Tuesday, January 01, 2008

Playing God

Happy New Year, everyone! We had an awesome bon fire, karaoke and non-alcoholic champagne to ring in the New Year. It was a helluva party until some idiots started throwing empty cans of silly string into the bon fire. Fortunately no one was injured. Still, there was a lot more duck-and-cover then I usually like in a war zone.

So, New Year's Day greets me with some interesting tasks. I'm struggling with how to tell this story because it's quite unbelievable, even to me. Rather than try to spin a good yarn, I'll just lay out the facts.

We have a young detainee (in his 20s) with one huge tumor in his chest and a bunch of smaller tumors in his lung. It turns out he had a bone cancer as a child. Sometimes these kids get either recurrent disease or a new cancer like lymphoma. We don't know exactly what it is and we really don't have the equipment needed to find out.

He's going to die unless someone figures out what this mass is made of.

In my new job as chief of staff, I can request a Compassionate Release. This is reserved for detainees (note that we don't call them prisoners) whose conditions have worsened significantly since their capture and who would probably not be able to participate in the insurgency if they are released. He seems like a good candidate, right?

So today I get a question from Legal, "Umm, do you think there is any chance of him recovering if he gets the care he needs after he's released?"

It's a good but difficult question. Based on what I know of the Iraqi healthcare system, the odds of him getting the appropriate care are pretty slim. But assuming he got to a good doctor and assuming this is something treatable like lymphoma, then yes, he could recover.

"Umm, do you think he could recover enough to participate in the insurgency?"

Think about my dilemma for a second. I am a physician sworn to care for patients and Do No Harm. If I say he CAN'T recover, he can be compassionately released (and potentially get the care he needs to recover). If I say he CAN recover, they won't let him go and he will surely die.

Before you decide what I should do, would it change your mind to know that he killed a bunch of soldiers? What if he was just an innocent bystander?

After you've got that figured out, tell me what to do with my other 20 year old with the 6 centimeter brain tumor. In this case, I KNOW he's a Bad Guy.


katitude said...
This comment has been removed by the author.
katitude said...

hmmm...that is a sticky wicket. On the one hand there's the knee jerk reaction. But on the other, even if they *are* bad guys, can you ignore conscience and the Hippocratic oath? Wouldn't you want mercy shown by the other side, where US and other allied wounded are the "bad guys"?

But that's easily said from someone safe and warm; I don't know nothing from nothing.

Thank you for giving me something to think about today, other than the self-centered pursuit of winning at poker (like that's gonna happen!).

It can't be easy Doc, and I don't envy you. Thinking of you and everyone else who is far from hearth and home.

Smiles and hugs!

TenMile said...

Sounds like they want you to change you original answer, Doc.

The problem with the cancer is it makes the guppy hate all the more - and wanting to "get even." 'Course, it doesnt make any difference to him as to whom or what makes him even.

Good luck with it. My mother had the brain cancer/tumor schitck and I, as eldest born, had a miserable time dealing with the hate.

Unknown said...

Do no harm.

Pray for an answer and do what your heart says.

We back you either way


BamBam said...

At this particular momment...
more than any other....
I do not envy your situation.
I do however, trust that that decision you make,(or made) will be the correct one for the situation involved.

My personal decision would be to go with my allegiance, rather than my oath. It would be incredibly tough serving two masters. I would have to ultimately side with the security and safety of those I serve with.

I can't begin to imagine your circumstances. I do know that if the "detainee" could possibly be a threat to my fellow compatriats, I'd have issues releasing him from his "detainee" status, despite his own personal issues.

There is no way to make the correct decision for you personally. There is only the right decision based on the facts at hand. You better than anyone, know what the situation is. Whatever that ends up being, know that it is supported based on my knowledge of you the man.

Be safe !

Anonymous said...

This is The Sister, just in case it comes up as anonymous again. The right answer is which ever you choose as Commander. You can't make the wrong choice since you cannot predict the future. As both your roles as my brother and a superior officer I am sorry you have to make such a decision.

911siren said...

Oh Dear Brother.

I say, with heavy heart and sick soul, let him go. As a doctor you must ignore the fact that he has killed. It is not something your oath even allows you to consider. If you cannot treat him then he should be released to find someone who may be able to help him.

I do not believe he will find the help he needs. Karma is already kicking his ass into an early grave and the world will be a better place when he is dead.

But the decision to keep him there till he dies because he may be cured if you release him has already been made. It was made the day you took the oath.

Could you live with yourself if you let him die, knowing that something else could possibly be done (such as finding help outside) If you let him die in custody without even a chance to try outside of your hospital then you will not have done all you could for your patient and your oath will be broken.

Take comfort in the fact that if he finds help, the process will be long, painful and will be life-draining. And maybe at the end of his treatment/end of his life he will remember that an American let him go.

I cannot stress this point enough, if I were there, he would be dead already. And there would have been a great deal of agony involved in his death. I am going to finish weeping now.

Chuck I am so very sorry these are decisions that you have to make.

I love you!

Sister Michele (not a nun)

Anonymous said...

You should have reraised preflop....sorry.

If i'm an isurgent, and i know i'm going to die...then i would take out as many allied soldier as i could.

Knowing that, i just couldn't release them. I don't suppose there is a place for detainees w/
terminal illness.

Good luck w/ that...

Wwonka said...

Kill em all and let god sort em out.

No seriously I don't envy the decision you have to make.

I would choose to let them Die, Especially #2.

Too bad they don't treat our Prisoners as nice as we treat theirs.

Be safe