A 65-year-old patient with widely metastatic pancreatic cancer was emergently transferred to our facility in the early hours of the morning with free air suggestive of a perforated viscus. The patient is from a small town several hundred miles away from our academic center, which can be quite typical for many patients in our large state. After discussions with the patient and family as to whether or not to proceed with operative intervention in someone with incurable disease, it was decided to proceed to respect their wishes. It was clearly outlined to the patient’s family that the intent of the treatment was to address the immediate emergent issue and not to cure the patient of metastatic disease.
Chandrakanth Are, MBBS, MBA, FRCS, FACS
The patient underwent a Hartmann’s procedure, which he tolerated well. During his postoperative period, the patient’s recovery was prolonged but smooth with no issues. His pain was well controlled, and his wound care was satisfactory. He recovered well from the surgery and was transferred back to a nursing facility close to home within 2 weeks. Assessed by any metric and considering where we started with this patient, it can be said that the patient received satisfactory care with a good outcome.
But if you peer deeper, there is more to taking care of patients than just having good clinical outcomes. Did the patient receive preoperative antibiotics? Yes. Was the operating room temperature maintained to prevent hypothermia? Yes. Did the patient receive good postoperative pain medications? Yes. Was the patient given total parenteral nutrition to help with his poor nutritional status? Yes. Did the patient receive good nursing care? Yes. But on a lonely Saturday morning, with no family members around, did the patient’s wife have someone to wipe her inconsolable tears, the ones she had been holding back so resolutely until then? Did she have someone to comfort and console her through the solitary alley of despair—The answer to these two questions would be a very certain no.
Changing the Face of Medicine—Again
For all the boxes we tick to justify the good clinical care we provide, we continue to miss this vulnerably human aspect of medicine. And this will more than likely get worse as we get more and more enamored and enveloped by technology. We are in an era where a new drug, technique, or treatment approach is pioneered on an impressive scale and pace. Science and technology have, and will, continue to reshape how we treat the sick and infirm. In 1953, Watson and Crick unraveled the structure of DNA, which changed the face of medicine. Nearly 60 years later, a 2012 publication in Science described the CRISPR-Cas9 technique to perform gene editing, which can tinker with the genome at will and will likely change the face of medicine again.
We are on the doorstep of performing many or all the tests we need on a drop of blood or saliva. A drop of blood can also tell patients what a blessing or curse their heredity holds and what diseases they may be prone to. Companies are working actively to slow down or stop aging along the quest to longevity.
A Pivotal Movement in Cancer Research
Although cardiovascular disease, influenza, and cerebrovascular disease are no longer the guaranteed messengers of death, as they were in the past, we still have some diseases that portend a poor prognosis, of which cancer is often one of them. Despite the impressive improvement in overall 5-year survival for all cancers combined, it still kills more than we can cure.
The Moonshot program was a part of the State of the Union address by President Barack Obama and was launched with much fanfare by Vice President Joe Biden to tackle and develop cures for cancer. The Vice President is no stranger to the devastating effects of cancer and so are many other patients and family members.
The Moonshot program we hope will serve as a pivotal movement, when the stubbornly unyielding cancer curve witnessed an inflection point from death and despair toward hope and cure. The additional funding from the Moonshot program will no doubt spur another volcanic burst of research, which will certainly be aided by new technologies such as CRISPR-Cas9. The additional funding and its potential ramifications were greeted with much enthusiasm in the clinical and research communities. Although all of this is definitely encouraging, let us not forget that individual patient or family member in despair who needs more than a novel technology or a new cure.
In Search of Human Interaction
Surrounded by all the technologic advances in health care, we seem to have conveniently forgotten—or not had the time to acknowledge—the human aspects of medicine and the humanistic needs of our patients and their family members. It certainly appears that technologic advances and compassionate care have an inverse relationship.
Walk into any hospital, and it is not uncommon to see desolate faces surrounded by technology. We have video systems to monitor patients from afar, which precludes the need to walk into the patient’s room for human interaction. Patients are surrounded by caring health-care professionals, but they still look isolated. Patients and families can obtain all the medical information they need about their illness from an impressive list of digital media, but they still appear confused. Hospitals have become impressive public relations machines, with advertisements claiming success stories, positions on national ranking systems, and valet parking.
But the look on the face of that individual patient wheeled on a stretcher or a wheelchair through the cavernous corridors of hospitals the size of mini-cities to the scanner says it all. Individual patients and their attendant human vulnerabilities have become mere specks in the megalithic mosaic of the technologically advancing modern health-care system. In the modern era of health care, efficiency and resource generation have taken prime positions on the ladder of success. We have our moments of compassion, but just as much as the logistics and predetermined time limits permit. Instead so much more of our time is taken away to feed the insatiable hunger of technologic and administrative requirements.
As we chatted on that lonely Saturday morning in the hospital cafeteria over a doughnut, the wife’s tears permeated the entire conversation about her husband, family members of a few generations, how she tries to stay strong for her husband, how her siblings have become estranged, and how her much-caring children could not be there that weekend due to other commitments or their own illnesses. She continued to talk of how psychiatric disorders run on her side of the family tree for three generations and what effect it has had on her brother, who otherwise could have been of help and how lack of insurance prevented her husband from seeking care earlier, if not for which the outcome could have been different.
If not for that chance encounter with his wife, we could have merrily deluded ourselves to think that we had provided complete care. We provided adequate clinical care, but not sure we provided adequate compassionate care, which then equates to incomplete care. As we trundle down this fast-paced irreversible path of technologic takeover of health care, it would serve our health-care community to be omnisciently conscious of the human side of medicine and the humanistic aspects of health care.
Until then, or until we find or fund a Moonshot program to compassion, our innovative technology, efficient systems, profitable hospitals, diverse resources, miracle cures, novel drugs, expensive education, and imperfect science will continue to fail our patients and their families. ■
Disclosure: Dr. Are reported no potential conflicts of interest.
