Are there any other House fanatics out there? It’s okay. Raise your hands high. Be proud.
As insufferably condescending and irritating as Hugh Laurie’s character can sometimes be, I’m a bit endeared to him nonetheless. I love how imperfect he is. I’m also kind of drawn to broken people, and he is certainly that. Most of all, I appreciate the questions posed by his actions and attitude.
In one episode, Foreman (a Dr. who works under House) hands in his resignation because he sees in House the same vices that dwell within himself. He fears that if he isn’t careful, he’ll turn into House. His parting remarks to House were something to the effect of, “You’ll save more people than I will. But I’ll settle for killing less.”
It’s a dilemma that every medical professional comes up against eventually. Do you take a risk, knowing that your patient might die as a direct result of your actions? What if it’s really a long shot? What if it’s their only shot? Or what if it’s a 50/50 gamble, and they might be just as well off if you do nothing—but you have no idea which course of action will save them, and there’s a pretty decent chance that neither will?
As insufferably condescending and irritating as Hugh Laurie’s character can sometimes be, I’m a bit endeared to him nonetheless. I love how imperfect he is. I’m also kind of drawn to broken people, and he is certainly that. Most of all, I appreciate the questions posed by his actions and attitude.
In one episode, Foreman (a Dr. who works under House) hands in his resignation because he sees in House the same vices that dwell within himself. He fears that if he isn’t careful, he’ll turn into House. His parting remarks to House were something to the effect of, “You’ll save more people than I will. But I’ll settle for killing less.”
It’s a dilemma that every medical professional comes up against eventually. Do you take a risk, knowing that your patient might die as a direct result of your actions? What if it’s really a long shot? What if it’s their only shot? Or what if it’s a 50/50 gamble, and they might be just as well off if you do nothing—but you have no idea which course of action will save them, and there’s a pretty decent chance that neither will?
My least favorite medical procedure that I have ever performed is an NG tube insertion. On one hand, it’s pretty easy—stick a tube in someone’s nostril and push. Getting it down the hole isn’t the hard part. Getting it down the right hole into the right organ is a bit trickier.
The day I arrived in Kazembe, I met a very sick little boy named Nicholas. He wasn’t eating, and that on top of whatever illness he had was causing him to fade fast. Amy and I tossed around the idea of trying a feeding tube, but I was way out of my element. I had never done the procedure on a real person before. I know the theory like the back of my hand, but the actuality is nothing short of terrifying. Depending on the statistics you trust, as many as 50% of NG tubes inserted on neonates are placed incorrectly initially. If the tube is in too far, the milk bypasses the stomach and little to no nutrients are absorbed. If it’s still in the esophagus, aspiration pneumonia will be your next battle. If it’s in the lungs and you push milk through the tube…
The only sure-fire way to verify placement (that I’m aware of, at any rate…) is an X-ray. Wanna guess how plentiful those are in the African bush?
Little Nicholas didn’t make it. I suspect he may have had a heart condition—there was an audible third heart sound. Of course, it’s impossible to know if the condition caused the heart failure or the other way around.
The day I arrived in Kazembe, I met a very sick little boy named Nicholas. He wasn’t eating, and that on top of whatever illness he had was causing him to fade fast. Amy and I tossed around the idea of trying a feeding tube, but I was way out of my element. I had never done the procedure on a real person before. I know the theory like the back of my hand, but the actuality is nothing short of terrifying. Depending on the statistics you trust, as many as 50% of NG tubes inserted on neonates are placed incorrectly initially. If the tube is in too far, the milk bypasses the stomach and little to no nutrients are absorbed. If it’s still in the esophagus, aspiration pneumonia will be your next battle. If it’s in the lungs and you push milk through the tube…
The only sure-fire way to verify placement (that I’m aware of, at any rate…) is an X-ray. Wanna guess how plentiful those are in the African bush?
Little Nicholas didn’t make it. I suspect he may have had a heart condition—there was an audible third heart sound. Of course, it’s impossible to know if the condition caused the heart failure or the other way around.
Let me pause for a moment to clarify something. I’m not blaming myself entirely for the deaths of these kids. That being said, it would be foolish not to acknowledge the direct role that my (and everyone else’s) actions played in the way circumstances panned out. Some of the most impactful lessons my professors have taught me have been in the form of stories about their own mistakes. No, I can’t change what happened to Nicholas and Jessie, but perhaps I can take from my time with them lessons that will save the next one.
When Jessie could not find the strength to eat, it became very evident very quickly that an NG tube was pretty much her only chance. I’ve written about the whole well-meaning-but-inept-midwife-putting-the-NG-tube-down episode before, and since she pulled it out two hours later I ended up having to put it back down myself. A couple days before she died, she stopped eating again. I tried eight times with two different tubes before I finally felt it might possibly be in the right place, and she immediately developed breathing difficulties again. I’m not sure how many times I had to insert and reinsert that stupid tube during the short six weeks of her life, but it must have been close to a dozen if you count each attempt. That is incredibly hard on a very small and weak body. Unfortunately, so is starvation. It was our only choice.
In Jessie’s case, circumstances made the decision for me. It’s not always that easy. Sometimes, you have to choose whether to be House or Foreman.
There are very few instances where I will side with House, but I think that for the most part this is one of them. Abdication of responsibility does not confer innocence. Better to be guilty of trying than “innocent” of messing up. In medicine, that’s a pretty tough pill to swallow. When nurses and doctors mess up, people die.
Many folks, upon seeing Jessie for the first time, totally wrote her off. She was too little, too sick, and too far gone. They couldn’t see anything in her worth fighting for. I did.
Maybe, just maybe, deciding it’s worth the fight is half the battle.
When Jessie could not find the strength to eat, it became very evident very quickly that an NG tube was pretty much her only chance. I’ve written about the whole well-meaning-but-inept-midwife-putting-the-NG-tube-down episode before, and since she pulled it out two hours later I ended up having to put it back down myself. A couple days before she died, she stopped eating again. I tried eight times with two different tubes before I finally felt it might possibly be in the right place, and she immediately developed breathing difficulties again. I’m not sure how many times I had to insert and reinsert that stupid tube during the short six weeks of her life, but it must have been close to a dozen if you count each attempt. That is incredibly hard on a very small and weak body. Unfortunately, so is starvation. It was our only choice.
In Jessie’s case, circumstances made the decision for me. It’s not always that easy. Sometimes, you have to choose whether to be House or Foreman.
There are very few instances where I will side with House, but I think that for the most part this is one of them. Abdication of responsibility does not confer innocence. Better to be guilty of trying than “innocent” of messing up. In medicine, that’s a pretty tough pill to swallow. When nurses and doctors mess up, people die.
Many folks, upon seeing Jessie for the first time, totally wrote her off. She was too little, too sick, and too far gone. They couldn’t see anything in her worth fighting for. I did.
Maybe, just maybe, deciding it’s worth the fight is half the battle.
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