Patrick Patrick Dismuke was a young African American boy, at the age of fifteen when the story starts, and a regular patient at Hermann Hospital. Patrick was born with a severe case of Hirschsprung’s disease, a disorder of the digestive tract, and was unable to digest his food. Throughout Patrick’s life, he spent more days in the hospital than out and came to be quite comfortable with the environment and staff at Hermann. Due to his disease his only way of nutrition was through a feeding tube, unfortunately these tubes often got infected.
Since Patrick’s immune system was also weak, the infections were almost as bad as the disease itself. The doctors were forced to put the boy through surgery multiple times to replace infected tubes, each time making him weaker and bringing him closer to death. Once the he became too weak for the surgeries, the doctors were faced with a dilemma- to do surgery or not? The surgery to place a new tube directly into his heart would be risky and potentially kill him, but if the surgery did not occur, the infection would slowly destroy his body and block the tube causing him to starve to death.
Before any decisions could be made, the doctors needed to consult the patients mother, Oria Dismuke, was a single mother who worked extensive hours at whatever jobs she could find sometimes working as many as three at a time. Oria was a quiet and didn’t have much to say about her opinion, it’s not that she didn’t care; she was just exhausted and wanted her son to be both happy and comfortable. Along with the mother, the doctors also had to meet with a hospital ethics committee before taking action.
The committee met many times throughout the book and made many contradictory decisions depending on his progress at the time of the meeting. First, the committee decides to make Patrick DNR but he began to get better, so after consulting him, they ended up doing another risky surgery. The committee seemed to have a utilitarianism ethical view, they were concerned with Patrick’s overall wellbeing, and what would make him happy. Luckily he made it off the operating table alive, despite the fact that the tube had slipped too far. However, he was paralyzed on his left side and died a few weeks later.
The dilemma for ethics committees brought up by the story of Patrick is a question of how much is too much. As technologies in the medical field continue to advance, people can live substantially longer lives, but are they lives worth living? Some people, like Patrick, don’t think being paralyzed is a quality of life worth living. Others, like Armando, refuse to be made DNR and cling to life even if it consists of communicating by blinking of the eye. The questions raised in this book are awful decisions that nobody should ever have to make.
Whatever the committees and doctors choose to do can keep patients alive and allow them to have a low quality of live, be in constant pain and be a burden to society, or keep a terminally ill patient comfortable until he or she has said their good-byes and let nature take its course. Another concern that an ethics committee must address is the cost of care. Wealthy patients with health insurance are much more likely to be welcomed into hospitals with open arms while patients without insurance are often given poor medical care and sometimes even turned away.
Hermann Hospital started off as a charity hospital and was supposed to be widely available to the poor and underprivileged. However as the initial funds started to deteriorate and the hospital started getting substantial debt, Hermann started taking in more patients with insurance and less charity patients. When patients like Patrick and Armando were admitted to the hospital, no one was able to pay the bulk of medical bills and the hospital goes further into debt. Memorable Moment First, Do No Harm is full of captivating stories of real life events, all of which are hard to forget.
Perhaps the most shocking aspect of the book is what was said by one of the nurses when Armando was brought into Hermann. The nurse was angry at the fact that he survived and said the only reason he was admitted in the first place was because he was an organ donor. The fact that a hospital would admit someone with the hopes of them not surviving is scary. If more people knew this is the attitude that medical staff had, surely they would be more hesitant before going to a hospital and be more skeptical of their doctors.
From a patient’s perspective, hospitals are supposed to be establishments that help heal people, not hope that they die. However, from a nurse or doctors perspective, they are to help treat the most curable patients even if that means letting the weaker ones die to save the healthier ones. This passage makes the reader realize that there is more than one perspective in every situation that occurs at hospitals. Doctors and nurses are used to being in the presence of terminally ill patients and often have hardened hearts, as a result of seeing death on a daily basis.
This passage also reminds the reader that nurses are people too and when stressed they can say rude or demeaning statements that shouldn’t be taken too personally. Gossip tends to spread throughout hospitals, just like any other large establishment, even though it shouldn’t. Author’s Perspective Despite the variety of tough ethical decisions made throughout the book, Lisa Blekin never quite makes sure what her opinion on healthcare issues is. Belkin is sure to include both opposing perspectives in every dilemma that is put forth. In each decision, there is a long process that is conducted before any decision is actually made.
One of the first questions asked in each case is whether or not the patient has a DNR or Do Not Resuscitate order. If the patient does not, and is terminally ill with no possible chance of a cure, they hold an ethical committee meeting to decide if a DNR order should be made. The committee is made up of a variety of diverse doctors, nurses, medical staff, and parents of the patient, along with civilians that have experience with tough decisions. In the case where the parents decide to make their child DNR and the committee disagrees, they can call a lawyer and have a foster parent take temporary custody of the child.
The theme expressed in this book is about ethical issues that have no clear right answer and the steps that must be carried out in order to find the best answer. According to ethical objectivism, discussed by Rauhut, there are at least some ethical norms true for all people at all times. The dilemma arises because cultural relativism, the fact that different cultures have different moral principles and values. In the Case of Taylor, a premature baby girl whose twin brother had already passed, the decision of whether or not to keep her on the ventilator was easily the toughest decision a parent could ever have to make.
Due to her young age, the doctors were unable to tell if she’d be severely brain damaged or even live. By keeping her on the ventilator would they just be prolonging the inevitable? Or would she become a fully functioning citizen? There is no way to tell which would happen so there is no way to tell which the right answer is. After months of meeting with doctors and committees, Taylor’s parents decided that the best decision would be to take her off the ventilator, and if she was meant to live she would breathe on her own.
Belkin never states what she would do in such a situation, but clearly supports the ethical decision making process at Hermann Hospital. Overall Review As a first time reader of this book, it was not at all what was expected from the cover. The book is organized in chronological order; the author keeps up with each patient every month. The chapters are divided up by patient, or committee meeting to help guide the reader along the story lines. Despite the bland visual appeal the book has, it’s full of captivating stories, lovable characters and heart breaking ethical issues.
The intense drama of constant ethical issues makes this book extremely hard to stop reading. Lisa Belkin does an extraordinary job describing medical conditions and making them easy for the readers to understand. The point of the book is to raise ethical questions and engage the readers in critical thinking about tough real life situations. This book turns readers’ focus away from petty everyday problems, and makes them realize that there are worse things happening and harder decisions to be made. First, Do No Harm also brings a variety of perspectives, leaving a lasting impression.
