Not Enough Technology to Go Around?


In a modern industrialized society like the U. S., we tend
to take certain things for granted.  One
of these things is that if someone needs emergency medical care, that care will
always be available.  The COVID-19
pandemic is calling that assumption into question.

For a time in late spring, many hospitals in New York State
were overwhelmed by COVID-19 patients who needed ventilators to keep from
dying.  Even with ventilators, many died
anyway, and it took weeks for the healthcare system there to recover to the
extent that it could handle its normal emergency traffic along with the
extraordinary COVID-19 patient load.  In
Texas, where I’m writing this on July 12, we are currently being warned that if
the COVID-19 infection rate continues to rise like it has in the last few
weeks, we may be in a similar situation with maxed-out hospitals and the need
to set up emergency wards in convention centers. 

Broadly speaking, a modern healthcare system is a technology
in the same sense that a postal system is a technology.  It involves machinery, to be sure, but it
also involves complex human relationships, states of training, and command
structures that are just as essential as MRI machines and ventilators.  It takes a huge amount of resources in money,
time, and investments of lifetimes of training and practice to develop the
capabilities represented in a modern hospital. 
So it’s not surprising that when demands are placed on it that it wasn’t
designed for, you run into problems.  But
the problems you run into aren’t just failures of equipment.  It’s things like what happened to Michael
Hickson at St. David’s South Austin Medical Center in Texas.

Until three years ago, Mr. Hickson was a reasonably healthy
husband and father of five children.  In
2017, he had a heart attack while driving his wife to work, and suffered
permanent brain damage from lack of oxygen before he received emergency
treatment.  The injury left him a
quadriplegic and in need of continuous medical care, which he was receiving at
an Austin nursing and rehabilitation center when he tested positive for
COVID-19 on May 15.  He ended up in St.
David’s ICU on June 3, and on June 5 the hospital informed Mrs. Hickson that he
wasn’t doing well. 

That day at the hospital, she had a conversation with an ICU
doctor regarding her husband’s care.  The
situation was complicated by the fact that she had temporarily lost medical
power of attorney to a court-appointed agency called Family Eldercare.  Someone recorded this conversation, and it
makes for chilling listening and reading (the YouTube version is captioned).

When Mrs. Hickson asks why her husband isn’t receiving a
medication that can alleviate symptoms of COVID-19 and being considered for
intubation, the doctor explains that her husband “doesn’t meet certain
criteria.” 

The doctor explains that doing these things probably
wouldn’t change his quality of life and  wouldn’t change the outcome.  When she asks him why the hospital decided
these things, the doctor replies, ” ‘Cause as of right now, his quality of
life . . . he doesn’t have much of one.” 

Mrs. Hickson asks who gets to make the decision whether
another person’s quality of life is not good. 
The doctor says it’s definitely not him, but the answer to the question
about whether more treatment would improve his quality of life was no.

She asks, “Being able to live isn’t improving the
quality of life?”  He counters with
the picture of Mr. Hickson being intubated with a bunch of lines and tubes and
living that way for more than two weeks, but Mrs. Hickson gets him to admit that
he knows of three people who went through that ordeal and survived.  She tells him that her 90-year-old uncle with
cancer got COVID-19 and survived. 

His response? “Well, I’m going to go with the data, I
don’t go with stories, because stories don’t help me, OK?”  Toward the end of the conversation, he says,
“. . . we are going to do what we feel is best for him along with the
state and this is what we decided.” 

The next day, Mr. Hickson was moved to hospice care.  According to Mrs. Hickson, there they “withdrew
food, fluid, and and any type of medical treatment” from him, and he died
on June 11, despite his wife’s attempts to gain medical power of attorney back
from the court-appointed agency.

There are at least two sides to this story, and in
recounting this tragedy I am not saying that the Hicksons were completely in
the right in all regards, nor that the hospital, its doctors, or Family
Eldercare was completely in the wrong. 
But clearly, the hospital was under pressure to allocate its limited
resources to those who would benefit from them the most.  And it fell to the unhappy ICU doctor to explain
to Mrs. Hickson that her quadriplegic, brain-damaged (and maybe I shouldn’t
mention this, but he was also Afro-American) husband was going to be left
behind in their efforts to help others who had what the hospital and the state
determined were higher qualities of life.

It isn’t often that conflicting philosophies clash in a way
that gets crystallized in a conversation, but that happened when the doctor
said, “I’m going to go with the data, I don’t go with stories.”  In going with the data, he declared his
loyalty to the science of medicine and its supposed objective viewpoint that
reduces society to statistics and optimized outcomes.  In refusing to go with stories, he rejected
the world of subjectivity, in which each of us is the main character in our own
mysterious story that comes from we know not where and ends—well, indications
are that the Hicksons are Christians, so their conviction is that their stories
end in the Beatific Vision of the face of God.

But Mrs. Hickson would have been willing to look into the
face of her beloved husband for a little longer.  Unfortunately, the ICU doctor and the state
had other ideas.  Mr. Hickson might have
died even if he had received the best that St. David’s could offer.  But the lesson to engineers in this sad tale
is that the best designs at the lowest price mean nothing if the human systems
designed to use medical technology fail those that they are intended to
help. 



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