Wrapping Things Up

I never was any good at wrapping presents. I just can't estimate the surface area of irregular polyhedrons. In any case, we finished up the endocrine unit. We had a lecture on the ethics of artificial nutrition (feeding through a tube). I'm not interested in writing about the specifics of artificial nutrition, but one thing struck me. Withdrawing artificial nutrition is ethically and legally equivalent to withholding artificial nutrition. It's definitely a lot harder (emotionally) to take someone off tube feeding, but it's the same as not giving it to them in the first place. The patient is not dying because he's not eating; he's not eating because he's dying. The underlying disease is killing the patient. A feeding tube does not stop, and may not even hinder, the inevitable. In any case, this is the conclusion that contemporary philosophy tends to side on, though we didn't really delve into the issues. I thought that was interesting because I pondered this topic in a February post on "Some Dilemmas."

We also had patients come in to talk about their diseases. One was a woman with type 1 diabetes. It was really amazing to hear her speak about the impact of the disease on her life. As a medical student, we learn about the disease presentation, diagnosis, epidemiology, complications, and treatment. We're taught that diabetes is treatable with good insulin management. But we never really see the impact of the disease. Patients have to learn to count calories and carbohydrates in the foods they eat, to calculate the dose of insulin they need, to plan out their day from snacks to exercise. There's social stigma and parental involvement and the looming threat of diabetic ketoacidosis. It's scary. It's not easy to have good glycemic control. I learned a lot from hearing the patient's perspective.