Death and Life on American Samoa: Update

Note: This is the final update to the article Dr. Halderman wrote about the extraordinary efforts of the United States Air Force to save the life of a 5-year-old on a remote Pacific American outpost:

Whoever destroys a soul, it is considered as if he destroyed an entire world. And whoever saves a life, it is considered as if he saved an entire world.
  -Jerusalem Talmud, Sanhedrin 4:1 (22a)
This morning, a little boy died.  His name was not Abe, but I call him that.  He was five.

I was one of a massive team of doctors, nurses, social workers, x-ray technologists, respiratory therapists, and hospital staff who cared for Abe. We were assisted by pilots, military command center personnel, logistics officers, technical crew, and relay operators. 

Our work was made possible by three members of Congress, two governors, and a U.S. senator. The heavy lifting of red tape was done by their staff members in Pago Pago, Honolulu, Los Angeles, Fresno, and Washington, D.C.

Much of what we did for Abe depended on decades of research by scientists and lab personnel in cardiovascular surgery, pediatric infectious diseases, epidemiology, immunology, transfusion medicine, virology, and H1N1-subtype influenza. 

The equipment we used was created by innovators in medical technology, including ventilators, artificial lungs ("ECMO" bypass), surgical instruments, and catheters for infusion and monitoring.

The drugs that treated Abe's series of infections, blood abnormalities, electrolyte disturbances, heart failure, and kidney malfunctions were the result of research and development done by pharmaceutical manufacturers and by workers in universities and labs across the world.

Abe was my patient, but he was not only my patient. He belonged to all of us who stood at his bedside, entered his test results in a computer, or just made a phone call on his behalf. 

His father was with him constantly after he was transferred off the island to a Pediatric Intensive Care Unit on Hawaii, and his mother never left the hospital here on American Samoa. 

The American Red Cross is arranging Abe's last trip home. As is tradition, he will be buried in his family's village so his brothers and sisters can visit him as they do his ancestors. And his mother and father will never be far from his side.

The financial burden of caring for this little boy during the last weeks of his life is staggering. The U.S. Air Force's C-17 medical transport plane trip alone cost hundreds of thousands of dollars. This is America, but the island does not even share the same side of the equator as California. We see the Southern Cross in the night sky, not the North Star.

I've been criticized for participating in this outrageously expensive attempt to salvage the life of a single child. 

Was Abe's life worth it?

I understand the criticism, and it is logical: if we spent less on Abe and allowed him to die, we could theoretically take that money and allocate it to help many more children.
I'll leave that debate to others who can view this "case" more objectively than I can.
I was Abe's doctor. I will attend his funeral service. His family includes me in their nightly prayers. As did the army of caregivers who tried to save Abe's life, I did everything I could. When our remote medical facility reached the limits of its resources, we called for help.

The call was answered -- by elected officials, by the United States Air Force, by Tripler Army Medical Center, by Kapi'olani Women and Children's Medical Center -- even by the Children's Hospital of Central California, which volunteered to care for this child if he could have been transported the 5,000 miles.

Was Abe's life worth it? He was a five-year-old who liked to eat potato chips and tease his older brothers, not a head of state or a Nobel Prize nominee or even a famous athlete. He was just a boy whose family loved him. He was just my patient.

Was Abe's life worth it? It's not a question I can answer as a health care policy wonk. I can't answer it as a writer, or even as a doctor. 

I can answer it only as one person who was there and served as a witness to modern medicine's miracles and one family's painful tragedy.

Linda Halderman, M.D., FACS
Department of General Surgery
LBJ Tropical Medical Center
Pago Pago, American Samoa
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