Imagine you have been cast as a doctor on the front lines of a World War II movie. A major battle is raging as you stand in the middle of a field hospital and wounded soldiers are being carried in by the hundreds, if not thousands.
You are exhausted. You can’t remember the last time you slept for more than a few hours. You know you can’t save everyone, and it weighs heavily on your heart. As a doctor, your job is to save lives, as many as you can. But you barely have time to go from one patient to the next. Who to save, who is too far gone? The rest of the medical staff is beyond exhaustion as well. They are doing their best without enough equipment, without enough preparation. You think to yourself, “I’m not prepared either. Nothing could have prepared me for this.”
If you are watching the news, this is the new reality in places like New York, New Orleans, Chicago and Detroit. All of our big cities are at risk. In a few weeks we may be seeing the same in our own state of Florida with headlines about Orlando, Miami, Tampa and Jacksonville.
Night after night we are hearing the stories of valiant medical staff trying to do their best, while risking contagion for themselves and their families. Governors are begging for PPE (personal protective equipment) to help save the lives of our front-line nurses and doctors.
We already know that these doctors are being faced with decisions they should not have to make. They are sworn by their Hippocratic Oath to save lives. The bioethics committees in hospitals already have, or are creating, guidelines for criteria if they have to ration ventilators.
No one wants to talk about this, and I don’t blame them. As Dr. Samuel Gorovitz said recently in a powerful interview with The Washington Post, “It is searingly difficult.”
He served on the New York State Task Force on “Life and the Law,” and helped write the 2015 guidelines should there be a flu pandemic in the United States. Basically this paper suggests triage committees should help determine if a patient was “not improving or whose prospects were hopeless.”
Everyone agrees that this decision should not have to be made by the front-line doctors. As one of the chief residents at Mount Sinai Hospital in New York City put it, most of the medical staff will likely have post-traumatic stress disorder when this is over, if they are lucky enough to survive.
The question confronting us is huge: Should scarce resources go to patients most likely to be saved? I don’t have the answers, but we need to be asking these questions as a country. How do we wisely use the resources we do have? What structures need to be in place to back the front-line physicians?
We need to establish “Triage Teams” at our hospitals who immediately consult and make ethical decisions, perhaps using a criteria similar to others currently in use to evaluate critical transplant candidates. This sensible and ethical team approach would give the front-line doctors the support they need.
We need a task force set up quickly, to bring educators from the medical and legal community to lend their expertise. We need our legislators to put this issue on the front burner.
At a time when real leadership is being shown from the bottom up, we look to our own communities for answers. This is bigger than political – it is our lives, our families and the future of our communities. Let us call on our retired leaders and movers to speak out, make proposals and urge action!
Across the country our hospitals and staff are putting their lives on the line. We must support them by addressing these issues fearlessly. If courage can be defined as taking action in spite of fear, then we are imploring our leaders to find their courage and act now, for the sake of our communities and our country. Lives depend on it.
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