The nightmare of rationing health care

In Haiti, there were too many patients, and we were too few. They needed so much, and we had so little to give. That’s not how it is supposed to be for doctors and nurses. We are trained to take care of everyone — it is our moral duty to do what’s best for each and every patient we see. Nobody dies until we have tried everything to save them. That’s how I was taught; that’s how I practice in my overstocked, well-staffed, technology-filled American emergency department. But it wasn’t like that after the earthquake. We couldn’t treat everyone. Some just died.

The first decision was easy: I gave the last of the antibiotics to the little girl with the fever, instead of the older man. He was my age; I wondered if, like me, he had sons. I was hoping we’d get more medicine the next day so we could treat him too. We didn’t. He died.

Then there was the young man paralyzed from a broken neck. We had no neurosurgeon, IV fluids, neck brace, wheelchair. And even if we did, anything we gave him wouldn’t be available for someone who might live. We moved him to the dark tomb-like ward with 50 patients and two nurses who didn’t have enough time to change all the dressings.