Re: Update (12/01): Status of patients from the JCO Criticality

[Tom Mohaupt <tom.mohaupt@wright.edu>]

Richard,

Your questions point to the poignant realm of bioethics. Physicians and
care givers are constrained to do all they can for the patient, and the
best do just that. I worked in a burn unit many years ago. I've seen
literally dozens of victims with thermal burns who had prognoses as bad or
worse than Mr. "A". Some of the symptoms and complications for severe
thermal burn victims are different than for persons irradiated to lethal
radiation doses. But the unrelenting pain and anguish inscribed on their
faces are probably very much the same. Perhaps the only answer I can give
as to "Why even try to save a patient when the prognosis is so grim?" is
that some patients have a chance to walk out if you try, none will walk out
if you don't. 

Perhaps the most important lesson I carry from by younger days working in a
burn unit is that fire is much more dangerous than radiation. This very
severe criticality accident in Japan may lead to zero to 2 deaths. If you
advocate the LNT theory you can even calculate some future cancer deaths
for other persons exposed. House fires occur relatively frequently and
account for many, many more lives lost. If you advocate the LNT theory for
chemical carcinogens, you can calculate some future cancer deaths for
persons exposed to dioxins and other products from burned plastics,
fiberglass, etc. Some of the survivors from house fires suffer severe burns
and end up in a burn unit in a condition, sometimes, not any better than
Mr. "A". Bioethics is a complicated subject with as many perspectives as
there are personal opinions.

Please don't get me wrong. Both criticality accidents and house fires are
tragic and unacceptable. I just wanted to show that the critical condition
of Mr. A is not so unique if you take a stroll through a burn or intensive
care unit.

Tom

"Richard C. Mannix" wrote:
> 
> At 01:25 AM 12/03/1999 -0600, you wrote:
> 
> >Mr. A: 9.06 Sv
> >---------------------------------------------------------------------------
> ---
> >12/01/99 17:00
> > Continuing with sedative and ventilation.  WBC count in small blood
> vessels is
> >7,700/mm^3.  Since there is no urine, on dialysis machine continuously.
> Slight
> >improvement in liver function.  Radiation damage to intestine and skin
> >continues. Continuing problem with large volume of fluid seeping out from the
> >areas of injuries due to radiation burn. Because of this, the patient
> requires
> >massive amount of fluid and blood products transfusion daily.  Bleeding from
> >digestive tract decreased and the severity decreased (176 gm in bowel, 435 gm
> >through tube through nostril, from midnight to 4:00 PM).
> >Treatment Direction:  Continue massive volume of transfusion and continue
> with
> >dialysis. Continue ventilation management, infection prevention, nutrition
> >management, continued transfusion management, and detailed total body
> >management.
> >Others:  With medication, blood pressure, pulse and other vital signs remain
> >relatively stable, but the condition continue to require vigilance.
> ****************************************************************
> 
> Every time I read one of these reports about "Mr. A", I ask myself the same
> question. Are the doctors doing this poor soul a favor by intervening to
> this phenomenal extent to keep him alive? Is there any reasonable
> likelihood that he can survive and lead any semblance of an enjoyable,
> relatively pain-free, and productive life?
> 
> Occasionally I find myself thinking that perhaps he is a "guinea pig" for
> these doctors. It seems as if almost all of the major organ systems of "Mr.
> A" have been substantially impacted -- perhaps permanently -- by the
> radiation. It is indeed remarkable what the doctors have done to keep him
> going.. But are they doing more for medical science, radiation biology,
> etc., or for the victim of this tragedy?
> 
> I would like nothing better than for "Mr. A" to fully recover. But after
> reading his depressing medical reports, I fear that his demise is more or
> less a foregone conclusion.
> 
> Rick Mannix
> Health Physicist
> Laser Safety Officer
> Univ. of California
> 300 University Tower
> Irvine, CA 92697-2725
> 
> 949-824-6098
> rcmannix@uci.edu
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-- 
Thomas Mohaupt, M.S., CHP
University Radiation Safety Officer

104 Health Sciences Bldg
Wright State University
Dayton, Ohio 45424
tom.mohaupt@wright.edu
(937) 775-2169
(937) 775-3761 (fax)
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information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html