Thursday, March 20, 2008



The patient was identified many years ago. There was pathology present, chronic illness with acute episodic flare-ups of various maladies. For an extended period of time the physicians merely observed, they did not intervene beyond some management issues, a few palliative measures conducted more for their sake than the patients.

As time went by new physicians took over management of this patient. They seemed to share very different views and opinions regarding the pathologies involved, the manifestations of the various ills the patient had exhibited in the past and his potential to act as a vector, a carrier of some contagions that could pose a wider threat. Without timely, accurate clinical data available, they relied on theories and the past history of the patient. Discarding the clinical course the previous team of doctors had charted, they began to plot a new path. They could, in their minds, solve all the problems ailing the patient while also eliminating the possibility his illnesses would spread.

They began to develop their plans even as some of the consultants and specialists called in voiced grave doubts regarding the efficacy of what they were planning. Their concerns and doubts were ignored. This team of doctors was experienced. They were seasoned experts in a broad range of specialties; many had worked well together in the past on other difficult cases. Their past success had given them a collective confidence, an arrogance, actually, that would prove fatal.

Best practices demand that prior to any procedure and certainly one of the magnitude planned, the entire battery of diagnostics and imaging modalities be employed. No operation can be commenced without a wealth of information. The doctors do not want to be surprised once the patient is open on the table. In this particular case, this group of doctors was not very diligent in the pre-op phase. They relied on dated imagery and old diagnostic information that was not only aged and suspect, in was seriously flawed. Using improper data is the surest way to make erroneous decisions and undertake actions that are doomed to fail. That is precisely what happened in this tragic case.

The fear of a malpractice suit never crossed the minds of these stubborn doctors. This team, individually and collectively, felt absolutely immune to any negative repercussions resulting from their actions. They were so bold in their certainty that prior to the actual procedure they offered a glowing prognosis: not only would their operation be a success, the patient would be healed beyond anyone’s expectations, this patient’s recovery would usher in a new era of robust health and wellness for many other patients similar to this one. The threat of a widespread, virulent contagion would forever be eradicated and never again would there be cases of this pathology again. They were not simply performing their miracle on this one patient but, by virtue of that one operation, many others would be healed, cured and brought to a level of wellness they long aspired to.

What transpired since has been the typical cascading of events. The patient has been a clinical nightmare and, truly to the disbelief of anyone familiar with the case, the patient had languished in critical condition for four entire years before a new approach was implemented. The suffering and trauma from that four year state of near death has taken a toll that has not only dramatically impacted the patient’s ultimate chances for recovery but his survival. That he has lasted this long, endured so many invasive procedures, lost so much blood and been clinical dead untold times is miraculous. Now, five years later, to announce that he has achieved partial recovery based on the drastic measures taken one year ago, four years into the raging illness, is an almost criminal statement. Having left the patient in such abysmal condition, under the care of so many grossly incompetent doctors defines neglect and tragedy of the highest order. Other patients have watched this course; some have grown sicker while others have lost all confidence in the abilities of the institution for which all these doctors worked is capable of anything beneficial.

Looking at the patient today one cannot help but feel pain. Pain mixed with anger that such an abomination was permitted to be perpetrated. Arguments pro and con are rhetorical at this point. What’s done is done and even now, the life of the patient hangs in the balance.

This clinical presentation provides a brief summary of our patient, Iraq. Iraq has endured what George W. Bush and his cast of maniacal imbeciles have inflicted upon it and its ultimate prognosis now, even this far along, remains no better than 50-50. Soon, this group will abandon the patient and leave the case management for another group to resolve. That is part of their arrogance, ineptitude and abject cowardice. They have admitted defeat, kept the patient on life support for five years and will soon exit the arena.

We have a stake in Iraq’s recovery. Everyone does. America, Iraq’s geographical neighbors, every one has an interest. The failures so sadly and blatantly demonstrated during the course of the last five years has not only inflicted irreparable harm on our patient, Iraq and it’s people, but on people all over the globe who once possessed faith and confidence that America could and would cure ills. Their faith has been shattered as they have witnessed what has transpired in Iraq.

It is beyond shameful that the original planners and implementers of this operation had not the fortitude, intelligence and judgment to adhere to the adage, “First, do no harm.” This applies in medicine and geopolitics especially when military intervention is chosen as an option to the exclusion of all others. First, do no harm. How many lives would have been spared had someone in authority, someone in this administration of lunatics, some one brave individual among them would have voiced our prime responsibility to first, do no harm.

The operation may have been a success but the patient is just about dead.

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