10:56 – The Minute a Patient’s Life Ends and a Medical Student’s Life Changes

By Rachael D’Auria

The hierarchy in medicine, dark humor used to cope with difficult patients, and embarrassment of not knowing answers to endless questions being thrown your way are some of the many horror stories students above me have attempted to prepare me for. However, no amount of preparation could prepare me for witnessing my first death.

As I watched the residents add notes to patients’ charts, an announcement over the loudspeaker made all the physicians abruptly look up from their computers. “A 79-year-old male is being transported to the ER in a full code.” Immediately, residents, nurses, and attending physicians started prepping the trauma bay, as I, a rising second-year medical student doing clinical research in the emergency department, attempted to stay out of everyone’s way. I squeezed myself into a corner of the trauma bay and made sure I was not blocking any important machinery. The trauma bay erupted with activity as EMS workers rolled the patient into the room while administering CPR and rhythmically squeezing the ventilation bag. He was quickly moved onto the trauma bed and the CPR machine continued chest compressions. The patient’s wife sat near the room’s entrance as the team administered epinephrine, calcium chloride, and bicarbonate while attempting to intubate him.

Every few minutes, a nurse called out “pulse check,” and the resident briefly turned off the CPR machine. The room held its breath with anticipation for a returned pulse, but the resident would respond, “No pulse.” Every time I heard this, my spirits declined as I stole a look at the patient’s disappointed wife. I watched the patient’s wife text family members, the physicians’ hopeless looks after administering another medication, and the machines showing no cardiac movement. After 50 minutes of the pounding CPR machine attempting to revive this patient, the resident and attending talked to the patient’s wife and described what they had done and the poor prognosis. Ultimately, they turned off the CPR machine and called out, “10:56,” and silence took over the room. While I have seen family members in open casket funerals and cadavers in the anatomy lab, I had never witnessed someone pass away before 10:56 a.m. on that Monday morning. The nurse called for a moment of silence to appreciate the valiant efforts of the team, and then the medical team filed out of the room and carried on with their day.

I felt noticeably sad for the remainder of my shift as I grieved this patient I had never met. I felt guilty for feeling this way as his wife held his hand to say her goodbyes because I played no role in his medical care nor did I know this patient. Even though the medical team carried on with their day seemingly unaffected, I imagine many of the caregivers in that room felt the aftereffects of witnessing a passing of a life throughout the rest of their day. As I processed the passing of this man’s life, I realized the importance of building an emotional attachment to patients and allowing myself to address my emotions no matter the duration of a patient interaction or my role in medical care. I will carry this lesson forward in my medical education, as I inevitably am forced to cope with countless tragedies.

 

Rachael D’Auria is a second-year medical student at Drexel University College of Medicine. She is passionate about bioethics and hopes to continue researching ethical dilemmas occurring in patient care settings throughout her clinical years.

In the Defense of Plastic Surgery as a Feminist Choice

by Anu Antony

 

I am a plastic surgeon, a profession that involves understanding women’s aspirations not only in the corporeal sense, but also being cognizant and mindful of their psyche – the inner thoughts and feelings that drive them to choose plastic surgery.

While choosing plastic surgery can be an empowering undertaking, many women still harbor feelings of guilt. Will their friends and family will think they have succumbed to societal pressure to look a certain way?

Remarkably, many women can feel guilty even when they are getting breast reconstruction surgery after mastectomy. Reconstruction surgery is now widely accepted as a medical treatment for cancer patients – although the breast once removed is not a functional organ like a kidney or liver. I’ve even been told by other medical professionals that I am a “real doctor” because breast reconstruction surgery is my specialty. But a generation ago, even breast cancer patients seeking reconstruction were chastised for seeking procedures that were considered superficial and unnecessary.

Changing attitudes were reflected in 1998 when the Women’s Health and Cancer Rights Act (WHCRA) legalized the right for patients to seek out breast reconstructive services and have those procedures covered by insurance. Perhaps the fact that insurance provides this coverage as a medical necessity gives many patients comfort they are not seeking superfluous cosmetic procedures.

But women seeking other kinds of plastic surgery often still don’t receive the same empathy that my breast reconstruction patients receive. I am wondering if we can broaden this conversation. Might plastic surgery become a right for women to choose?

In my conversations with patients, I hear patients express their desires. Some wish to restore that which cancer took away. Some want to defy their genetics. Others want to undo the effects of pregnancy on their body. I have yet to hear a woman say she is acquiescing to a societal demand for perfection.

To take the “defy genetics” notion a step further, consider gender confirmation surgery. Kaitlin Jenner and others like her have highlighted the plastic surgery procedures they have undergone to live as transgender females. Surely, an understanding of “the why” of a transgender woman is complex, but in a more conceptual sense might be ascribed to an assimilation of their internal conflict with their external selves. This driving pressure to physically change comes from within rather than an external pressure from society to become a woman.

To be sure, as plastic surgeons, we must balance expectation with reality, and the delivery of surgical procedures is as much of an art as is understanding our patients. If exercised judiciously, plastic surgery is intended to improve the quality of life for patients – it is not intended to win the battle of aging or establish cultural norms.

Choosing plastic surgery may not necessarily be an internalization of societal values, but rather stem from agency of the individual. In social science, agency is the capacity of individuals to act independently and to make their own free choices. Thus, the stigmatized interpretation that individuals seeking plastic surgery have internalized societal pressure may be inaccurate. Instead, we may consider another construct inclusive of authenticity of the individual and comprehend that the reasons why women choose plastic surgery most often lie within.

Even for breast reconstruction surgery, the research has borne out that restoration of the breast means the restoration of psychological well-being, not the restoration of the ability to breast feed. Agency in this forum and a woman’s right to choose breast reconstruction surgery post-mastectomy might be considered the direct result of one’s inner Freudian id seeking to restore its psychological self.

Those opposed to aesthetic plastic surgery might consider a nature versus nurture argument. Must we choose to embrace our genetics or do have the power to decide who we are? Perhaps we can remove some of the guilt and understand that plastic surgery can be a source of empowerment whether to treat a congenital birth defect, acne scars of youth, disproportionate breasts, or a tendency to retain weight in certain areas. Can we remove the blame and the unconscious shaming of individuals and understand the decision to choose plastic surgery through a different lens? This is a historical time in the US, where there is a lot of intolerance. However, we are a country founded on choice.

The crux of the feminist movement centers around having equal rights and opportunities – having choice. Being a plastic surgeon has allowed me the opportunity to give women choice: the right to choose who we are in society, have control of our bodies, and what we look like in the world. While some of my most satisfying work to date has been in reconstructing women after breast cancer, I would like to take a moment to encourage tolerance for all. Each of us is on a different path and while we may not all choose the same journey – we can choose understanding.

Anuja (Anu) Antony, MD, MPH, MBA, FACS is a Professor and Vice Chair of the Department of Surgery and Chief of Breast Reconstruction and Medical Director of the Division of Plastic and Reconstructive Surgery at Rush University. Dr. Antony is a Public Voices Fellow with the Op-Ed project and an accomplished writer, researcher, and speaker who lectures nationally and internationally about plastic and reconstructive surgery.

On the Eve of a New Year

By Hedy Wald

Looking back, looking forward. It’s what we do on the eve of a new year. 24 hours away from a fresh start, resolutions, inspirations, and even some trepidations . . .  2020 sounds like science fiction and yet, here we are.

Social media is gushing with good wishes and plenty of party hat and heart emojis. @pranaysinha summed it up nicely: “Hope, love, and gratitude.” And following the Dalai Lama on Twitter can make your day; @dalailama: “I believe that if we make an effort to develop peace of mind within ourselves and cultivate a proper appreciation of the oneness of humanity, we can create a happier, more peaceful world. What we need is common sense-the positive use of intelligence-and warm-heartedness.”

So it’s not all party gaiety, it’s also serious contemplation of where we’ve been, where we are, and where we’re going. Resonates for me with the Ten Days of Repentance associated with the Jewish new year . . . reflect, look inward before looking outward – apologize, improve, be kind.

So many parallels to our vision for humanism in medicine. And for the work we do in medical education.  It’s about doing the work of a physician but it’s also about being a physician1 –how do we cultivate a prepared heart and mind for the inevitable complexities? Ethical vigilance? Values? Moral integrity and resilience? And when we close that exam door and are face-to-face, heart-to-heart with that vulnerable, suffering human being and/or family caregiver, how do we bring intentional presence2 to that sacred space with readiness to receive and hear the narrative, readiness for responsibility?Read More »