Less Is More but sometimes More Is Good

I feel like I have a very cynical attitude towards medicine.  I'm often surprised by how little we can do to help some patients.  There are even times when I feel that we do too much and are too invasive.  I want to scream that "less is more".  I want to tell the patient to leave the hospital or to refuse treatment.  But occasionally, my faith in medicine is actually restored and there comes a scenario or two when a life is actually saved.

A little boy with a severe asthma exaacerbation and possible anaphylactic reaction was in acute respiratory distress...  It is scary to watch a young child struggle for air with complete panic in his eyes.  The parents are crying and do not know how to help their son.  Life or death really does lie in the hands of the physician at this point.

This situation occurred last night when I was on call in the Emergency Department.  Although my shift was over at 11pm, I stayed until 2am just to make sure that this kid was still breathing.  I listened to his lungs and have never heard a more severe exam.  There were no normal breath sounds.  The space between his ribs was visible as his work of breathing increased.  This is what I call Stress.

Thankfully, a barrage of medications, including an EpiPen, nebulizer treatments, and several IV meds, calmed his breathing.  He was eventually able to fall asleep.  On exam, I was amazed to hear that his lungs were completely clear.  It was as though this episode had never even happened.

In this acute case, it was necessary to use as many medications that could possibly help.  The stakes were so high.  And despite the vomiting and shakiness and headaches that followed some of the medications, this boy was able to breathe deeply once again.

Thus, my rule in life is that "Less is More but sometimes More is Good".  I think that it is our job as future physicians to learn this distinction.  We need to determine when we have done enough, when the body is better off healing without our help, and when we have pushed the limits of our knowledge.  But we also need to determine the situations in which a well-orchestrated intervention can mean the difference between life and death.