Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: WEDNESDAY, March 28, 1990                   TAG: 9003280472
SECTION: EDITORIAL                    PAGE: A-6   EDITION: METRO 
SOURCE: GERALD W. ROLLER, M.D.
DATELINE:                                 LENGTH: Medium

WHEN MEDICINE IS AT ITS BEST

I would, however, take issue with the statement that "intensive-care units are American medicine at its best - and its most agonizing." I believe that American medicine at its best is wherever the physician finds him/herself doing a superb job in the care of the patient.

Ask the mother of a healthy newborn baby where she thinks American's best medicine is; or the family torn apart by mental illness a few weeks before who receives back a son who, with psychiatric help, has changed his life; or the 86-year-old male patient afraid he will not be allowed to drive his car, only to find that his family physician believes him capable of safely driving for another year; or the mother whose son has just been examined by the family pediatrician for the earache that kept him up all the night before and reassured he is going to be OK. These and the many other acts of medical care are also American medicine at its best, and at times its most agonizing.

Virginia has a Natural Death Act allowing persons to direct that procedures serving only to prolong the dying process be withheld or withdrawn if, in the view of the attending physician, a terminal condition exists and death seems imminent. Not enough persons are using the Natural Death Act. It could have applied to many of the patients in Hite's article.

There is also confusion between the Natural Death Act and the "do not resuscitate" order. The DNR, wrritten by the physician, frequently is issued whether or not there is a Natural Death Act statement. Oftentimes patients are critically ill, but not necessarily terminally ill, and it is apparent that acute resuscitative measures would be unwise and, indeed, unkind.

An example might be a person who has severe pneumonia and an associated severe obstructive lung disease. The latter has made him an invalid, but not terminal; and the pneumonia produces a life-threatening illness that might or might not be successfully treated. In this case, the person's quality of life prior to the pneumonia and his expressed wishes as well as those of the family in his behalf would allow a DNR order even though he may recover and go home and live several years longer. A DNR order does not mean to stop treatment.

The nursing team is much more than the physician and skilled nurses! Less-skilled nursing staff, nurses' aides, orderlies, maids and janitors, housekeeping, dietary staff, administration, security staff, and the multitude of other persons make up the heartbeat of patient care and help make medicine best. We are indeed fortunate to be benefactors of health care in the United States.

I agree that technology may impart a false hope. It is just as wrong to give a patient false hope as it is to take away all hope. Nurses, physicians, family members, ministers and others involved with the patient must continue to show loving care and support and allow the patient to deal with the problem.

Many times the words "do everything" may have a special meaning - to "do nothing" but show love through alleviation of pain and suffering, comfort, reassurance and kindness for all concerned. This is, after all, a large part of the art of medicine.