When Caring Becomes Secondary

I knew it. She was going to die, eventually.

She shouldn't have been operated on. It defied logic. She had intestinal cancer with multiple metastasis to the liver. They may have reasons for persuading the patient to undergo metastasectomy, but I'm pretty sure it's not for the good of the patient.

As far as I know, the fact that there are multiple metastases is a contraindication for operation. If there's just a single primary tumor, by all means remove it. If there are some metastasis and they're all resectable, then remove those too--- it could result to permanent cure after all. But were those liver masses really resectable? Removing them entailed removing huge chunks of liver tissue... and judging from the outcome, it was a bad decision overall. Never mind the fact that I shelled out a huge amount of money because the relatives could no longer afford the endless need for more supplies. Intraoperatively, they found it hard to control the bleeding. There was also an iatrogenic injury to one artery. The patient was dangerously hypotensive, even several days after the operation. Several re-operations were necessary because of continued internal bleeding.

What made them decide to operate on the patient, who was previously active and looked fairly healthy if not for the cancer that was gradually eating through her system? It was a showcase for that visiting foreign physician. There was no other patient available for him to operate on, for him to show us this far advanced method of operation. How advanced was it? From my standpoint, the only glaring difference was the exorbitant cost. The outcome was arguably much worse. We promised a cure, and we only hastened her death. Was a cure possible? If she was not operated on, she would still die eventually because of the disease, but the probably would have had more months, probably years to live. The way the case was handled was unethical. I know it was unethical, yet there I was, just a first year resident, who's voices are never really heard, and opinions set aside--- I felt powerless at i simply watched the whole tragedy unfold in front of my eyes. And as the resident in charge of the patient i was the one the family of the patient frequently talked to. I heard all their troubles, doubts, weariness. They sought out all means to produce money as they tried to save their patient's life with numerous blood transfusions, medications, lab exams... with the hope that the patients life will be saved if they remained vigilant. Because all the doctors were telling them that going through the operation was the right choice. The patient will be cured. The patient will be saved.

It was hard to keep a straight face as my seniors kept telling them more and more lies. It was harder to keep a straight face when I was the one telling those lies just to reaffirm the statements of those seniors, and to reassure and comfort the relatives... to tell them everything was all right, everything was under control. Even though I know it wasn't. Even though I was aware that it was a wrong decision to begin with.

Many times, it seemed that the only thing that's important was to get the patients inside the operating room no matter what. Even if they were not ready for operation, when operation involved huge risks and it would do more harm than good. Many times we fight with anesthesiologists because they refused to induce anesthesia due to inadequate pre-operative preparation. We fight with them even when we know they're right, just so we can start the operation. Many times, we just view these patients as simply instruments for learning. We do not care for them at all. We just want to learn, saving lives become secondary. We tell ourselves that we care, that we want to help, but in truth, the only people that we want to help is ourselves.

Just yesterday, I heard that the patient died. After a long battle, she eventually gave in. I made the right decision. What I was back there wasn't me at all. I know myself, I know who I am. i refuse to take part in such a rotten system any longer.