Thanks to advances in medicine, life goes on

DAN PAGE/-

Many years ago, a little girl was rushed to a rural county hospital from summer camp for an emergency appendectomy. As a teenager, she received antibiotics for a bad case of pneumonia. When she grew up and was about to deliver her first child, fetal monitors indicated that the baby’s heart rate had slowed, and a Cesarian section was performed urgently. In middle age, she underwent laparoscopic repair of an injured knee.

The little girl, the teenager, the young mother, the middle aged woman, was — is — me.

My medical history isn’t remarkable — and that’s the point. Like most people alive today, I’ve been the fortunate recipient of treatments now so routine that we take for granted they haven’t always been available. Yet, a century ago, or even less, I could easily have died at summer camp or succumbed to pneumonia; my baby and I might not have lived through that pregnancy; and if I had survived to middle age, I would have done so limping and in pain.

Ask a nurse, doctor, or patient which words they associate with “medicine” and “broken” is likely to top the list. Reports of the millions of Americans who remain uninsured (and the difficulty of trying to insure them), nursing shortages, physician burnout, rising rates of chronic health problems like diabetes and mental illness, and patient dissatisfaction with the care they receive dominate the news.

A couple of generations ago, though, the word “miracle” would have come to mind when medicine was mentioned. During my own, not so distant childhood, front page stories about medicine included the first heart transplant, the first joint replacements, and the eradication of smallpox. Now, medical miracles are no less frequent, though perhaps often less dramatic. And I find myself, in this season of thanksgiving, thinking with gratitude of the patients whose lives have been saved or improved by recent medical advances.

I’m thinking, for example, of a man with HIV infection — a death sentence when I was a resident — who has been living for many years symptom-free. Or the woman cured of hepatitis C, a condition that couldn’t be accurately diagnosed, let alone successfully treated, just a few years ago. Or the many patients who have had minimally invasive surgery instead of the more aggressive procedures they would have had to undergo before the development of laparoscopy and robotics. Or the man who spent six months near death in the hospital, and is now back home with his family after receiving a heart-double lung transplant this summer at Mass General.

But at this time of year, especially, I think of my patient Julie.

In early November 2006, Julie and her husband were expecting their second child, due in two weeks. On the way to a prenatal appointment near her suburban home, Julie’s car flipped over and she sustained horrific injuries to her head, spine, and upper extremities. In less than an hour, Julie arrived by helicopter at Mass General where a large, multi-specialty team including nurses, anesthesiologists, trauma, orthopedic, and plastic surgeons, neurosurgeons, obstetricians, and pediatricians waited.

The team was unable to save Julie’s baby, or her right arm. But they saved her life. After a long rehabilitation, Julie returned home and is now doing well. When I asked her permission to share her story, she agreed enthusiastically.

“I could spend a whole lifetime and then another reaching out to thank all the people who helped me,” she said. She’s grateful to her nurses and doctors, of course. But she also wanted to thank the social workers and medical secretaries who helped facilitate her care. And she’s especially thankful for the EMTs who stabilized her at the roadside.

Sophisticated treatment by EMTs in the field is a relatively recent medical advance. Until the second half of the 20th century, when emergency medical procedures employed in the military were adopted for civilian use, ambulances were barely more than taxis to the hospital. The idea that timing is critical in care of trauma victims and therefore first responders require advanced medical skills is fairly recent. Julie knows that the superb care she received began minutes after her accident. “If one person had stumbled I wouldn’t have made it,” she told me. “Everyone was so well trained, so on top of their game.”

In addition to looking for better treatments for conditions that devastate individuals — pancreatic cancer and amyotrophic lateral sclerosis (Lou Gehrig’s disease) come to mind — researchers around the world are now also trying to effect medical miracles for whole populations.

At a recent symposium marking the 100th anniversary of the Harvard School of Public Health, physicians from several countries discussed some of the challenges they face.

The health minister of Afghanistan spoke movingly of a cemetery near Kabul in which scores of children killed by measles are buried. The health minister of Nigeria described injured and ill patients forced to walk miles for surgery. And the health minister of Thailand asked whether human trafficking might be considered a public health emergency. American doctors spoke of inequitable access to health care, obesity, hunger, and violence as problems awaiting solutions by the next generation of medical miracle workers.

Earlier this month, two days after the seventh anniversary of her accident, Julie celebrated her son’s third birthday. Julie reflected recently on the timing of her accident, so near her son’s birthday and also the holidays. “In a way, I’m kind of lucky the anniversary of my accident is right before Thanksgiving,” she said. “As low as I sometimes get, it’s still a time to be thankful.”