Pneumonochrome

Today’s random photo is of a tree near my home.  I really like the way the leaves arc across the trunk there.

I found some old photos I took, and have no idea why I took some of them, other than that I might have been playing with my camera. This is one of them.

I think I’m going to try to start a weekly post where I briefly discuss some medical treatment that I think is neat, interesting, cool, amazing, or otherwise worth mentioning. This week, I’m going to talk about ECMO, or ExtraCorporeal Membrane Oxygenation. You’re welcome to click on through to Wikipedia to read about it there, or you can just read my short summary below.

ECMO is used in some cases where a person’s lungs aren’t working well enough for them to get enough Oxygen. It works as follows:

1. Blood is removed from a large vein in the patient’s body.
2. That blood crosses a special membrane that causes carbon dioxide to be released and oxygen to be absorbed.
3. The blood is returned to the patient’s body either through a large artery or a large vein.

This way, the patient gets the oxygen he needs, even though his lungs aren’t working well. It’s already used with newborn babies when their lungs aren’t working well, whether because of infection, underdevelopment, or trauma. You can check out the Wikipedia article if you’re curious about when the blood is returned via an artery and when it is returned via a vein.

One of the things I think is cool about it, though, is that it’s under investigation for the management of Hanta Virus Respiratory Syndrome. When a person in the US gets the Hanta Virus* it almost always causes lung problems. The person’s lungs fill up with junk, leaving no room for air to go in and out (this is a really simplified way of talking about ARDS) The standard treatment is mechanical ventilation, but that can cause injury to the lungs and isn’t as effective as it could be because the lungs are full of stuff, rather than just not moving like they should.

That’s why I think it’s so cool that they’re looking into ECMO for treatment of it. There’s no guarantee it’ll be the best approach, or any better than the current approach, but it’s a cool way of approaching the problem, I think.

*I said, “When a person in the US gets the Hanta Virus” because the strains that are more common in Europe and Asia cause a very different set of symptoms.

In the May 28th issue of JAMA the “A Piece of My Mind” feature is titled “In Defense of Phobias“. Rosenbaum concludes with the following:

I hope that you all experience many times the opportunity to participate in an action or a decision that could do harm to a patient. These activities are an unavoidable component of medical care. And if you fear that participation, do not lose your fear. Instead, remember that our profession seeks to extend the quality and quantity of life, but the effort to conquer illness will always bear inherent risk. Be afraid, because that fear makes you more human, and greater humanity makes you a better physician. Be not so afraid that you cannot take action, but not so confident that you forget the potential consequences of that action.

This really rang true for me. I’ve commented before on the awe that I believe a physician should maintain for the trust extended to him by his patients, but I really don’t think enough can be said about it. At least, I never feel like I’ve completely come to terms with it myself.

Rosenberg uses as an example in the article the unease, or fear, that a physician may feel just before inserting a needle into a patient’s eye to administer treatment. Even if that treatment is the best hope of saving the patient’s vision, even if it is the two-thousandth time the physician has done it, doing this should give a person pause. The fear should be felt by the physician because it is likely being felt in a much greater degree by his patient. The ability to sense that fear, to feel it a little with the patient helps us to keep proper perspective as we attempt to help our patients solve the problems they bring to us.

That fear will help us avoid arrogance. It will help us maintain humanism in our relationship to our patients. That discomfort that we feel when considering if the potential benefits of a treatment justify the risks will help us remember that our patients are considering the same balance, though usually without the specific education and experience the physician will have to inform that decision.

I understand that not every patient we see will need a treatment that is really risky, most of them won’t. Not feeling fear when working with those patients is fine, because the patient probably isn’t feeling much fear.

I have no delusions that every decision I make as a physician will be earth-shattering in some way, but I hope I never forget that some decisions I make will be earth shattering, and that I’ll feel a little of the shudder.

So, yeah. My kids are cute. I love this picture of my son and his sister right after she was born.