February 2003

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Of rivalries and disappointments.

Gee, you think I'm going to talk about basketball, don't you? Well, I'm not. I'm talking about healthcare, and arrogant attitudes. And two highly-respected institutions. This is more immediately about Duke University, and the Jesica Santillan case. But I'm going to drag an asshole from Carolina through the mud, too. Stay tuned.

I'm not going to link to news stories about Jesica, because those links may go away at any time the news organizations take them down. I am going to give you the gist; you may fact-check the story through the search engine of your choice.

Jesica Santillan needed a heart and lung transplant. She was being treated by physicians at Duke University's medical center, which is one of the parts of Duke I had most respected. A heart and lungs were found, that should have suited her just fine, except through several layers of mistake they didn't suit her at all. They were from a donor with a non-matching blood type.

After this was discovered, physicians at Duke did all they could to keep her alive and do another transplant. That one, with all blood types matching, was done last week. But apparently Jesica had already suffered some brain damage, and the damage worsened. It became clear to her physicians that her brain had died.

Two physicians evaluated her, and the determination of brain death was confirmed by both. The next step was to inform her parents that all life support measures would be removed, since there was no hope. The parents made a request for a second opinion. And Duke lost all sorts of points with me for what happened next.

Duke refused, on the grounds that there was no alternative treatment, which, as they explained, was what a second opinion was all about. Then they proceeded to do as they planned, in terms of discontinuing life support.

They had the legal right to do this. But I think they could have handled it ever so much better. They could rather easily have honored the family's wishes, and called in an outside physician (one not on Duke's staff), to evaluate Jesica's condition. I doubt very seriously that any other physician would have disputed the findings of the first two. But it would have provided some solace for the family, and left Duke looking like the good guys they have the reputation of being in terms of medicine, and not the arrogant assholes they have the reputation of being in other circles.

And I'm disappointed because Duke now looks as bad in my eyes as the attending physician at UNC Hospitals who tried his level best to coerce me into discontinuing life support for my mother before a proper diagnosis had been reached. I've written of this doctor and his fellow physicians before, and it still angers me nearly seven years after the fact. When he asked me what Mother would want, I said that we had only discussed what to do in cases of brain death, in which situation I was sure she would not want to be kept breathing, etc. He dismissed my statement by saying that under those circumstances they would do that without anyone's permission, since they could under North Carolina law.

That was such a huge amount of help. I'm sure the Santillan family must have appreciated Duke's physicians' attitudes toward their concerns as much as I did the attitude of the one at UNC.

Perhaps the two schools could quit being rivals now. They both lose.

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If you're looking for the Februarium entries, they're here: Monday, Tuesday, Wednesday, Thursday, and Friday.