Now and then, amid the stories of financial conflict, medical errors
and political intrigue that so often undermine health care, comes a
story of the miraculous, where patients in impossible conditions not
only survive, but thrive, due to the skill and resources of many
dedicated clinicians, due to luck and due to who knows what
extraordinary circumstances that are still beyond our understanding.
The New York Times has a story like this today.
On December 7th, Alcides Moreno and his brother Edgar, window washers,
fell 47 stories down the side of the Upper East Side apartment building
they were working on. His brother was killed instantly, but Alcides
survived, consuming 24 units of blood and 19 units of plasma. In a
coma, he went through 9 orthopedic operations, and then amazingly – I’m
not making this up – awoke on Christmas Day.
incredible still, Mr. Moreno is now on a path to full recovery, at
least from the looks of it, walking and talking as he did before his
fall. This has prompted Dr. Philip Barie, the chief of the Division of
Critical Surgery at the hospital where Mr. Moreno is being treated to
comment, “If you believe in miracles, this would be one.”
A David Bowie movie, anyone? Check out this story.
I agree with all you say about emergency medicine, but my comment specifically addressed the trauma system, a subset of our emergency room care, as the shining star. Its strengths, however, have improved care for other dire surgical emergencies such as ruptured aortic aneurysms, etc.
Addressing the totality of cases seen in ER’s, I think the huge overburden on them inherent in our healthcare dysfunction has put most of them, and their staffs, under unimaginable stress. The new reluctance of specialists to come in and see emergently sick patients has exacerbated this problem immensely. I know a few of the practitioners (both M.D’s and nurses), and the strain is showing.
There’s no question that you’re right about this, and that this view is terribly under-appreciated by the public. Emergency departments must, at a moment’s notice, be prepared for the entirety of the human condition, from hangnails and gunshots to heart attacks and infectious disease. Now add to this the fact that we’ve allowed EDs to become default primary care clinics. The requirement that they deal with such complexity and variation contributes to the difficulties it has demonstrated in obtaining efficient organization. I agree with you that Emergency Medicine is one of health care’s shining stars.
And by the way, I will add a note from personal experience. I have found that, as a group, Emergency Physicians tend to be more socially conscious, selfless, and systems-oriented about the changes necessary to fix health care. Unlike office-based physicians, they tend to see patients from every walk of life, and their view of the world becomes far more expansive. Many of the most open-minded and progressive physicians I’ve known have come from Emergency Medicine.
I think at least 2 of these stories have hit on one of the strengths of our healthcare system (after we’ve examined its weaknesses exhaustively on this blog), and that is its trauma system. I think I am right in saying that a large part of this system grew out of what the military learned during the Vietnam war. Interestingly, trauma care is one of the areas where care protocols and checklists are used extensively. (Also, it’s more “sexy” than chronic care and therefore may attract the best practitioners – even though many of the victims are uninsured.)
There were some mutterings at the time of Princess Di’s accident that she may have survived if she had been in the U.S.
Wonderful story, Doug. Your daughter’s a very fortunate young woman, and you’re a lucky man.
Chester, I feel strongly that it is not a double standard (which would imply intentional provision of care to some and withholding it from others), but rather a case of variable quality throughout the system. I also believe that the tools that are now coming online will go far to help professionals and institutions improve quality at every level of the system.
A few years ago, a colleague of mine’s son was crushed by falling metal at a construction site. The metal nearly cut him in half. Through many surgeries, he has survived and has regained almost all normal function. He has three children, and the youngest was born just a few months before his accident. Survival stories like these fill me with hope and at the same time enrage me when people die of minor complications. It seems that medical science (and the practice there of) has a strange double standard.
Here’s another medical miracle story for you. My 20 year old daughter Marissa probably should have died from a massive stroke in Oct. 2006. She was saved by some quick-acting friends, skilled surgeons and some incredible technology, the MERCI system from Concentric Medical. See video below from Today Show 10/27/06.
Enjoy your blog.