An ethical dilemma, a last second miracle.

Every so often, I base a blog post on a TV show. Not just any show, not merely for entertainment, but mostly when the show presents an ethical dilemma with universal implications. The latest installment of Chicago Med had quite a few ethical dilemmas, but the one that stood out for me was: A plane crash and cabin fire at O’Hare airport sent lots of victims to hospitals. One such was burned so badly that he wasn’t recognizable, but the manifest from the flight showed that the guy sitting in his seat was Sam Abrams, the chief neurosurgeon of Gaffney Chicago Med, the hospital the series is named after. The trauma surgeons assigned to him are Drs. Ethan Choi and Crockett Marcel, who have personally clashed in the past due to very different personalities. Choi is a second generation Naval veteran, superficially quick to judge and condemn, traits which cover his PTSD and deep compassion. Despite his cool and collected demeanor, it is apparent that he has been deeply affected by the horrors he witnessed overseas as well as in the Emergency department (ED). He has a notebook in which he writes down the name, date and time of death and description of every patient who has died on his watch.

Under the assumption that this unconscious, badly burned, paralyzed victim is their own Sam Abrams, the hospital contacts his wife Michelle, who is so much younger than Abrams that Choi mistakes her for his daughter, Lucy. With as much certainty as they could, they proceeded to perform life-saving measures on Dr. Abrams. While Sam was not brain dead, he would be dependent on others for the rest of his life. Dr. Marcel and Dr. Choi were optimistic that he would wake up once the swelling in his brain went down. Imagine that you are recently married, and one day you find your spouse in the emergency room, informed that they are likely to wake up horribly disfigured, unable to ever walk, or use their hands, and will be totally dependent on you for dressing, eating, toileting and every other function of daily living. This is not what you signed up for, despite the marriage vows “in sickness and in health, for better or worse, as long as you both shall live.” Abrams’ wife even repeats those vows, before declaring that she wants Sam taken off life support. Ethan was hesitant, but she insisted, not for herself, she emphatically declared, but for him, as he would not want to live that way. Ethan thought that Sam’s daughter Lucy should be the one to make the call, but she was backpacking in the Andes, and Michelle insisted that Sam would not want Lucy to see him like this, but rather to remember him as he was.

Ethan also found out about Sam’s huge life insurance policy, and was suspicious of Michelle, who stood to gain millions in life insurance if Sam were to die. She was the one who had rushed into marriage, and Ethan wasn’t comfortable not giving Lucy a chance to speak for her father. Dr. Marcel said that they should rule in favor of Michelle, because legally, she was next of kin. Ethan took it to the ethics committee, who also ruled in Michelle’s favor. Before I go on, I want to ask you: Would you want your spouse or children to be in this position, making a life or death decision for you, in the absence of your direction for post trauma medical care? There’s really no excuse for not having the proper documents on file and available to your loved ones. My daughters are very reluctant to discuss these matters with me, but I have let them all know where the documents are. Those are: healthcare directive/living will; physicians orders for life sustaining treatment (POLST); durable power of attorney for healthcare. Get it done people!

As the ED staff was getting ready to turn off life support, Choi was too upset to watch, and took a minute outside, just as Sam Abrams was getting out of a taxi. Yes, that’s right. Dr. Abrams was alive and well, having taken a later flight after ceding his seat to another conference participant. Choi raced back in, hoping it wasn’t too late to revive the ill fated John Doe. You can imagine the shock, the consternation, and the relief as Sam shows up in the room where Choi is frantically trying to revive the John Doe, over the shouted objections of Michelle, Dr. Marcel and the hospital administrator (representing the ethics committee). After considerable hugging, tears and explanations, Michelle leaves as Sam prepares for work. What was the obvious ethical dilemma? It was not, “who should decide about life support” since Michelle was legal next of kin. Was it “the greater vested interest” that Michelle was facing? Whose true interests was she representing? The decision to let him die, so soon after the disaster, rather than to maintain life support until he could wake up, was in whose best interests? Was it really true, that he would not want to live, dependent on others, or was it that she, faced with the choice to be a young, attractive, rich widow or a lifetime caregiver, chose the former? Or was she fooling herself in insisting that Sam would not want to live that way nor would want Lucy to see him helpless and disfigured?

There was yet another ethical dilemma. Ethan and Sam were friends and colleagues, and Ethan was under the impression that Sam’s wife was choosing to end his life for her own selfish reasons. Dr. Marcel’s previous conflicts with Dr. Choi were almost all about how emotionally involved to get with a patient. Choi erred on the side of too much, overstepping his boundaries to interfere in the choices the patients and their families made. Marcel was perhaps too much the other extreme, so emotionally nonchalant that he could seem insensitive. Now that Sam was alive and well, Choi decided he needed to inform Sam “of the kind of woman he married”, by discussing with him the decisions that Michelle made. Would you have done that? Could anything good come of it? Self righteousness can be a poison. My perspective on telling Sam would be: “Even if he believes what I tell him about Michelle, he’s not likely to divorce her; it’s more likely that he will be angry at me, and I will have sown the seeds of suspicion, destroyed trust between them, and their marriage would eventually suffer. Is it really my responsibility? Aren’t there some decisions that shouldn’t be disclosed if they were made under great duress?” What would your perspective be?

Ethan did tell Sam, and was surprised to find that Sam agreed with all of Michelle’s decisions. Apparently they had discussed such eventualities proactively. An even bigger surprise was in store for Ethan regarding the financial implications. Michelle held a patent on a longevity formula that was immensely popular, and she was considerably wealthier than Sam. Maybe she didn’t marry for money after all. But could Ethan’s disclosures have sown seeds of suspicion anyway? All people harbor secrets, and spouses, who should have no secrets from each other, probably harbor more secrets than they should. If Sam and Michelle are wise, they will thoroughly discuss the decisions at the hospital and not withhold any suspicions, lest distrust undermine their marriage. What will be their fate?