“How far do you go?” Some needed perspective from a Haitian ICU

My hard copy July 5 New England Journal just arrived. As usual, the perspectives section is excellent.

Antonia P. Eyssallenne, MD, PhD, considers quandaries ICU physicians in Haiti confront on a daily basis. (The web version seems slightly behind. I’ll post links when available.)

This short essay stops you in your tracks for many reasons. Dr. Eyssallenne is affiliated with the Hospital Bernard Mevs, Project Medishare, Port-au-Prince, Haiti, and also the University of Miami’s Jackson Memorial Hospital. It’s heartbreaking to consider the yawning gaps between these two places. Jackson hospital routinely provides life-saving or comforting treatments. Meanwhile, a boat ride away, Haitian facilities face shortages of basic narcotics such as morphine and fentanyl for dying patients who need palliative care.

It’s no consolation, but fundamental scarcity brings a certain crisp and brutal clarity. At one point Eyssallenne commented:

In many ways, we are better equipped than U.S. physicians to serve as midwives through the dying process… In the Western world, decisions regarding palliative care are often driven by the availability of a plethora of resources that can prolong the agony of everyone involved—the physicians, the family, and most important, the patient. In Haiti, there are no nursing homes, facilities for long-term ventilation, or home hospice services. But our new capability for intensive care has allowed us, to some extent, to redefine “futility,” and has brought a second chance to our patients; some will succumb, and some will overcome. We tell ourselves that those who overcome with our help were meant to do so—and, sadly, those who do not were not.

There’s a lot wrong and wasteful about American healthcare. We should get more efficiency and more humanity out of our $2.8 trillion system. It still has our backs. We’re amazingly blessed to have it. We are equally obliged to do more to help billions of people across the world. Their predicament could be ours, but for one roll of the dice.

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