The Resident (Season 2; Episode 17)
Austin’s mentor, Abe, may have been shot in the chest. If he is saved, he may be able to identify who did it (or did he try suicide?). A second patient is Evan, an engineering student initially diagnosed with mono but whose lungs are failing. ECMO is a last ditch effort to try and keep each alive and give their lungs a chance to heal. The hospital has two machines, but only one is available. How to decide who gets it? Bell suggests transferring one of them to a different hospital, but both are too sick and he closest machine is a day’s drive. Both have compelling medical needs requiring ECMO in the next 30 minutes. Austin pleads that his patient is a world renowned surgeon who can teach many future surgeons. Nevin pleads that Evan is a 22-year-old kid with his whole life ahead of him. Okafur suggests keeping emotions out of it and look at the statistics: Evan has more years ahead of him. Bell says they must also consider that the patient has to survive ECMO and Evan is stronger while Abe just had surgery. Pravesh wants to know what information Abe has about who did this to him. Bell decides that Evan goes on ECMO.
Limited resource decisions are among the most difficult that a hospital has to make. This conversation covers several ways that one can make such a choice: Medical need, potential future contributions, and past contributions among others that they do not raise. In this case, the decision is a medical needs one—who has the greatest likelihood of benefiting (surviving and recovering).
Greys Anatomy (Season 15; Episode 17): “Just because you can doesn’t mean you should
Vincenzo Delucca has brought his research from Italy to Memorial-Grey Sloan where he is attempting to perfect extracorporeal wombs on a sheep model. His children (both doctors) feel that he is manic (he has a history of bipolar). When a 21-week-old pregnant patient comes in after a motor vehicle accident she has internal bleeding that will require a hysterectomy. As Teddy goes to tell the patient and her husband the bad news, Vincenzo is already in the patient’s room, pitching his experiment as a way to save their baby. The problem? The experiment has a 50% failure rate. The project is only in animal testing, has not been approved by an IRB or research review board, and has no FDA approval as an investigational medical device. Is he a genius or suffering a manic episode? Now their medical team has to let this young couple know that this miracle is not something available. From Vincenzo’s perspective though, he could have given a 21-week-old fetus a chance, which is more than it had. There is a logic to that, but the regulations exist for a reason: Good intentions are not enough. The slippery slope is real if we put aside our guideposts when convenient.