Just Me Raising Questions I Can't Answer

I've been one of the fortunate few to be in the MICU (medical intensive care unit) currently. While I really don't consider myself fortunate to have the hardest block last (16 days of 'tern life left!), it is, however, an eye-opening experience to care for the sickest patients in the hospital. I'm generalizing to say the majority of patients roll into the unit mostly dead, but its hard to adequately describe just how profound the medical deficiencies these patients have, and somehow 'disarray' just doesn't cut it. The proverbial "poo hitting the fan" is probably a better descriptor.

It goes without saying, the capabilities of modern medicine have had exponential advances in the last half century. This does not mean, however, that we, as docs, should advance ourselves to the dangerous precipice of dictating life and death. But, it does seem at times that though we are not the authors of life and death, we can temporize it more than just a little. There is no better example of this than working in an ICU.

Almost mirroring the rise of medical advances, the expectations for the medical field are at an all-time high. The iconic example is curing cancer, but my impression from interacting with a host of patients is, as a society, we expect to never get sick, or at the very least never have our life impacted by disease. This became ever more clear to me after hearing the words spoken by the mother of one of my patients. "I want everything done for my son, there should be nothing held back," she said. Without the proper context, an innocuous statement to be sure. I have to be careful because of HIPAA, but what if I mentioned the patient was around my age. Would that change your reaction? How about if I said that he/she had no less than four major body systems not working, one of which being the brain? What if you knew this all came about because of a deliberate action by the patient? And finally, what if I mentioned the patient had no insurance whatsoever. Would that change anything?

Expectations are good, they push us to excel and reach goals we thought previously not possible. But at the same time, expectations are also quite unwieldy when they are out of proportion to reality. This is the frustration I have experienced time and again this year. As a physician I am expected to heal, to cure, to make all right again; but at what cost? At what cost to me? At what cost to other doctors and nurses? At what cost to the hospital? At what cost to society? I'm not speaking entirely monetarily, but certainly that is a piece of the grander puzzle. I can understand society's expectations for medical care, but doesn't quality of life matter too? Sure I can keep a patient alive on a ventilator for years, but is that whats best given their life consists only of bed sores and recurrent infections?

I've entered wholly into the philosophical realm and I don't have an answer for my previous question. Maybe to you, its a stupid question. But then likely, you haven't seen the horrors I have.