Louisville Medicine Volume 69, Issue 8 - Page 28

DOCTORS ' LOUNGE
( continued from page 25 ) with an open mind . My patient was not going to get the vaccine and I knew , in that moment , she likely never would . I understood then , as I do now in her critical care admission , that she was voiceless . While her early dementia diminished her ability to express her point of view and her preference for Farsi challenged our communications , she was voiceless , at the hands of those family caring for her . She was voiceless to accept the one tool that could have prevented the onset of her rapid decline .
Faced with her ominous admission , my mind wanders back a decade or so to one of my first voiceless patients , muted by his own hypotension and intubation . In the first week of my intern ICU rotation , I fretted over an early morning decline of my new patient . I recall my peripheral acknowledgment of the weakness of my fourth-year medical school ICU rotation , though I was woefully unaware of the depth of my ignorance heading into a storm of sepsis . The sun was breaking over the Potomac River , just out the ICU window , as I forged forward applying the Surviving Sepsis guidelines to the quiet storm inside . I learned all too soon the understanding required in the care of the ICU patient , all body systems included , and the interconnectedness therein . The knowledge required stretched far beyond any guidelines , especially ones dreamed up by the marketing department at Eli Lilly . I will never , ever forget the moment my house of cards came tumbling down , and the ire of my fellow . The sun shining brightly over the Potomac framed a sublime background while my patient ’ s startling EKG supplied an emergent and foreboding foreground .
My hands felt so dirty and it took some time for them to feel clean again . I was humbled in my ignorance , but I was spurred by my ignorance to learn . Through my rage in the present , I am able to muster some empathy toward my patient ’ s son , acknowledging we all have the capacity to be less than informed .
My rage remains , though , and it is rooted not just in the voicelessness of my patient but the belligerence of her son . I uttered aloud to myself , when I learned of her admission this morning , “ Her son has blood on his hands !” ( If I am truthful , the full transcript of my self-utterance cannot be printed in these pages .) The unfettered part of my rage , allowing those inner thoughts to escape from my tongue , is unsettling . My profession tells me I should be more discreet , more impartial , more professional , but COVID-19 has worn me down too . Keeping it all inside has , of late , not been my strong suit .
After my outburst , I started thinking , “ Just who has blood on their hands ?? I ’ d slammed the gauntlet down on the son , furious at his belligerent and determined ignorance . Yet , do I have soiled hands , as well ? Could I have educated more and done so more compassionately ? Could I have followed up with a phone call to urge vaccination after some time and space ?
I wondered further if the son ’ s Sunday school class members have soiled hands , as well . Could they have urged their classmate to listen and understand the urgency of the situation ? Could they
26 LOUISVILLE MEDICINE have framed the vaccine as a way to “ do unto others ?” They could have , in their very community , reminded the son of the value of community and the actions needed to not just live next to one another , but with one another .
Do we all , in this country , have sanguine hands ? Do we really collectively understand the opportunity we have wasted ? Can anyone claim not to be complicit in allowing the polarization that has gripped this country and insidiously seeped into the conversations around COVID-19 ?
Americans understand from an early age that United We Stand , Divided We Fall , and no one more than Kentuckians , but have we forgotten this lesson of adolescence ?
Ignorance is rife . Humble ignorance , one should hope , would take the lion ’ s share . Recent experience would suggest otherwise . Belligerent ignorance seems to predominate and COVID-19 has colored this trend like a fluorescent highlighter on an otherwise unread page . Taking a nod from history , if anyone cares to read it , the voiceless always suffer in spades at the hands of the belligerently ill-informed . Ignorance can nearly always be rectified , at least to those receptive , and it can even be forgiven . Belligerence , though , is a poison , toxic at its core , that readily alters even the most principled path . I can forgive ignorance . Belligerence , well , that is a different story . Dr . Kolter is a practicing internist with Baptist Health .