Publications

On Being a Doctor

To Respond Always

May 30th … graduation day at last. The ceremony was moved inside at the last minute because of rain. The exercises began with the speaker’s suggestion to find a niche in medicine for which we had a passion. Her passion for her own work was evident, encouraging. The candidates were presented. We became doctors, our degree stating, “… with all the rights, privileges and honors, as well as the obligations and responsibilities …” “Responsibilities” grabbed me. While we were reciting the Physician’s Oath, I heard it again: “to respond always.” Benediction … recessional … then the search through the crowd to find my family. After accepting their congratulations, my wife and I excused ourselves to pick up our young children from a friend’s house. On the way, we were talking about the events of the evening when we passed several stopped vehicles. My wife said, “Someone’s down!”

I ran to the scene to find a young Asian man face down in the street. He wore no shirt, no shoes, and blood was everywhere. His only movement was a slight rhythmic head nod; he silently gasped for air. The people standing around did nothing but stare. I knelt beside him; there was no pulse, no respiration.

Instinctively, I knew what to do. I asked for help. The only response was, “Don’t move him.” Although it felt strange, I said, “I’m a doctor.” While turning him over, I was nauseated by the smell of stale beer and fresh blood.

ABCs.

His jaw was shattered. I removed several teeth while attempting to clear his airway. I wiped as much of the blood from his mouth and face as I could. I knew the next step was to establish breathing, but I had no mask

Blood. AIDS. Hepatitis.

I recalled the lifesaving instructor at Boy Scout camp saying, “When saving a life, the most important life is your own.” I stared at this man, knowing that mouth-to-mouth was his only chance. Again I wiped his face, but blood still oozed from his mouth.

I was relieved when the emergency medical service arrived soon after. They began cardiopulmonary resuscitation with gloved hands and a bag-mask. They quickly loaded him into the ambulance and were working on him while I watched. Feeling helpless and confused, I got back in my car and wiped my hands with every baby-wipe I could find. We left quietly to retrieve our children. On the way back, we passed the still blocked off area and I slowed, trying to see if the blood was still on the ground. The pavement had been washed by the steady drizzle. There was no sign of where that young man had fallen.

Over the next few days I struggled with my response to those events. Was I irresponsible in not starting mouth-to-mouth immediately? What if he had been dressed in coat and tie? Was I fulfilling the responsibility demanded of me? Was I upholding the Physician’s Oath? I questioned my actions, sought the advice of more experienced physicians, and asked several people what they would have done.

I am still confused about what happened that night, but I do know a little more about what responsibility means. That young man lay dying in the middle of the street and I had stopped. Although I had been trained for emergencies, that became superfluous in the events of that night. I had routinely helped resuscitate trauma victims in the emergency room of Parkland Memorial Hospital. In the middle of a wet street, kneeling in the blood of a dying man, I felt what responsibility means. I have spent many hours trying to put into words the tumult of emotions I experienced while caring for my first patient as a doctor. I can say that caring for people no longer seems routine. I also believe that responsibility has much to do with living the Physician’s Oath, which states in part “to approach each patient with integrity, candor, empathy and respect” and “to remain conscious of my limitations.”This was quite a beginning, especially after taking “responsibility” so seriously. I am a doctor; that seems to be the easy part. Becoming a physician and living the Oath is the real challenge. While our commencement speaker encouraged us to find something worthwhile for which we had a passion, I had wondered if I would find mine. I believe I have.

Copyright ©2004 by the American College of Physicians

http://www.annals.org/content/120/8/688.full

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