Four Brain Cells

The never-ending ethical dilemma in healthcare

Patch Adams, a first-year medical student, was sitting in his college Dean’s office with a bunch of files and papers strewn across the desk.

He was about to get kicked out of medical school.

Why? Because they believed he suffered from “excessive happiness.“

And what was his fault? That he loved communicating with patients and healing them through humour.

But Patch wasn’t allowed to do so until his third year of medical school, by law. So, he’d dress up as a clown, sneak into his college hospital wards, and make random patients laugh.

While this was not ethically allowed, Patch continued this practice of connecting with patients in the first year- solely because it brought him and the people around him joy.

Never have I ever related to the main character of a movie to this extent. Patch Adams, starring Robin Williams, was a welcome change in my list of gory, dark movies. It’s not a great movie by conventional standards, but the themes it discusses are rather close to my heart.

In real life, Patch Adams is a physician and a clown who founded the Gesundheit Institute– providing holistic care to people in need.

As a medical student, Patch believed in “improving the quality of life, not just delaying death.”

Naturally, it’s something you’d expect from every doctor.

But being in healthcare makes me realize how rare that is, and how not all students live up to their presumed ethics.

For instance, one of my biggest fears throughout dental college has been losing hold of my moral compass. In a cutthroat competition with peers, where do I stand?

Should I jump on the bandwagon and treat patients as cases and not humans? Detachment is probably why you can work well on them, but oh boy. What dental school demands of you in the name of exams and quotas and practice has left an indelible mark on me.

I’ll tell you what, healthcare is a theoretical field by and large. A traditional healthcare degree in India is a 4.5-5.5 years course. You complete 2 years of rigorous theory, after which you’re introduced to the hospital wards but only to observe, assist or perform minor procedures. There’s nothing wrong with this, mind you- it’s a systematic approach to condition students. However, I believe it’s a 5-year course on average only so that even the worst of us can catch up.

Now, imagine doing your first patient ever- a living, carbon-based water balloon with floating consciousness and intact sensors sitting right in front of you. You’re about to insert a sharp, pointed needle into this human and cut him open layer by layer. The icing on the cake? You’ve never done this before.

Exactly, I’d freak out too.

Throughout medical school, we’re loaded with theory knowledge and know-hows, but the practical world can be ruthless. The human body is magically fascinating, and each case brings with it a minor unexpected element. This reminds me of a quote from the medical drama House M.D:

It is in the nature of medicine that you are gonna screw up. You are gonna kill someone. If you can’t handle that reality, pick another profession or finish medical school and teach.

Yes, I’m aware I sound dramatic. Ideally, you’re trained enough to not make any mistakes, and are assisted by senior doctors throughout the case. But I still can’t help and wonder about stupid little what-ifs.

For some reason, losing a few million dollars, screwing up a contract, or embarrassing my company in a meeting suddenly seems more appealing. While the weight of the issue is still heavy, at least I’ll be able to take the blame without any long-standing guilt.

The French surgeon Leriche once said, “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray —a place of bitterness and regret, where he must look for an explanation for his failures.” The following excerpt from Do No Harm sums up my thoughts and internal dilemma better than I ever could. Talking about a pineal gland tumor surgery he was about to perform, neurosurgeon Henry Marsh writes,

“The outcome of the pineal operation- whether the tumor was malignant or not, whether I could remove the tumor or whether it was hopelessly stuck to the brain and everything went horribly wrong- was largely outside my control. I also knew that as time went by, the grief I felt at what I had done to the young woman would fade. The memory of her lying in her hospital bed, with a paralyzed arm and leg, would become a scar rather than a painful wound. She would be added to the list of my disasters- another headstone in that cemetery which the French surgeon Leriche once said all surgeons carry within themselves.”
Henry Marsh, Do No Harm

That said, this blog is a celebration of two kinds of people: The students who choose to live by treating others, and understand the massive responsibility of another life. It’s also to celebrate those who step back, and say “I don’t know and I do not see myself doing X procedure.” Ironically, you’ve saved many lives simply by being self-aware.

I also don’t mean to scare you away or paint a bad picture of healthcare- there’s equally enough brilliance and honesty, the kind that makes us intensify the pedestal on which doctors are raised. It all boils down to self-awareness on both the patient’s and doctor’s part, coupled with the one thing that makes and breaks us as humans: trust.

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