Recipe for Disaster

I found out from the media that I have Godlike powers, given to me by a federal commission. Someone, however, apparently forgot to tell my children – I specifically commanded Grace to eat her breakfast, but then, less than three minutes later, I found her plate on the floor with the dog licking it. Perhaps there has been a communications glitch?

But that hardly seems likely. After all, the announcement of my God status was plastered all over the national news last week – a federal commission of experts released a report outlining the steps that doctors should take in the event of major disaster. These federal experts specifically mentioned the fact that “Godlike” powers should be used by doctors to decide who should live and who should die. On the spot.

As a God, I decided to step over the breakfast plate (and the dog) and hurry in to clinic. Some minion would, undoubtedly, clean the mess up later. But after I arrived at work, I thought at first that no one there knew about my promotion – I mean, why would there be such a pall hanging over the place?

See, I work in a clinic for the homeless with a pretty sophisticated team of highly-trained and compassionate people. Nurses, social workers, health workers, phlebotomists, clerks, security guards, substance abuse counselors, and so on and so on. I don’t want to imply that they too have superpowers (how could they?), but let’s just say we have medical records clerks who could find an illegible doctor note from 1994. Blindfolded.

When I asked why the glum faces, Bob, another doc, told me he’d read the article and discovered if he was hurt in a disaster – he wouldn’t make the cut. Hannah, a nurse, said her mother was doomed. Martina would only snort as she came through to re-stock supplies. Their reaction reminded me of this little fact that had been bothering me, ever since I read the report – it was, frankly, a mixed message. I was expected to assume Godlike powers, but then – kind of implying that I might not know what I was doing – the experts proceeded to spell out, nationwide, who should live and who should die.

I said to Hannah that I kind of thought everyone was overreacting. Hannah said oh yeah, then why not just euthanize everyone who wouldn’t make the cut – and speed things along. Despite my supposed omniscience, I didn’t have a quick answer to that. She and the others were obviously struggling with their new status as lesser beings. To humor her (we gods can have compassion), I huddled with everyone else surfing the Internet, looking for live or die candidates.

Stephen Hawking? Way dead. Mother Theresa? Okay, in reality, she’s already dead, but if she wasn’t she would be, if you know what I mean. Ronald Reagen? Early years of presidency, possible save. Second term, when the forgetfulness set in – dead.

Paris Hilton? She gets, as we say in medicine, the full-court press. For some reason, my stomach started to do a rhumba. As I headed to the staff toilet, I saw Roger, another federally-annointed God, wiping his hands on a paper towel. I discreetly let him know his barn door was still open before I went inside the bathroom and splashed water on my face.

I thought about Paris getting it all – the ambulance, the technology, the last ventilator – and how I’d have to command people to wheel good old Stephen and Theresa and Ronald into a corner and “pay them no mind.” Somehow my promotion didn’t seem as peachy as it had when I first got the news. But what could I do? Someone has to be God. My stomach clenched even more but I decided not to worry about it now, and see some patients. Clinic didn’t go as well as it usually did. I commanded Hannah to ignore some people and rush others through, using my new vision. Unfortunately, the Young and the Pretty are generally harder to find at a homeless clinic – most every patient we see wouldn’t make the cut in a disaster – which means the whole triage process got into a muddle. I also commanded staff to clean up after me, and to never question my decisions, but Monica only slid her eyes sideways and asked if that meant she shouldn’t point out, like she usually does (with a kindness I’ve always appreciated), the times when I’ve accidentally picked up the wrong person’s chart.

I spent my ten minute break hiding in the bathroom, where I distinctly thought I heard laughter outside the door (could gods get paranoid?). I decided then that perhaps I needed a back-up plan. The God thing wasn’t working out. The experts on the federal commission are clearly way better Gods than I am – after all, they reported to the news media that they sat in a room, deciding who should live and who should die – in theory, that is – and then cried about their decisions. Now that shows a true belief in your Godlike power, wouldn’t you say?

But that’s just not me. I looked at my haggard face over the sink and decided, then and there, that I wasn’t cut out to be a God. Now – oh hell- what we were going to do in a disaster?

If not a God, what could I be? Well, one thing that bugged me about the commission’s report was that it lumped bird flu outbreaks with the kind of national disasters we’re seeing in Myanmar and China. Why would anyone refuse care to a grandmother in a car wreck if there’s no treatment –at all– for bird flu? It just didn’t make sense. Perhaps, instead of being God, I could use logic. A logician. I could be that.

And the commission didn’t seem to get the idea that a massive earthquake shouldn’t get the same response as a (relatively) slow-moving flu epidemic. The rules would be different – with the flu, you’d need lots of ventilators to keep people breathing. Vents (as we call them) would be the rate-limiting step to saving more and more people. If you had more vents, you’d could save more people. Maybe, for a terror attack, the limiting factor would be ambulances (heck, we’ve only got a few dozen in all of San Francisco). I could look for rate limiting steps – I could be a chemist.

I heard someone bang on the staff bathroom door, but I realized there were more jobs I could do. It was clear someone would need to be a rapid-response supply sergeant, moving things around where they were needed. And if there was no way to save everyone, someone (unlike the commission) needed to be an ethicist. An ethicist, instead of deciding who should live and who should die, would figure out how to help the most with what we had – as impartially as possible, based on what was available. There are ethics rules than anyone can learn, like doing no harm, and the theory and application of futility in medical practice. I realized, over the banging on the door, that maybe the federal disaster commission started out trying to provide data on how futile or hopeless certain treatments are, but got kind of carried away with their Godlike powers and ended up with a list of who should live and who should die. What was actually needed was data – rapidly evolving data unique to each setting that could be used to maximize lives saved. Epidemiology? I could be an epidemiologist.

Someone shouted “Are you ever coming out of there?” which reminded me of that poor woman who refused to leave New Orleans – you know, the doctor who stayed behind, with no electricity, no water, and rising floods. When most everyone left, she stayed to care for the frail elderly. She got charged with murder. I felt a deep shudder. Seems like people really hate even the suspicion of a doctor assuming Godlike powers. Maybe that federal commission would have done better by pushing for Good Samaritan Disaster legislation. I’m pretty sure more doctors would stay behind to help if they knew they wouldn’t get charged with murder. Hey! Those 1,800 people who died in Katrina – those are exactly the people this commission says should die.

That’s when I realized that all these jobs – logician, chemist, supply sergeant, ethicist, epidemiologist, legislator – I’d rather do any of them than be God. I stepped out to find a crowd gathered at the toilet door, worried looks on their faces. “Are you okay?” Hannah asked. That’s when I knew that the people in my clinic could do a better job than me at many of those things. Who would make a better rapid-response logician than the kind of highly trained nurses I worked with every day? If someone has to be God, personally I’d vote for Hector in housekeeping – there’s never been a kinder human ever. He’d never do it, but still. As for me, if true disaster struck (God forbid!) I wanted to do my best, and give my all, but with other people. I flashed back to my Trauma Training, when someone asked the wonderful trauma surgeon, Dr. Schecter – how do you stand it when you can’t help everyone, and he answered, in a really quiet voice, “you do the best you can. Everyone does. You just do what you can.” That’s what I wanted. I wanted to be on the team. I wanted to be only human. But I’ve been commanded by a federal disaster commission to be a God. What choice do I have?

I overheard several people comment on how unusually quiet I was the rest of the afternoon. When I got home that night, I picked up the breakfast plate everyone stepped over. The dog licked me on the hand, like he felt sorry for me. All I can say is, I sure learned one thing from my day as a deity – I refuse to be God. So sue me.

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