So much of what we do in the operating room and the intensive care unit is immediately gratifying. Just adding or subtracting a medicine can make a huge difference to a patient, and you don’t have to wait long to see the results.
Recently, I saw that a patient recovering from cardiac surgery had dangerously low blood pressure, and his urine production was dropping — a telltale sign that his circulation was failing.
This could have been caused by ongoing bleeding, the lingering effects of anesthesia, or having decreased heart function after surgery, among other causes.
Based on his vital signs, lab values, and other clues on the physical exam, we decided the patient needed more medicine that helps boost heart function.
“Can you please increase the dose of his epinephrine?” I asked the nurse.
She increased the rate on the IV pump, and within minutes, the patient’s blood pressure normalized. The next day he was well enough to leave the ICU.
Instant gratification like that can be almost addicting. In modern medicine, we can manipulate virtually any function of the human body. We can raise the heart rate or slow it down. We can target specific microorganisms. We can breathe for the lungs, filter for the kidneys, and pump for the heart. It is a tantalizing power to behold.
Under its spell, sometimes I catch myself taking this expectation to matters outside of the hospital. When I find myself in situations that are slow-moving or do not respond as I hope, I can easily become frustrated and restless.
But the more time I spend in the hospital, the more I realize that the most important and also the most challenging interventions are neither immediately gratifying nor certain.
Lasting changes take time, and patience. Some never come about at all.
Especially during the pandemic, I have seen nurses and physicians speak to the family members of patients who are unlikely to recover every single day, patiently helping them navigate this frightening process.
I have seen nurses speak kindly and respectfully to patients who have not woken up in weeks or who may never wake up. I have seen teachers encourage trainees through moments of failure and self-doubt.
These interventions do not manipulate the heart; they inspire it. They are not medications that elevate the blood pressure, but rather assuage tension and frustration.
In the end, what makes modern medicine so gratifying is not the immediate and exact nature of our interventions. It’s that we continue to value and affirm humanity at every step, even when these equations are not as direct or efficient, without any expectation of a reward.
Jason Han is a cardiac surgery resident at a Philadelphia hospital.