Today I watched a man die - Chinese medicine and emergency medicine

About two hours ago along one of the busiest streets in Portland, I held a man (feeling his pulses all the while) as he died from a heart attack. To be fair, I couldn’t stay until the bitter end and the man could have pulled through but I strongly, strongly doubt this.

I was taking the bus from my house to my connection at this busy intersection. When I reached my stop, I pulled the cord and both he and I waited until the bus came to a stop to rise. He was older - probably 55+ and using a cane to walk. He was quite overweight and his breathing was labored. I was walking a good deal quicker than he was and said, “Excuse me” as I passed him on the sidewalk. It seems strange now to realize that those are likely the last words he ever heard. Somehow I was interested in him, I thought about waiting in the intersection with him as he crossed as he seemed not to have the energy to make it all the way before the light changed. He barely made it across. I continued to my connection stop.

I placed my bag on the ground and started to look around. I suddenly had an urge to look behind me and there he was, flat on his back with his red and white striped umbrella and Oregon State Beavers’ cap lying unceremoniously in the street. I ran to him at the same time as another two men ran to him. He wasn’t breathing. I grabbed his arm to find a pulse and found something very slow and ponderous forcing itself against his vessel walls. This was almost immediately followed by an intense fluttering that grew dimmer and dimmer… Yin and Yang were separating. He began to turn blue, the man next to me started CPR as a recently arrived woman called 9-11.

We worked on him for about 7-8 minutes before the paramedics came. During that time he gurgled once or twice and thrust his tongue out as it turned purple. All I could think was, “That’s the color of his heart muscle right now and that is not good.” I felt him leave, but we kept working with him. He grew cold. The paramedics arrived and began their hard work - but got no response. I remained for a short time but knew there was nothing more for me to do, so I left a short time later when my bus arrived.

For the last two hours, I’ve been thinking hard about what I saw. I’ve also been thinking a lot about our medicine. I am never going to be a M.D. I do have CPR training and our program gives us a fair overview of Western medicine. When my fellow students and I discuss the limits of Chinese medicine we usually indicate our boundaries somewhere around the realm of acute heart attacks, intense bacterial and viral infections and, of course, major surgical conditions. I understand that it is best for me to refer patients in these conditions to Western doctors as this is their realm of expertise. I’m happy to do that. However, what about when I’m the only one around? I know our medicine is capable of helping people in dire situations and I am inexplicably drawn to the most severe illnesses and disorders.

We have acupuncture points that are meant to revive consciousness, we have herbs that in certain administrations are meant to reverse terminal conditions. But how far can we go? What do you know about emergency medicine in Chinese medicine? Do you have any experiences with it? I’m going to start doing some investigation - but your thoughts would be most appreciated.

Eric

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Tags: Acupuncture, Acute conditions, chinese-medicine, chinese-medicine-research, death, emergencies, emergency-medicine

September 18, 2007 · Filed Under Acute conditions, The profession

7 Comments

Chinese medicine: NOT just for pain!

It’s summer between my second and third year of school in Classical Chinese medicine. I’ve had these past two summers “off” which means I do a lot of studying and thinking and many odd jobs along with caring for my daughter. The time is always a little disconcerting without the steady pendulum effect of classes and assignments. Last summer I spent most of my time just getting over the mind-blowing effect of learning about Chinese culture and symbolism. I couldn’t tell you in any way what kind of medicine I would like to practice at that point. This summer is disconcerting in a new way. I find that the kind of doctor I want to be is becoming too broad! I want to treat everyone for everything!

Trying to narrow this down has led me to consider the “scope of practice” for Chinese medicine. In Oregon we have a Board of Medical Examiners defined Scope of Practice:

77.757 Definitions for ORS 677.757 to 677.770. As used in ORS 677.757 to 677.770 (current as of 2005, I don’t think any major revisions have been made, but I’m looking into it):

(1)(a) “Acupuncture” means an Oriental health care practice used to promote health and to treat neurological, organic or functional disorders by the stimulation of specific points on the surface of the body by the insertion of needles. “Acupuncture” includes the treatment method of moxibustion, as well as the use of electrical, thermal, mechanical or magnetic devices, with or without needles, to stimulate acupuncture points and acupuncture meridians and to induce acupuncture anesthesia or analgesia.

(b) The practice of acupuncture also includes the following modalities as authorized by the Board of Medical Examiners for the State of Oregon:

(A) Traditional and modern techniques of diagnosis and evaluation;

(B) Oriental massage, exercise and related therapeutic methods; and

(C) The use of Oriental pharmacopoeia, vitamins, minerals and dietary advice.

(2) “Oriental pharmacopoeia” means a list of herbs described in traditional Oriental texts commonly used in accredited schools of Oriental medicine if the texts are approved by the Board of Medical Examiners for the State of Oregon. [1993 c.378 §1]

There is another section of interest - 677.190, section (9). It explains that a physician’s license can be revoked because of “unprofessional conduct” if the doctor is found to be, “Making statements that the licensee knows, or with the exercise of reasonable care should know, are false or misleading, regarding skill or the efficacy or value of the medicine, treatment or remedy prescribed or administered by the licensee or at the direction of the licensee in the treatment of any disease or other condition of the human body or mind.”

This is interesting given that earlier in the statutes it is explained that,

(b) For purposes of this subsection, the use of an alternative medical treatment shall not by itself constitute unprofessional conduct. For purposes of this paragraph:

(A) “Alternative medical treatment” means:

(i) A treatment that the treating physician, based on the physician’s professional experience, has an objective basis to believe has a reasonable probability for effectiveness in its intended use even if the treatment is outside recognized scientific guidelines, is unproven, is no longer used as a generally recognized or standard treatment or lacks the approval of the United States Food and Drug Administration;

(ii) A treatment that is supported for specific usages or outcomes by at least one other physician licensed by the Board of Medical Examiners; and

(iii) A treatment that poses no greater risk to a patient than the generally recognized or standard treatment.

So, despite the fact that some treatments may not be FDA approved or may not be within contemporary Western scientific guidelines they do not constitute unprofessional conduct, and thus cannot be said to violate the statute that recommends dismissal for licensed CM docs claiming that their medicine can treat conditions if such claims are supported by the medical philosophy under which they operate. OK. What does this mean for me?

Many people talk about the effectiveness of Chinese medicine for pain. The general public has also begun to understand that Chinese medicine is good for a few chronic conditions, including infertility. However, Chinese medicine is capable of much more than this. It is effective in treating acute stages of many illnesses, including febrile diseases, the common cold, trauma and even more life threatening conditions. One needs only to find an excellent practitioner with experience in this realm.

To provide an example, my daughter came down with something during the winter that involved an extremely high fever, sinus congestion and extreme throat pain - to the point where she couldn’t swallow. You’re all thinking strep throat, right? Well, me too. I wrestled with the thing for a while - just giving her fluids, keeping her cooled down. However, she wasn’t eating and her fever wasn’t breaking and I know better than to try to break the fever with over the counter medications. I debated taking her to urgent care (Western) or to my school’s clinic. It was difficult because even as committed to Chinese medicine as I am, I still have a lot of embedded beliefs that make me pause. I decided that I had to give it a shot. I took her to the clinic in the early evening and she was given acupuncture and an herbal formula. The formula was meant to be taken at a high frequency - we followed the instructions perfectly. The next morning she awoke with no fever, no sore throat, no sinus congestion and - most important - good energy and a smile on her face.

This isn’t an isolated incident. A well trained CM doctor can take care of any medical situation that comes up, save transplant situations or some similar condition that requires surgery. It may be a little fringe to suggest this is the case, but it has been my experience and the experience of many people I know personally.

Eric

Tags: Acupuncture, Acute conditions, law, Personal Development, scope-of-practice