young patient was in a bad place.  Her blood count was already dangerously low when she arrived, and by the time she was done with her necessary surgery to repair her scalp and clean her wounds her counts had dropped even further.  Truthfully, they were nearly incompatible with life. 

While I can’t predict the future I can say this: in my best estimate with blood transfusions this young lady would have walked out of this hospital in four or five days with some really bad scars but no lasting disability.  Without a transfusion, she would likely die.  The patient was awake enough to understand these words and she insisted on not receiving a blood transfusion.  Her mother was at her bedside and was adamant about honoring her daughter’s wishes. 

Within two days her brain was showing signs of not receiving enough oxygen.  By the fourth day she was brain-dead.  I guess it was a peaceful death. 

And all she needed was some blood.  A few bags hanging amongst her other IVs.  Maybe nobody would have even noticed.  We routinely transfuse our trauma patients.  It’s so easy. 

But this women didn’t want it, and while that’s nearly impossible for us to understand I guess that’s not really our job.  We’re here to serve, and sometimes that means putting the patients’ beliefs over our own understanding of life.  We did what this women and her family wanted, and I suppose for that we honored her.  But by the same token we sat back and watched her die, when the treatment was literally within out grasp.  If she had walked in off the street and asked us to help us die we would have refused.  Somehow this was just enough different. 

At least, I pray it is.