We always speak of tending to the sick, injured poor and forsaken as doing “God’s Work!” There is no better metaphor to examine that metaphor than the disaster in Haiti. There, we ascribe the disaster to God, of course. We call it an “Act of God”. In this case, God has done His work, and now, we do clean up in His name. Go figure!
What got me thinking about this was an article sent me by one of my paramedic partners from years ago. He’s still in the business, believe it or not! It’s called “How the Ethics of Triage Play Out in Haiti”
Triage, as any Emergency Worker will tell you, is among the most harrowing things a medic is called upon to do. Arriving at the scene of multiple illness or injury, the first medics present must move swiftly through the chaos, treat no one, and assess everyone.
It’s not a full assessment by any means. Most agencies use a Color coded or Numerical or Alphabet-based grading system to sort through the severity of the victims. Most have five or less categories. “Immediate Attention” is top priority and reserved for those who can not only survive with intervention, but can also get back into some form of productivity. At the bottom of the gradient is the Do Nothing category; essentially those whose injuries are serious enough to suggest any intervention would offer no tangible good to anyone. This is the “It’s God’s Will” class.
But whose will is it really? This is the crazy-making, burn-out facilitating stuff that haunts practitioners who thrust themselves into the midst of one of God’s little tantrums. For every one of their patients they think they might help, there are hundreds more who they suspect will be literally condemned to slow, agonizing deaths because the resources, time, personnel or whatever are simply not available for them to expend.
In a disaster like Haiti, however, you cannot afford to waste a precious moment contemplating the things you can’t do. There’s only one thing to cling to, the one you actually CAN help, and that means keep the line moving until that One appears. You are searching for a fleeting moment where an action you take appears to make a difference. Along the way, you can offer the others tokens of caring, if nothing more than that you are there.
So many of the decisions being made by the physicians on scene in Haiti of who to treat and who to ignore are being based on available resources. Oxygen, for example, is reserved for those who need it to get to the next stage of recovery, which needs to be right around the corner. For the thousands of others whose use of oxygen could relieve them of suffering as they progress to certain death, well…
My favorite quote from the show was from Dr. Millin, one of the interviewees. His response to the need for mental health assistance for the volunteers was: “I’m not a mental health professional, though I’m fortunate to be married to one.”
The good Dr. will have many safety nets, fortunately. He will be one of the very few who was actually there and could help, if only a little. Most everyone else, rendered impotent beside the enormity of the calamity if not totally immersed in self-preservation, will certainly be limited to being witnesses, rather than actors. He didn’t sound cold (I listened to the show) but he was quite clinical, which, in this case, is absolutely appropriate.
Still, every triage decision the doctor made brought some one closer to life and many others closer to death. He explained his actions in terms of the “appropriate allocation of resources”, but in the long term, no I don’t think that will help him sleep at night.
The absolute fact is we’re all going to die unless something quite radical shifts. (Even if it does, prolonged life wouldn’t become available to anyone other than the rich and powerful for a few generations, if at all!) In a calamity such as Haiti, all that is happening is there’s a lot of people meeting their Makers all at once. It’s just an accelerated rate, happening at a specific place, for a limited (hopefully!) amount of time. I would think, under those circumstances, the best you would be able to do is to play loving witness and reduce as much pain and suffering as you could along the way.
But the doctor’s job was not to reduce pain and suffering, it was to find some people who were fixable. Odds are the images that will haunt him are the faces of those for whom he had no relief to offer.
Many of those the Doc did not treat were referred to the Painful and Prolonged Death Ward (in Haiti’s case, the streets). At some point, he will probably realize this. How could we spare him from such devastating consequences born of his heart-felt desire to serve?
Were we to be truly honest with ourselves, we’d frame the definition of healer to include the certainty of death, which could mean, in a disaster such as Haiti, relieving suffering would be at least equally important as getting the few fixed. Today, unrealistically and at much cost — medicine is designed to keep TRYING, this, that, its mother and the other as if death were not an inevitability and pain didn’t matter.
What would we do, how would we act, if we truly accepted we’re all going to die?