Ten years ago, as part of a Burn Unit team, I faced a moral dilemma.
Should a doctor give a patient’s loved ones hope no matter the situation? Or should he allow them to say goodbye when a situation seems hopeless?
The decision we made haunts me to this day.
I am a junior surgery resident.
I stand with my attending surgeon, Dr. M., a physician who has spent more than 25 years in the Burn Unit. We’re gowned, gloved, and waiting in silence with the rest of the team for our patient to arrive. The double doors fly open, and the EMTs wheel in our patient - Jerry, in his mid-30s, the victim of an industrial explosion.
Severe burns cover over 90% of Jerry’s body. I can see that Jerry is awake and able to speak through a large plastic mask blowing oxygen into his face. I help the EMTs and nurses sweep him from the stretcher to the table.
I look at Dr. M. I’ve been in the Burn Unit only a few days, but anyone could read the concern on his face. Jerry is fighting for his life.
The nurses spring into action. They cut off the remainder of Jerry’s charred clothing, place another IV and insert a catheter into his bladder. As Dr. M assesses the extent of the burns, Jerry thrashes in agony. The Burn Unit secretary pulls me aside. “His family is here. His wife and young daughter are in the waiting room.”
I look at Jerry. His breathing becomes more labored.
“We need to intubate,” Dr. M says.
The anesthesiologist, the respiratory therapist and Dr. M ready the ventilator.
I know what this means. A patient who has suffered severe burns over 90% of his body faces approximately a 15% chance of survival. If Dr. M puts Jerry to sleep on the ventilator, chances are he will never wake up.
I’m new on the Burn Unit and we are working against the clock, but I am part of the team and the moral dilemma hits me head on. I have to ask.
“Before you intubate him, do you think we should have his wife and daughter come in to say goodbye?”
Dr. M stops. He considers my question.
“No, Tony,” he says. “They don’t want to hear that. He’s in terrible shape and can barely speak. We need to give them hope.”
I look at the head nurse. She nods.
Dr. M and the anesthesiologist sedate Jerry, insert a breathing tube and attach it to the ventilator. Dr. M walks out to the waiting room to speak to his wife and daughter.
In a few minutes, he returns with Jerry’s wife. They walk to Jerry’s bedside where Dr. M pulls a chair over for her. She sits heavily, looks at her peacefully sleeping husband and holds his bandaged hand. When I leave a few minutes later to prepare physician orders, Jerry’s wife is still sitting by his side.
He dies less than 24 hours later.
I have no doubt that Dr. M believed he was doing the right thing. He’s an experienced, compassionate physician who’s saved thousands of lives.
Would it have been preferable for Jerry’s wife to see him sedated, peaceful and for her to cling to the slight hope that he might survive? Or would it have eased her loss to have had the opportunity to say goodbye, even if it meant seeing him in grave pain?
Ten years later, I still wonder.
Hope or letting go: The final goodbye
उस पल को शब्दों में बाँधना शायद मुमकिन न हो लेकिन फिर भी उसके आसपास तो पहुंचा ही जा सकता है .आज २४ बरस बाद भी .
हरी -ॐ शरण के भजन हमने बहुत धीमी आवाज़ करके टेप में चला दिए थे .डॉक्टरों की टीम अपना काम कर रही थी .इंजेक्शन लगाने की रफ़्तार इससे ज्यादा शायद हो नहीं सकती ,बिजली की फुर्ती से काम चल रहा था .एक श्रृंखला बन गई थी सिरिंज आगे बढाने और सुईं लगाने की .कितने इंजेक्शन लगे गिनना मुमकिन नहीं . बस २-३ मिनिट बाद ही सांस को बनाए रखने के लिए आरटी-फिशियल रिसशिटेशन से तकनीकी तौर पर छाती पर मुष्ठी प्रहार .सांस तो मुक़र्रर थी मौत का पल भी. सांस की धौंकनी न उसे और चलना था न वह चली .रक्त की एक लकीर मुख से निकली ,और उस क्षण हमें लगा जैसे माँ दुर्गा का यह रक्ताभ टीका उनके माथे पर भी है .अलविदा .और एक निर्भय भाव ,अभयदान हमें देकर जीवात्मा जा चुका था .
बेहद ज़ज्बा था इस औरत में जीने की इच्छा भी दुर्घटना के बाद बलवती हो गई थी .इसीलिए तो हादसे के ६६ घंटे के बाद तक दर्द के साथ आखिरी यात्रा सम्पन्न की .कई बार कहा -संतोष (तुतलाती जबान में ,तंतोश सबसे बड़ा धन है ).यही थी उनके बाबा की सीख .बचपन की स्मृतियाँ जैसे लौट रहीं थीं .कहतें हैं संकट के समय इतनी एड्रेनेलिन स्रावित हो जाती है ,जो मोर्फीन बनके पीड़ा का हरण कर लेती है .शायद यही हुआ था .
यहाँ मूल सवाल वही है -क्या डॉक्टरों को उम्मीद थी ?लेकिन चिकित्सा नीति -शाश्त्र यही सिखाता है -मिरेकिल्स डू हेपिंन .आस का पल्लू छोड़ना नहीं है भले आस छुडा भागे पल्लू .फिर ऐसे में कैसे कह दें कोई उम्मीद नहीं है आपके मरीज़ के बचने की तीमारदारों से ,सिरहाने खड़े लोगों से ?
Reference :
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डॉ.के प्यार से मरीज की मौत भी आसान हो जाती है ...?
हाँ भाई साहब अशोक भाई (यादें )डॉ .के प्यार से दुलार से स्नेहिल स्पर्श से मरीज़ की मौत आसान हो जाती है .डॉ .आखिरी पल तक संघर्ष करतें हैं यही चिकित्सा नीति -शास्त्र की नीति है .
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