Why Can't We Save Everyone?

Why can't we save everyone?  Yes it is a rhetorical question, because obviously everyone cannot be saved. But I'm not talking about the patient with stage 4 lung cancer diagnosed too late, or revealing to someone a diagnosis of ALS for which there is no treatment, only a terminal course. As physicians, there is a certain degree of complacency when it comes to these situations when someone has an end stage disease that sobers us into realizing that nature is stronger than our drugs and tools.  But there are some acute life threatening problems that we can save people from. We know so much more, have so many more advanced medications and therapies that we have managed to markedly decrease mortality, to improve outcomes, and to preserve people's quality of life across the spectrum of medical diseases--from HIV to heart disease.  But despite this, nothing is ever perfect.

Lets take a heart attack.  A big one.

30 years ago when someone had a heart attack (where an artery supplying the heart muscle becomes blocked), the treatment was aspirin, and watching them closely, while treating their pain, and letting them "ride it out".  Of course not "fixing" the problem caused many people to die.  A few years later we developed medications to unclog the blocked artery, and a few years after that we developed invasive procedures (i.e. angioplasty) to go inside the heart artery and mechanically open up the blockage.  Now opening a blocked artery is almost like another day at the office.  We know the problem, and we can fix the problem, and sometimes save lives--even when people are really sick and sometimes when they are half dead.  We can pretty much bring some people back from the dead now (If they die in front of us at least...) But you know, we can't save everyone... 

Last week we had a 37 year old Indian man come in with a massive heart attack.  Now for heart disease, that is extremely young.  It is usually people over 50 and 60 that have heart attacks.  You would be unlikely to even suspect a heart attack in someone so young--and neither did he which is why he waited 5 days to seek medical help.  Unfortunately crazy things can happen to almost anyone.  If this guy was in his 70's, he would have died well before making it to the hospital, let alone lasting 5 days at home with his symptoms.  His age kept him alive until he decided to come in to seek help.  Though when he did arrive, he was super sick.  He had the coronary blood vessels of an 80 year old smoker--terribly diseased and clogged.  He was a smoker, he was a diabetic, and he was South Asian. Unfortunately many South Asians have bad genetics when it comes to cholesterol and atherosclerosis (blockages in the arteries) .  He came in with a 100%  blocked artery in his heart--the LAD (left anterior descending) artery, the largest one of three heart arteries, he also had a 99% blockages of his RCA (right coronary artery).  His heart had suffered major damage and his Ejection Fraction was down to 15% (normal is 65%).  We had to use stents to fix the vessels, and help support his heart function, since it was barely pumping.  We used a new device called the Impella.  It is a small cylindrical motor that sits half in the heart, half in the aorta and helps suck blood out of the heart and into the body.  We insert it in the cath lab through the femoral artery.  It helped keep him alive and allowed us to fix the vessels.  Over the next few days his condition stabilized.  He remained on the respirator though.  After a few days however, we realized he wasnt moving his right side.  A head CT (catscan) was done revealing he had suffered a massive stroke.  He was not waking up and showed no sign of purposeful brain function.  The family was not ready to let him go, and decided to put a feeding tube in and a tracheostomy for a permanent ventilator.  Even though medically it was unlikely he would recover, sometimes you need to give the family some time.  Three days later, he suffered a cardiac arrest and died.

Sometimes, despite all our knowledge, skills and advanced technology, we still can't fix everything.  We can always hypothesize what if's: Should we have done this... or that differently?  Then again maybe the patient is to blame for not seeking help earlier? Or his family for not forcing him to go? And so forth... But the reality is, sometimes people just die.  Sometimes it is just your time.  You can't save everyone.  The lady I spoke of last time was 87 and survived despite the odds, but this poor 37 year old didn't fair as well.  We always wonder how some of these old people can sometimes live through anything. They will never die on you!  But on the other end a completely healthy 30 year old comes in and can just die no matter what you do. You just never know... Once you accept this reality, get past the improbable and the unfortunate, and continue treating the next patient no different than the last, you are one step closer to becoming the experienced doctor that people need.

 

 

Comments

[Humaira]

I love reading your posts.

[Adsense in urdu]

I think we can't save everyone because we r not a god life and death to god hand, we are only caring everyone.