Do No Harm
Disclaimer: I don't own any of the characters, SEGA and Archie comics does.
...If it is given me to save a life, all thanks. But it may also be within my power to take a life; this responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body, as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection hereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
-From the actual revised Hippocratic Oath by Louis Lasagna.
(Shadow's POV)
The Hippocratic Oath, the oath that every physician has to take into good earnest before practicing the art of medicine. From the moment I raised my hand to recite that oath, I have committed myself to dedicate my life in promoting, maintaining and restoring health for as long as I live.
Most people think about the Hippocratic Oath whenever the principle: 'Do no Harm' is mentioned but when you look at it in a closer perspective, that word was never mentioned in the oath all. It became a huge misconception ever since but one thing is for sure, whether it's part of the oath or not, both ironically express a similar idea: that we should not do harm at all costs like one of the principles of bioethics that states: "It's better not to do something than to risk causing more harm than good."
But in this modern society, that principle may be less practical than what we might think.
Hippocrates, the father of Medicine, proposed the idea that doctors shouldn't harm their patients no matter what the circumstances are and most people find that idea actually quite appealing. However, if we think about it in a literal sense, most patients wouldn't even last a day in the hospital if we follow that principle.
Surgeries wouldn't be recommended, medicines wouldn't be prescribed, blood extractions would be prohibited, and biopsies as well as chemotherapies would be banned from the hospital. To put it simply, none of those medical procedures would be performed no matter how vital they are to diagnose or treat a patient. Why? Recommending these tests or treatments can cause harm to the patient despite the benefits outweighing the risks involved.
Like for instance, if I surgically remove a diseased part of an organ from a patient, despite the procedure being therapeutic, cutting a patient is considered as 'doing harm' and it literally violates Hippocrates' principle.
Which brings me to question: Is it really necessary to follow that principle?
My name is Shadow the Hedgehog and I am proud to call myself a physician as well as adding the suffix "M.D." at the end of my name as well as bearing the symbolic white coat.
The White Coat. It has remained a symbol of medical authority for years. Ask anyone what a doctor looks like and they would describe it to you as a person wearing a white coat and a stethoscope. But nowadays, not all doctors wear it like pediatricians and psychiatrists, for instance. Some people find the white color intimidating enough that they develop fear just a mere sight of it, especially children.
But for us doctors and other health care professionals, we symbolize the white color as a standard of professionalism, hope and the symbol of a healer.
They say that being in the field of medicine is a noble profession. People look up to you like you are some sort of 'miracle worker' whenever they see you along the corridors wearing a white coat, however, being a doctor is not all about the title. In fact, having the privilege to wear a white coat is not exactly like playing a game of dress-up and pretend. Earning the privilege to wear one is a very challenging task but in the end, all of the blood and sweat that were shed during those times were all worth it.
Once you wear that coat, that's where the true responsibilities begin. Say goodbye to those childhood fantasies of being a successful doctor who could treat everyone by just using a mini doctor kit and a toy syringe on a presumably sick teddy bear or stuffed animal because in reality, it's a lot messier and more complicated than it sounds.
Hearing mostly about patient complaints like chest pains, abdominal pains, difficulty in breathing as well as being exposed to communicable diseases, blood, amniotic fluid, pus, bile, vomitus, and all of the things that most people would cringe at the sight or the thought of getting in contact with, I could honestly say that this job isn't for everyone.
If we make mistakes, patients die, if we don't take risks, patients also die. We're mostly faced with matters regarding life or death.
Being in the medical field, taking risks is a part of our everyday lives. From a simple diagnosis, to a prescription of drugs, and even to a major surgical operation. A diagnosis isn't always accurate, drugs won't always guarantee a hundred percent recovery and surgeries don't always yield a successful result.
Even if we dedicated our lives to help people, once in our life, some decisions must be made that could sometimes harm the patients in order to save their lives. It cannot be avoided just as we cannot avoid death.
Most say that being a doctor is all about saving lives, but for me, being a doctor is not just all about healing the sick or saving lives, rather, it's also about the patients that you encounter in your everyday life.
A simple thank you from an elderly patient for giving her a daily dose of her pain medications, a child that smiled after being given a lollipop after injecting him his annual vaccine, the first cry heard from a newborn baby being delivered and telling the family that the delivery has been successful; all of the feelings felt in these situations aren't written and cannot be learned in the textbooks but in the field.
Those were the most fascinating things I've learned in my experience here.
"Doctor, the patient from bed no. 1 is asking if he can go home now," one of the nurses on duty called my attention.
"Inform him that he is still under observation. Until his blood pressure has become stable, he's staying for a while," I responded.
"Yes, doctor," were the nurse's response as she left.
Right now, I am currently on duty in Mobius General Hospital and I've been assigned to the Emergency room. Frankly, I've been working in this hospital for 12 hours now with nothing but caffeine as my best companion to keep me awake all throughout my shift. Sleep is becoming a stranger to me now and I could only enjoy it for a few hours in my life before my pager starts beeping again or if somebody pages me in this establishment.
I've been scanning the patients' vital signs monitoring sheet before proceeding to do my rounds.
So far, we only have three patients here in the emergency room. The first one has suffered from an allergic reaction due to an insect bite, the second one had an asthma attack and the third one had sudden chest pains after doing a little work out and is currently under observation.
Mobius General is starting to become literally my home for spending most of my time here as I continued to fulfill my duties as a physician.
My late great grandfather, my grandfather, my father, my uncle; almost all of the male hedgehogs on my father's side of the family pursued a medical field except for my mother's side since they are more inclined on the business field.
Being in the family of mostly doctors, some people think that I only wanted to become a doctor merely because of following the tradition but for me, it is an innate desire to become one.
In fact, most of my seniors and colleagues often praise my skills and my ability to work under pressure. Not to mention, I have an outstanding performance before in medical school as well as earning a spot on the top-notcher list in the Mobius Medical Licensing Examination (MMLE).
A lot of people have acknowledged my skills and performance except for one hedgehog in particular: my father.
My father is the Head of the Cardiology Department in Mobius General and has always been observing and criticizing my every move ever since I started working at the same hospital where he works at. He's observing me like he's monitoring an electrocardiogram, a device used to record a heart's electrical activity. If he finds something wrong or something that doesn't please him, he deliberately intervenes, disrupting my flow of work or in some occasions, he makes decisions for me like mine didn't matter.
It doesn't surprise me anymore. In fact, my father and I are very different individuals.
My calm and lenient behavior literally clashes with his stern, aggressive and principle-based one. While my focus is mostly for the good of the patients, my father tends to ignore that factor as long as the problem is taken care of.
To put it simply, the patients' feelings doesn't seem to matter to him as long as the problem is addressed. He's treating everything like a medical textbook and only sees the patients as mere bodies with diseases instead of a living and breathing individual with feelings.
I find it ironic how he managed to become a cardiologist with such a cold heart because for me, skills alone does not define a doctor.
But my father, he's driven with the belief that it's unnecessary to involve your feelings when treating people because it would only affect your efficiency at work.
I suddenly heard the double doors of the ER bursting and find a couple of paramedics wheeling in a stretcher with an unconscious male bat in it.
"55 year old male bat simply eating dinner with the family suddenly had difficulty in breathing. Relatives thought he was choking until he was seen grasping his chest firmly before falling into the floor. Patient was unresponsive upon our arrival. Pulse and Breathing were negative so we immediately initiated CPR and produced a pulse. We are able to establish a line and started a lidocaine drip. Patient has been unconscious since the arrest. Blood pressure is 60/44, heart rate is 56 and irregular. He's intubated and the current pulse oximetry is 90 percent. Patient has a history of hypertension 4 years earlier and a heart attack 1 year ago according to the wife. No drug allergies reported."
The nurses on duty urged them to put the patient to the treatment room while I immediately went towards them to help transfer the patient from the stretcher to the table.
"Injecting Atropine," I said as I injected a medication to increase the heart rate since it is dangerously low then we started the patient on blood thinners and beta blockers as prophylactic measures.
"Is my husband alright?" a feminine voice spoke in bursts of panic but the attendants tried to keep her calm.
"It's okay, ma'm we'll do everything we can," I briefly turned towards her then I proceeded to attend to the patient until I felt someone's hand gently tugging my own.
As I turned around, I saw a female bat with teal eyes who is probably in her early 20's and she was looking at me with pleading eyes. From the looks of it, she seems to be the daughter of the patient.
"Please doctor, don't let my father die…please…I'm begging you, do what it takes to save him…" she calmly told me while on the verge of tears then she slowly fell on her knees.
"Please, doctor," she said, clutching the cloth on my pants.
I was slightly taken aback at the behavior she was demonstrating because of all the years being on duty, I have never experienced a relative of a patient clutching onto me to plead for a family member's life like this before.
Truth to be told, not all doctors experience a case like this and it just so happens that I am "fortunate" enough to be on duty on a time like this.
She must have loved her father so much for her to be this desperate enough to plead.
"I…uh…" I couldn't find the words to say but I quickly managed to help her stand back on her feet.
"It's alright, miss. I…I'll do what it takes to save your father," I reassured but something inside me felt uneasy when I let those words slip from me because knowing about her father's history, there's a huge chance that I won't be able to keep such a promise.
His life is literally already hanging on a thread.
"…please, doctor," I heard her murmured once again.
"Miss, you'll see your father again. Keep it together, alright?" I placed a hand on her shoulder and looked at her straight in the eye to convince her that I am sincere with my words.
After my final attempt to reassure her, I quickly made my way to attend the patient while that bat girl's face and words still lingered into my mind as if her words are going to haunt me for the rest of my life.
'You should never allow your feelings to rule over you during an emergency situation.'
That is what most of my seniors would often warn me about; especially my father since he knows my tendency to get emotional in times like these because I share most of that personality from my mother.
Now that part of me is being put to the test. I guess I just had to keep my emotions at bay at all times so it wouldn't affect my performance.
Upon examination, I noticed that the patient's complexion was pale with an evidence of heavy sweating. The current blood pressure is quite low and the pulse rate is irregular. No jugular vein distention noted and no edema.
It wasn't a pretty good sight. Something tells me that this patient has gone through a lot of pain before falling into the ground, unconscious.
I used my stethoscope to assess his heart sounds. At first, all I heard were normal heart sounds but I turned the patient to his side to assess further. Normally, a heartbeat only has two distinctive sounds but the patient has a barely audible galloping heart sound that can be heard mostly in patients after a heart attack.
We immediately hooked the patient on the electrocardiogram while some of the medical staff took the patient's vitals.
I focused my eyes on the monitor and I see a normal rhythm as of now but looking closer, I could have sworn that I saw an ST segment elevation. An ST elevation is an indicator that a myocardial infarction, or commonly known as heart attack in layman's term, has occurred so I immediately took appropriate action and started the patient on oxygen therapy at 6 liters per minute to keep the patient's oxygen saturation level above 95 percent.
STEMI or ST-Elevation Myocardial Infarction is the irreversible death of a heart tissue due to the lack of oxygen because of a blockage in the blood vessels of the heart and it's often a fatal condition especially if left untreated. It's always important to note that the quicker the blockage is removed, the less likely for the heart muscles to be damaged.
The family made the right decision to call for medical assistance immediately. Otherwise, the patient would have died on the spot.
I was making records of the patient's EKG readings to send it to a cardiologist later on for further assessments when all of a sudden, the EKG monitor starts beeping uncontrollably.
I looked back and saw that the monitor indicates that the patient is suffering from Ventricular fibrillation or V-fib. V-fib is a case where the heart is said to be 'quivering' and it's no longer pumping blood properly as it should. This is one of the deadly rhythms that most doctors fear the most since the patient would most likely go into cardiac arrest if proper action was not taken immediately.
Patients undergoing V-fib requires shocking the patient using a defibrillator in order to temporary stop the heart so it would stop from fibrillating and possibly return to its normal rhythm. Defibrillation is similar to pushing a reset button like we do on machines and computers.
"Call the code!" I commanded and the other hospital staff on duty quickly went towards me bringing along the Emergency cart and the defibrillator.
As the curtains were closed, the attendants quickly established an airway as I quickly injected the patient 1 mg of epinephrine to increase coronary perfusion then we prepared the patient for defibrillation.
"Charging at 200 Joules" I said then I positioned the paddles on the patient's chest. After making sure that no one is touching the patient, I did what I had to do.
"And Clear!" I called out then I shocked the patient by pressing the buttons on the paddles.
I checked the patient and the monitors but there was no change noted, the patient is still in V-fib so I attempted to shock again.
"Let's go again. Charging at 200 Joules," I said as I looked around me once again and after seeing that it's alright to deliver another shock, I proceeded to defibrillate.
"Clear!" I pushed the paddles into the patient's chest but instead of fixing the problem, the monitors showed a flat line which made me promptly check for the patient's vitals as well as making sure that the wires of the EKG that are connected to his chest aren't disrupted or disconnected.
Unfortunately, all of the wires are still intact and the patient ceased breathing. His pulse isn't palpable as well which made me conclude that the patient went into a cardiac arrest. His heart has completely stopped beating.
'Damn!' I cursed inside me then I immediately took the defibrillator paddles away and initiated Cardio-pulmonary Resuscitation (CPR) while the attendants used an AMBU bag to provide artificial respiration as I do chest compressions.
Two minutes have passed and we checked the patient's vitals once again. Still a flat line, negative breathing and pulse so we did the same routine again, doing CPR while giving artificial respiration through an AMBU bag but the patient's condition didn't change no matter what we do.
'You can't die on me…Please, don't. You have to live! I promised your daughter that I'd save you.'
To be honest, I have never encountered a dying patient before while on duty. More often, I only hear reports of patients dying on a particular shift during endorsements and it devastated me that I have to be faced with someone who's on the verge of it for the first time right here in the Emergency Room.
My sweat trickled down my forehead and I could almost feel tears in my eyes forming at the thought of not being able to save this patient because I know at the back of my head that there's a very slim chance that he would survive.
Come on, live!
But the promise I made to his family kept me motivated enough to carry on because I never break promises.
It seems as though time has stopped temporarily and I found myself staring at the monitor and at my patient's face.
Judging from the male bat's appearance alone, he seems to be a nice man, and a caring father and I could imagine him spending most of his time being with his family.
Who knew that the family dinner they had would end up in a tragedy such as this?
I shook my head to get rid of those thoughts and tried to communicate with my patient.
"Your family needs you, sir! Come back to us.," I called out to him. My compressions are getting stronger and deeper compared before as desperation took over me.
But still, nothing has changed. The patient is still not breathing and he still has no palpable pulse.
"Drop 40 units of vasopressin and stat!"
That's when I saw my father entering the scene with his piercing gaze staring at me as I continued to attempt saving my patient's life.
I saw him taking a glance on his watch then he shifted his gaze back to me.
"Shadow," I heard his deep voice calling out to me but I decided to ignore him and kept on resuscitating the patient despite feeling tired already.
I never gave up. I know I can save him.
"Shadow!" his loud voice made me turn my head towards his direction without ceasing my actions.
"It's been three minutes already since Cardiac arrest. It's too late to save him. Call it…" he simply said that made the complexion on my face turn pale. He wanted me to announce that my patient is already dead and it enraged me because I know I could still save him.
It only takes three to four minutes to consider an irreversible brain damage from the lack of oxygen supply to the brain and as much as I wanted to believe him, a part of me wanted to disregard that fact.
I saw one of the attendants slowly letting go of the AMBU bag when I sharply glared at him.
"Don't even think about stopping. I'm the doctor here! We'll continue resuscitating the patient!" I warned fiercely that made him quickly continue pushing on the bag.
I simply ignored my father again and continued but I was suddenly halted when he placed a hand on my shoulder.
"It's pointless to go further, son. You and I know that well. Just call it now!"
I shook my head in disagreement. I can't stop now. Not after promising his family that I would make them see him again.
"No. I can still save him!" I snapped back. That's when I felt the tears that I've been holding trickling down on my muzzles as I gritted my teeth in desperation.
My father's lower lip curled at the sight.
"I thought I told you before to never let your emotions get in the way of your job. You are a doctor and not a miracle worker! You can't save everyone! Just accept the fact, Shadow. Call it," my father continued to convince me to give it up and let the patient go.
But I just couldn't do it because I am determined to save him. If I stop now, it would be just like allowing this patient to die.
Hippocrates' principle of 'Do No Harm' suggests that we should not do anything that's harmful for the patient but in an event that you were given a choice, would you still hold on to that principle in order to save a life or just disregard it so the patient could die a peaceful death instead of letting him suffer more by keeping him alive?
A/N: Would Shadow continue despite his father's protests?
For those who have read and followed my first story called "The Crimson Affair," you might notice that there are some characters in that story that may appear on this one. So it's like an Easter egg for those who have read it since this is set in an alternate universe of that story.
For those who haven't read that story I mentioned, don't worry. You don't have to read that story in order to understand this one. But if you're interested, you can check it out, too.
This is an experimental fanfiction that has a medical theme.
I apologize for some mistakes. I am not a med student nor a health care professional but I did some research in order to make this story possible since I got inspired by some friends in Deviantart to attempt this kind of theme. Not only that, I got quite an interest in the medical field after watching a lot of medical dramas so it literally sealed my interest to work on this one.
I hope you like it.