Monthly Archives: April 2025

Giving the Body Time to Heal or to Live

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When reading a book on ventilators* (mechanical breathing machines) to expand my knowledge of how to use them, I was struck by the author’s comment that ventilators are not curative but simply tools to buy the body time to cure itself. This factoid is known (at least subconsciously) by many physicians though not often so simply stated or at the forefront of our minds. The author’s bluntness made me wonder whether most of medicine is like that – interventions designed to keep death at bay until the body can mend itself, if such mending is possible. Or, if not mending, interventions that slow down damage to the body thereby allowing people to live longer than they would without the intervention.

The thought of medicine acting as a time warp – bending time to give the body space to mend– renewed my awe and appreciation of the body and its functioning. Without intervention the body is extremely resilient. With medicine available to help it along the way, it is incredible.

In primary care clinic, my patients and I frequently discuss the need for putting in time before results are realized. Medications and actions inherent to primary care are usually designed to prevent damage that would need mending. In that way, preventative medicine, as primary care is, is designed to give the body more time to live. Primary care time is composed of daily endeavors to live healthfully. It includes time spent doing physical therapy to optimize muscle function. Time spent sleeping, exercising, and eating well. Time – built from seconds – with each small action and decision along the way adding together, hopefully generating an outcome that may not have otherwise been possible.

In contrast to primary care, hospital time is more finite and about letting the body heal itself. In the hospital I also discuss time with my patients often. Common conversations include time left before patients can leave the hospital, time left to live, and time needed to recover. We discuss the shortcomings of the crystal ball I don’t have. We review the annoying truth that medicine isn’t magic and that sometimes it takes days to reduce leg swelling with pills that make one pee, to heal tissues that are infected, or to get medications to reach their therapeutic level in the body.

Bending time to let the body heal or to delay deadly damage is a simple concept but complex when applied to real life. The question remains: If time is bent will it change the outcome? And the more medicine I do the more muddied my answer to that question becomes. The answer is between sometimes and often. Medicine is based in research that investigates if behaviors, medications, and procedures help improve outcomes – survival, functionality, etc. Yet even the medical recommendations we are confident about are still probabilities and not certainties.

For example, there is no promise that if we control patients’ diabetes, they won’t die of a heart attack. They might. Research suggests that if we treat diabetes the chance of dying from a heart attack is lower for the person with diabetes. Similarly, we know that if we don’t place someone who can’t breathe for themselves on a ventilator, they will die. But we can’t promise that they won’t die after we place them on the ventilator. They might. In both examples, we are just giving the body a chance to pursue an alternative outcome from what is most likely at the time we act. It’s a chance, not a promise.

Even in the case of more definitive medical cures – like surgical removal of a tumor or chemotherapy – cure is not a guarantee. The body first must recover from surgery and avoid complications like infection to benefit from the surgery. The body first must survive chemotherapy before benefiting from the cure, and there is a risk of cancer returning.  Considering the limitations of even curative interventions, the argument that their primary role is to give the body an opportunity to heal itself remains. Fate is like magic, beyond medicine. Yet, the body is capable of astounding things. As such, even if medicine does nothing more than bend time for the body it is still a worthwhile pursuit. Because with medicine we might extend life and reduce suffering during whatever days remain in a person’s life. That opportunity, even if not guaranteed, is why people like me go into medicine.

*The Ventilator Book by William Owens

The Floors Don’t Shine Like They Used To

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I walked into the Veterans Affairs (VA) hospital where I have primary care clinic. I hadn’t been there for a few weeks between vacation and working in the ICU (critical care unit) at a different hospital. Yet, I’d heard about the budget cuts and other residents had shared murmurs of uncertainty related to what was to come for our patients. Entering the VA hospital for the first time since the budget cuts started to take effect, I was immediately struck by how gross the floors looked. And, as I was processing the dullness of the floors and their peeling finish, I heard a woman next to me comment on the floors too.

I used to joke to my spouse about how frequently they refinished the floors at the VA hospital. Over the past 2 years it seemed that every time I worked nights or left late, they were refinishing the floors. These efforts resulted in a floor as shiny as the shoes of the sentinels at the Tomb of the Unknown Soldier in Arlington Cemetery. And, until the floors looked dull, I’d never thought about their symbolism.

Every patient seen at the VA hospital is a veteran. Some of them wouldn’t have access to healthcare if it weren’t for the VA. Most of them wouldn’t have access to some of the most critical medical resources that our veterans need for good health without the VA. Mental health care is one example of such a resource.

I settled into my day at the clinic. A patient I hadn’t seen before was among my first patients. “I’d like to be screened for PTSD,” he said.

“Okay, why?” I asked. PTSD stands for “post-traumatic stress disorder.” It’s a condition that can occur when people experience things that are mentally traumatic. It can include flashbacks to the event(s) that disrupt life, nightmares that prevent sleep, and mood challenges that make it difficult to function in daily life.

“My daughter thinks I have it,” he said.

“Do you have nightmares?” I asked.

“No. But I think about things that happened. I just push the thoughts out of my head though. You know, I saw people die in Vietnam,” he said.

“How often do you have those thoughts?” I asked.

“Multiple times a day,” he said.

“How long has that been going on?” I asked.

“Years. I also get angry really easily,” he said.

“Do you get angry over things that other people don’t?” I asked.

“Yeah, all the time. I just get angry fast,” he said.

“Any thoughts of hurting yourself?” I asked.

“Hasn’t come to that,” he said.

“What about thoughts of hurting others?” I asked.

“All the time, but I don’t act on it,” he said.

The conversation unfolded. From my assessment he easily met criteria for PTSD. “Well, I think your daughter’s right that you have PTSD. Do you want treatment for it?” I said.

“Yes,” he said.

We discussed our options for treatment. I was grateful that we had options. How awful it was to think he’d potentially lived for 50 years with thoughts of the people he saw die in Vietnam haunting him multiple times daily.

Mental health is a huge part of health for all people and an especially common challenge for veterans. It has taken years of population education and eradication of misinformation to create an environment where veterans feel comfortable asking medical providers for help with their mental health. In my experience younger veterans are more comfortable discussing things like depression and PTSD than older veterans. But it’s an important issue for all veterans. To put it in perspective, about 18 veterans across the US die by suicide daily.

The VA offers more mental health services than any other healthcare system I have encountered. People using civilian healthcare often wait months to be seen by a therapist and longer to see a psychiatrist. When working at the VA, I can ensure my patients’ mental health is supported as soon as I learn it is a challenge for them thanks to the VA’s dedication to the mental health of our veterans. The VA’s effort to help manage mental health challenges among veterans matters. For example, suicides among veterans diagnosed with PTSD decreased by 32% been 2001 and 2022.

What makes medicine different from most other industries is that we don’t deal in money, property, or things. We deal in lives saved, lives lost, and human suffering. What does the shine of the VA hospital floor say about the future of our veterans’ healthcare? Time will tell. Yet, looking at the landscape of US federal budget cuts and executive mandates, people’s access to healthcare in this country is declining. I suspect that it’s only a matter of time before the health effects are felt broadly. Of course, these federal healthcare budget cuts and restrictions are concurrent with cuts in federal funding for research. As a result, we probably won’t be able to quantify the impact politics today had in terms of lives lost and population health deterioration. Perhaps the symbolism of a floor, which one walks all over for their personal benefit, is fitting symbolism for the value current political figures place on the health of others.

References:

  1. VA releases 2024 National Veteran Suicide Prevention Annual Report: https://news.va.gov/137221/va-2024-suicide-prevention-annual-report/