The Corpus Callosum

Only a Number?

I
specifically remember a phrase from a handout I read in the second
year of med school, imploring us to not depersonalize patients by
referring to them, for example, as “the pancreas in room XXX.”

That was the thought that I had when I saw a photo in the LA Times:

i-1a7b05d39ee5f967152242c661e4ced8-only-a-number.jpg

This
is only a part of the photo, the whole thing is unpleasnt to see.
 It is from a 3-part feature on the treatment and fate of
soldiers wounded in Iraq.  

I think it is a bad sign when someone writes a number on your chest
with a magic marker…
 


i-7f9dd33ca7215a7c31a6ec926839c969-only-a-number2.jpg


I
mean, I can see why they do it.  It probably helps, in two
ways.  One, you don’t want to operate on the wrong patient.
 Two, doing that kind of work, you probably have to,
to some extent, depersonalize the patient.

In a situation like this, you are specifically not
trying to establish a long-term treatment relationship with the
patient.   On the contrary, you are trying to get the guy
stabilized and moved on as quickly as possible.  

That is not to say that you don’t care about the
patient.  I am sure the medical personnel care deeply about
every one of them.   So it is not about a lack of concern.
 It is about protecting yourself from psychological trauma, as
a health care provider in a high-mortality setting.

href="http://www.latimes.com/news/nationworld/nation/la-na-wounded2apr02,0,2610364.story">Bringing
Back the Wounded With Heart, Soul and Surgery

Injured
troops are swept up in a lifesaving process unmatched in past wars –
reaching hospitals in minutes and the U.S. in days. But their agony
doesn’t end on the battlefield.

By David
Zucchino, Times Staff Writer

April 2, 2006

Vincent
Worrell lay shivering on a trauma bay. He felt something in his mouth.
He sat up and spat fragments of his front teeth into a bedpan. They
were mixed with blood and tissue torn from inside his mouth.

He
heard someone say: “Significant laceration to the cheek and lip.” And
then: “Frag under the eye … frag in the face …
frag in the shoulder … possible thumb fracture.”

A
bomb fashioned from two mortar rounds had detonated a few feet behind
Worrell, an Army staff sergeant, as he walked on patrol near Tall Afar
on the morning of Nov. 6. Now he was inside the Air Force Theater
Hospital, a tight web of interlocking tents set up on packed sand 50
miles north of Baghdad.

Worrell
was groggy; he had been given morphine.

He
asked a doctor: “Will I need reconstructive facial surgery?”

“Nope,
just some new teeth.”

Worrell
glanced down and was surprised to see a Purple Heart resting between
his legs. Somehow the medal made him think of his wife, Jayme.

“My
wife’s going to be pissed,” he told the doctor. “She specifically gave
me instructions not to get perforated over here.”…


I must say, I have a lot of respect for the people who can
do this kind of work, and simultaneously care about the patient enough
to be decent, but not so much as to open oneself to psychological
trauma.  It must be especially difficult to do this, when the
patient starts talking about his family.  

I wish them well: the patients and the medical personnel.

So when I say we need to end this war, bring these people home, it is
not because I don’t “support the troops.”  In fact, I find it
offensive when people say things like that.  It is just that I
think the best way to support them is to get them out of there.

Comments

  1. #1 bill
    May 20, 2007

    Let’s not argue about this–I’m not in favor of war, certainly, but is getting our own troops out of there the best thing for Iraq? Or for the world? We have to think bigger than just our own.

  2. #2 Greg P
    May 20, 2007

    1. I think when you’re talking about triage on the level done in the battlefield, in a war zone, the nice little wrist bracelets we use in our ERs may be impractical and too time-consuming to read.

    2. To me it’s not just about pulling our troops back to safety, it IS looking at the big picture — what are we accomplishing over there? Are we “winning” anything? Is Iraq now better off in ANY way?
    We send troops to a horrific situation, risking their lives. We punish them because under these conditions they lose control and kill Iraqi civilians. It’s hard to see the good coming out of this.

  3. #3 bill
    May 20, 2007

    Bagdhad is a mess, certainly, but other parts of the country are doing well–much better than under Saddam. Schools, women voting, work. No more rape rooms, torture, disappearings, etc. A recent poll showed a mojority of Iraqis think things are much better.

    My brother-in-law was there twice in special forces. His life was being risked, and he understood that well. He wants to go back because he saw how much better off the Iraquis are now. And I’ll take his word for it over any senator, Republican or Democrat.

  4. #4 Joseph j7uy5
    May 20, 2007

    Something like two million Iraqis have fled the country, another million are internally displaced, the death rate is much higher than it was under Saddam, there is more infant malnutrition. The unemployment rate is astronomical.

    I don’t listen to senators either; I listen to scientists.

  5. #5 jderby
    May 20, 2007

    “I don’t listen to senators either; I listen to scientists.”

    Well. Can’t argue with that logic. A biologist certanly has it all over someone who’s been there. Maybe a chemist can tell us what’s up. Glad you know where to get all the facts.

  6. #6 Joseph j7uy5
    May 21, 2007

    Look, it is impressive that the guys brother-in-law was there. Maybe he knows something. But there have been studies of mortality and of infant health, and of population movements, and those studies probably give a better picture of what is going on. One person’s observations are just that.

  7. #7 bill
    May 21, 2007

    Well, here’s some science from scientists whose experiment was living in Iraq–Iraquis! http://www.timesonline.co.uk/tol/news/world/iraq/article1530762.ece

    “The survey of more than 5,000 Iraqis found the majority optimistic despite their suffering in sectarian violence since the American-led invasion four years ago this week.”

    The question really is: will the Iraquis be better off if we leave? That’s the question. Pulling out now may be better for us–but what about for them? Do the Iraquis matter? “We shouldn’t have done it” is not an answer to this question. Deal with today’s reality.

  8. #8 Joseph j7uy5
    May 21, 2007

    The poll was not done by scientists. It was done by ORB, which, on their website(http://www.opinion.co.uk/who-we-are.aspx), they describe themselves as a corporate and issues-led market research company. Plus, that same poll said:

    One in four Iraqis has had a family member murdered, says the poll by Opinion Research Business. In Baghdad, the capital, one in four has had a relative kidnapped and one in three said members of their family had fled abroad…More than half say security will improve after a withdrawal of multinational forces.

    To the extent that they are optimistic, it is because they think the situation will improve after after the foreign fighters leave.

    The details of the survey are here: (http://www.opinion.co.uk/Newsroom_details.aspx?NewsId=67)

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