Is there a doctor in the room?” The question was asked by the chief surgical resident soon after he entered the trauma bay, full of confidence and clearly in charge in the midst of chaos. The nurses had been trying to get an IV line in. Several intern doctors and medical students (like myself) were trying to help. Afaid of death, which was obviously knocking, but excited at the same time to be where the action was.
In addition to this drama, we all questioned what he was getting at. What did he want? Did he not know? Was this a trick question? Was he trying to teach us something?
After the appropriate pause for effect, but not so long as to cause delay, the chief explained, “If there were a doctor in the room, he or she would have been getting a cut-down.” Of course! A venous cut-down. We could get IV access. We had been trained in how to “cut down” through the skin to a superficial vein, get an IV in it, and tie it up so it would not come out. I grabbed the kit and the chief and I did my first cut-down.
I think today it is time again to ask this question: “Is there a doctor in the room?” The day of Ebola. The disease on the headlines. This fearsome outbreak that has killed thousands in Africa and has reared its ugly head here in America as well.
If there were a doctor in the room, he would go and treat the patient. Even though he had never seen such a patient before in his life, he would remember his training and come up with a logical, determined, and reasonable plan to do something about the problem. He would do it, even if it made him shake in his boots. He would do something even if his friends did nothing. He would do something even if there were risks.
If there were a doctor in the room, she would volunteer to go to Africa and help treat the epidemic at the source. Some have gone. But recruiting doctors for this job has been very difficult. Many working at the Ebola Treatment Centers are on their second or third rotation. When the president of the United States put out a call for doctors to rise up and go, there was a surprising silence. Aid organizations have the money and the logistics personnel, but few doctors.
If there were a doctor in the room, she would stand up for reason and science and compassion for those returning from overseas. Instead, we have a fight between governors and lawyers as the people panic. A doctor, knowing history and literature and people, not merely science, would explain to the people that no life is without risk. A doctor would help bring people to balance, realizing that those who insist on an absolute risk-free life need therapy. She would realize that to send people overseas means they will come back and need support and help, and they themselves will be a risk.
If there were a doctor in the room, he would put his suit on to see the Ebola patient. Having read the literature about Ebola, he would know that it is found in the sweat of the patient, as well as in the other body fluids. He would know from lessons learned from prior outbreaks that a full body suit is required, with every inch of skin covered. Apparently there were no such doctors at the CDC when they gave out guidelines, telling doctors and nurses that no special protection was required. If there were a doctor in the room, he would do his best to find out who had treated Ebola patients before him, and he would realize it was the Africans and the Aid workers. He would contact them and read their reports and see what they did. He would not foolishly try to theorize the approaches on his own. He would not stop at improved suits. Until there was a clear reason to change strategies, he would do exactly what they do in Africa: send the Ebola patients to specialized centers, give them good supportive treatments including IV fluids, and use chlorine-based decontamination.
So the question remains in the air, as it did those years ago. That day of the gunshot and the blood. The question that made all of us very uncomfortable, but at the same time gave all of us a flag to carry and a rallying point: “Is there a doctor in the room?”