Mommy's Little Girl

Three mothers, three daughters. Each pair with their own neurosurgical misery.

One born with very little brain. No treatment mom says... unsure if there's anything left to save.
One born with blood in normal brain, and mom embraces the easy fix we can offer her to save her baby's life.
One born with normal brain, but hidden within, a tumor whose treatment wherewith causes her neurologic decline to mental retardation. Her mother fights and fights and ask for the improbable, hoping for the impossible.

Some decisions are easier than others it would seem. Some make more fiscal and pragmatic sense than others. But the ones such as the last that require operation after operation to save what little function is left leave me conflicted. One of our neurosurgical attendings mentioned that he once knew a neurosurgeon from the old Soviet block who stated that issues such as these shouldn't be an issue, for it would be cheaper to make another baby than to try and save what little was left of the one you were treating. I'm no communist, but there's a lot of truth to what he said. We performed a 23 hour operation on the 3rd child, involving 3 different surgical teams, tens of thousands of dollars of surgical equipment, hundreds of thousands of dollars of OR time, and thousands of dollars of postoperative care. And ultimately the treatment failed. Had it worked, it would only prevent further neurologic decline, but not restore function that had been lost. She would not be able to speak, she would not be able to care for herself. She would never go become a productive member of society and would likely have to be cared for for the rest of her life. Economically speaking she would be one of the hundreds of thousands of dependents within the US today, who require more in medical costs per year than the average wage earning American would usually make.

I don't believe that we as human beings have no right to judge the value of another life. And in a sense we are socially obligated as physicians to do what we can to improve the human condition and relieve suffering. But say we took those hundreds of thousands of dollars spent on one flickering flame and used it to feed, shelter, and educate hundreds of smoldering coals of a rural village in Tanzania. That money could have been used to provide retroviral medications for an entire town inflicted with HIV. It's enough to feed a rural community in a third world country ridden with belly bloated, fly invested children for an entire year. But instead for intellectual curiosity and an inability to refuse treatment with the slightest chance of improvement, the best and brightest flushed hundreds of thousands into the medical debt of America to give one soul a chance. So that she may continue lifting up her arms, as her fingers no longer move, a hundred children went without food and water last night. So that she may still get up to a chair, 50 men will succumb to HIV/AIDs for want of medication today. So that she can smile for a few more years, 20 women will die during childbirth for lack of sanitary delivery facilities tomorrow. How can we judge the worth of her smile? We argue that even if we didn't treat her, our monies would not reach those in need. But maybe that's the problem. The avenues do not exist, and if they do exist aren't readily available for us to use. Millions around the world are without food, water, shelter, medication, education, and possibly summed up - without hope, while we operate on the rare and esoteric. It doesn't take a neurosurgeon to realize there needs to be change. But I feel it'll take more than a doctor to figure out how.