Indexing Title:  DCHUA’s Medical Anecdotal Report [06-3]

MAR Title: Drowning in Poverty 

Date of Medical Observation: March 2006 

Narration: 

Five years ago, I witnessed a miracle of sorts.  A youth brought in under my care was revived after almost an hour since drowning while playing in a pool with friends in a nearby building.  We had used 8 ampules of epinephrine, among other medications.  He was discharged from the ICU a couple of weeks later with minimal brain damage. 

A week ago, a similar patient arrived under my care.  The differences were as follows- canal instead of pool, government hospital instead of private, and much vomitus in his mouth.  I swept the food from his mouth, tried to pump air into his lungs with a bag that didn’t fit the facemask, and attempted to intubate his airway with a lightless instrument.  When the anesthesiologist arrived with her own functional laryngoscope, she successfully placed an airway with the help of a defective suction machine.  I corrected some inaccurate resuscitation methods but pronounced the patient DOA after half an hour of CPR. 

The mother was crying that his only child was just about to graduate.  His friend was cursing himself for jumping onto his now dead friend, possibly knocking him unconscious while swimming in the shallow creek. 

Did the two patients receive the same treatment?  Was this because they came from different social classes?  Is a life worth less than another?

Insights: (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcement) 

“Equality is the public recognition, effectively expressed in institutions and manners, of the principle that an equal degree of attention is due to the needs of all human beings.” 

However, “That all men are equal is a proposition which, at ordinary times, no sane individual has ever given his assent.” 

For health care services in the USA, one quality-adjusted life-year is worth $50,000.  In the Philippines, most of the populace won’t make such money in their lifetimes.  Health care is expensive.  Living is expensive.  Dying is not cheap either.  Many people would sell their kidneys or even hearts if they knew how. 

Working in a government hospital, one sees the ugly face of the real world daily.  But just because I can’t do everything, doesn’t mean I will do nothing. 

The physician is taught to keep on trying, regardless of diminishing returns.  It is sobering that level-one evidence suggests the futility of CPR >31 minutes in the ER or using >3 doses of epinephrine.  Yet there are always exceptions, and in these two cases, sadly, inequality counts.