The Uncertainties of Medical Science
While there is much that we know in medicine, there is so much more that we don’t know. So, there are times when I marvel at how the human body recovers despite our best efforts. Best efforts are what we do as a medical community, but we are only human. Our medical knowledge and skills have their limitations. So, our best efforts are all that we can do. Ultimately, it is up to the patients themselves to recover and improve, possibly, in some small part from something intangible that we can’t measure or account for.
A Case Study: Viral Encephalitis in a Child
As an example, a child developed symptoms of viral encephalitis where a virus causes inflammation of the brain. The child had fevers and symptoms of a “cold”, just like most kids who are seen in the outpatient doctor’s office or local urgent care. However, this child developed headaches and became listless. She started to have trouble walking, eating, and drinking. Then, she progressively became less interactive and conversive. And, finally, she slipped into unconsciousness without being able to respond to her parents or anyone else for that matter.
The process progressed over about 4-5 days after the onset of the fevers and mild “cold” symptoms. The changes were subtle, until they weren’t. Upon admission to the pediatric ICU, she was breathing on her own, but could barely manage her own oral secretions and did not respond to any stimulus. Her parents were calling her name and pleading with her to move a finger or open her eyes. But, she did not respond. Her oral secretions accumulated to the point where she required frequent suctioning of her mouth and throat by the nurses. There was concern that she may need to have a breathing tube placed in her windpipe to protect her lungs from aspirating her own oral secretions.
After several days of close observation, fastidious airway suctioning, testing, and other medical management, her condition appeared unchanged. However, there were reports from the parents that she tried to open her eyes. Did she try to open her eyes or was it wishful thinking, as a random movement could have occurred and was interpreted as something intentional? However, the next day, a nurse reported that she possibly moved a finger in response to the nurse asking her to squeeze her hand. Then, the following day, the child definitely opened her eyes, but nothing more than that. Nevertheless, there was hope and there was some progress, albeit very slight.
Over the next several days, the child became more purposeful in her movements and was following instructions. Eventually, she was safe to transfer out to the pediatric ICU. A few days after the transfer, on the regular pediatric ward, she was feeding herself, conversing, and able to walk. She recovered, but there was never any certainty that she would.
The Balance of Hope and Reality in Medicine
In the pediatric ICU, we see children with the same diseases being given the same medical care have very different outcomes. Why does one child do better, and one does not? It causes me to pause and wonder at the victories and be crushed at the defeats. The victories infuse me with hope and patience during difficult illnesses which outshine the defeats. Nevertheless, one of the scariest things is to see a child slip into unconsciousness without the assurance that he or she will return to who they were before they became sick.
The Intangible Factor: The Unseen Elements of Healing
There are many causes of unconsciousness, but unconsciousness caused by viral encephalitis is always concerning. It is one of those illnesses that makes me really appreciate the recuperative capacity of the body, if a child fully recovers. While not every child recovers, the ones who do recover make me feel that there is something more than medical care that precipitated their recovery. It makes me feel that something intangible that we can’t measure or account for was responsible for the improvement. And, I have to say, that intangible something that we can’t measure or account for makes me marvel and believe in miracles.
Do you believe that there are intangible factors, beyond medical science, that contribute to patient recovery? Why or why not?
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