You often hear people say that medicine is more art than science. I am starting to realize that when they say art, they do not mean Michelangelo; they mean Jackson Pollock. It is messy and chaotic. The people holding the paintbrushes have as little idea of how it’s going to turn out as you or me. When you learn about a medication, a treatment, or a procedure, you expect it to work. But in real life, how effective are these measures? What are they really doing for the patient? How much does it cost? Does it just prolong their pain? Memorizing a list of drugs and their mechanism of action, contraindications, and side effects, does not paint a picture of a sick human being with an entirely different reality.
A woman we saw last week out on the ward got send to the Cardiac/Coronary Care Unit (CCU) yesterday. She has mitral stenosis and tricuspid regurgitation, which basically means that the valves in her heart are not working well and blood is not flowing the right way. As we talked about treatments and valve replacements and medications, I realized that this woman was going to die. She cannot afford a new valve for her heart. She may spend the rest of her life in the hospital getting pricked by needles and gawked at by medical students. She is only forty years old. So again I ask, what are we really doing to help her? On the flip side, in the United States this woman may be given a new heart valve regardless of her ability to pay for it. Only afterwards when she gets stuck with the medical bill and has to file for bankruptcy do we see the consequences of treating. The balance between under and over treating is difficult to find.
I find it interesting that Cho Ray Hospital has some very advanced equipment but lacks the staff or beds to support the number of patients they care for. A cardiology patient will get an echocardiogram, but will be missing something more simple such as their intake and output recorded. It seems that there is a discrepancy in resource allocation. Compared to the United States, doctors do much more here and nurses do much less. Family members take the role of caregiver by feeding, bathing, and changing their loved ones. Despite the challenges that family members, doctors, nurses, and hospital staff face every day in such a busy hospital, they still do a remarkable job treating patients with the system they have.
On a different note, I have been watching the videos of the murders of Alton Sterling and Philando Castile. I cannot imagine the feelings of anger, helplessness, and grief the black community must be experiencing, this week especially. I take for granted how safe I feel as a white person every day. Even here in Vietnam, I get special treatment. I have been ushered to the front of a long line of people waiting for an elevator. I have been helped by multiple people at a fruit market when other people were there first. I have been told that my white skin is very beautiful because the Vietnamese prize fairness and perceive darker skin as lower class. I have been taught by Vietnamese doctors when Vietnamese medical students vying for their attention and the chance to learn are ignored. I am halfway around the world and am still witnessing institutional racism. This is a global health problem as dire as any other.