A Revolution in Medicine

RC2 went over to Commentary to look for a 1974 article on Watergate that Powerline and others have been hyping as the best thing ever written on the subject. It's there, but you have to pay for it, and she didn't. She found something even better. Paul McHugh's article, "Annihilating Terri Schiavo," which is about the sea-change in medical training that has taken place to ennable us to think of the Terri Schiavo's of the world as "vegetative."

He includes a moving case from his early days in medicine, when he took interns on rounds of a floor dedicated to such patients. One person they cared for was a prominent surgeon who had made great contributions in his field. After a botched brain surgery, he was left in an altered state of health that was similar to Schiavo's. RC2 was struck by the profound difference in attitude in the health-care providers. McHugh says that he and others were proud to care for the man.

That's enough to meditate on right there, but he goes on. While guiding interns through rounds, McHugh finds himself challenged to say anything new or interesting each day --the patients' conditions didn't change much-- and, well, I'll let him tell the story:

Soon enough they began to grumble that I was repeating myself as I would note dutifully that, although Dr. A’s apathetic state was profound and unchanging, occasionally such a patient might, if startled, give out a coherent response revealing some human consciousness. Looking at the man lying before them, they thought they had ample reason to doubt the applicability of my ideas to this case. A particularly bold intern challenged me one morning: “Enough of that, show us that he can respond.”

I knew perfectly well that I was being baited over a matter where I was unsure of my ground, but I moved briskly from the records cart to the bed, shook the patient by the shoulder, and asked in a sharp voice: “Dr. A, what’s the serum calcium in pseudopseudohypoparathyroidism?” For the first time in my experience with him, he glanced up at me and, loudly enough for all the interns to hear, said: “It’s just about normal.”

A full and complete sentence had emerged from a man whom none of us had ever heard speak before. His answer was correct—as he should know, having discovered and named the condition I asked him about. Subsequently, in all the months we cared for him, he would never utter another word. But what a difference that moment had made to all of us. We matured that day not only in matters of the mind but in matters of the heart. Somehow, deep inside that body and damaged brain, he was there—and our job was to help him. If we had ever had misgivings before, we would never again doubt the value of caring for people like him. And we didn’t give a fig that his EEG was grossly abnormal."

Read the whole thing.