Saving lives

Doctors save lives. One needs to look no further than the recent tragedy in Boston to see that. First responders cleaned wounds and stopped the bleeding, ER docs prepared patients for surgery and teams of surgeons, anesthesiologists and nurses worked tirelessly in operating rooms around the city to repair as much damage as they could. Three victims of the bombing died within seconds, but of the more than 170 patients who came pouring into Boston hospitals with bombing-related injuries, not one patient died. Boston’s hospitals were ready. They did an admirable job.

One of the most oft-mentioned reasons for going into medicine is a desire to save lives. But after spending just a year in hospitals among doctors and patients, I have come to think that this is hardly the best reason for going into medicine. For one thing, I think it is too simple of a reason. For another, I think it is too naïve, perhaps even dangerous, to think that doctors are in the business of saving lives. These are just my opinions and observations, but I hope you will hear me out.

Doctors save lives—but it’s more complicated than that. The Boston case is a good example. It was a major team effort that helped to prevent the deaths of Boston’s bombing victims. In many respects, the emergency responders on site played the most important role: They succeeded in preventing huge losses of blood, which staved off death and kept surgery open as a possibility. ER teams stabilized patients and prepared them for surgery, and OR teams did the hands-on work of repairing the damage. Each team did its job well and possible, even probable, deaths were avoided. The first responders and surgical teams likely felt that they had saved the lives of their patients as well.

But the work does not end there. Many of the patients that these teams saved will have to learn to live with debilitating injuries for the rest of their lives. And it will be doctors—orthopedists, psychiatrists, rheumatologists, internists—who will be called on to help with that difficult task. This is not only the case with trauma patients. I remember shadowing a cardiologist who placed a stent into the clogged artery of an elderly heart attack patient—undoubtedly saving her life in the process—just before heading to the clinic to consult with a man who had the same intervention weeks before and was now complaining of more chest pain. Life-saving procedures may ward off death, but they rarely signal an end to medical maladies.

Doctors save lives—but it’s naïve to think that they do so every day. I’ve spent time shadowing physicians in some of the most high-impact settings—catheterization labs, ORs, emergency departments (including the one at Brigham and Women’s Hospital where 31 bomb patients were brought)—but the instances where I walked away feeling as though I saw a life saved were few and far between. It happens, but only every once in a while. Most of the patients that doctors see in a day come in with problems that are life-limiting, not life-threatening. In those cases, it is the doctor’s job to improve a person’s life, not save it.

All of this leads me to believe that going into medicine simply to “save lives” is a bit dangerous. Based on my experiences, a person who does so would be setting himself up for disappointment. It is also true that most doctors will quite regularly be presented with cases in which it is almost impossible to save the patient. I’ve come across patients in the ER with severe congestive heart failure or liver problems who have very little left to live for. I’ve met a number of pancreatic cancer patients in the Duke Cancer Center who have told me that they are more interested in living and dying well than they are in living for a long time. What do we do when a person cannot—or does not want to—be saved?

The best answer that I have found, which is also my greatest reason for wanting to be a physician, appears in Samuel Shem’s medical classic, “The House of God.” The book, for those who have not read it, is about the grueling internship year—the first year of residency where medical students are, for the first time, doctors with their own patients. Shem’s characters are brought to their knees by the physical, mental and emotional demands of their work. Ultimately, they realize that the physician’s great work and calling is not to save patients but to “be with” them—to “be with” patients in their sickness and brokenness and to address and heal their physiological and psychological problems.

Paul Horak, Trinity ’13, is a Duke pre-med. This column is the final installment in a semester-long series of weekly columns written on the pre-med experience at Duke, as well as the diverse ways students can pursue and engage with the field of medicine.