A case of the effects of religion

Having always been an atheist and being fortunate to live in a country where religion is mostly a non issue, I sometimes tend to forget how pernicious the influence of religion, and especially of religious conmen, can be. But then I am reminded.

There is this kid in our dialysis unit, he got HIV infection through vertical transmission, a couple of very foolish parents who never got him adequately treated and that eventually died of AIDS related diseases for lack of treating themselves. He stopped going to follow-up appointments in his teens and then showed up at 22 with full blown AIDS, with tuberculosis and HIV associated nephropathy that left him on dialysis. He was always a very sweet kid, and we all in the dialysis unit, full mostly of old people, cherished him dearly. He was never particularly responsible, and we always had a hard time making him go to medical appointments and take regularly his medications.

Then, last year, he became involved with a religious group, one of those Evangelical sects that started to bloom in Lisbon suburbs when we had a wave of Brazilian immigration in the 1990s. He was reading and studying "theology". We didn't care much, after all nobody cares much about religion and he seemed happy with it. Until, a few weeks ago, he stopped going to dialysis and left a message saying he was going to a religious retreat to get cured. We were obviously very concerned, but couldn't talk him out of it, and as an adult we couldn't stop him from doing what he wanted. We waited then, hoping he would come back when he would start feeling unwell.

After a couple of weeks, he showed up, looking emaciated, swollen and stinking of uremia. But he was convinced he was cured, and he wanted us to run some blood tests to confirm it. We told him we doubted it, and we did the blood tests to show him. As expected, the tests showed urea over 400 mg/dl and creatinine about 16 mg/dl. He couldn't believe it, he just looked at the results and cried, because he was so absolutely convinced he should have been cured by his faith. We tried to talk him into restarting dialysis, but he left saying he would think about it.

Another week went by, and then he was brought into the ER in acute pulmonary edema - when the retained fluids get into the lungs and cause respiratory distress - and he suffered a respiratory and cardiac stop, and was ressuscitated in the ER after 14 minutes in apnea, which is quite a while, but a young body can endure a lot. We dialysed him, and he woke up the next day, fortunately with no apparent neurologic deficits.

And the we heard his pastor had told them that we - the dialysis doctors, the dialysis nurses and his aunt, who is also a doctor - were the cause of his not being cured: our scepticism weakened his faith, and that was why he was still ill. How can you argue with that? It's the religious logic: if your prayers didn't work, it was because your faith was not strong enough. And we are the bad guys. I really don't know what will happen next, for the moment he seems really grateful to us for having saved him, but we have yet to see how he will feel after the crisis.

He's a grown up man, and responsible for his choices, but it's really infuriating to think of these pastors taking advantage of immaturity and despair and putting people's lives in danger. Let's just hope this kid sees what's really good for him; will he?

Satisfações

Depois de um dia de intenso trabalho, apesar do cansaço físico, fica-me sempre uma agradável sensação de satisfação e de realização. Não é só pelo sentimento de obrigação cumprida ligado à ética protestante de que por vezes sou acusado, ou pelo facto da imersão no trabalho me fazer abstrair de outros problemas. É porque gosto realmente do meu trabalho. Nunca me arrependi da especialidade que escolhi; pelo contrário, quanto mais passam os anos e aumenta a experiência mais me congratulo pelo acerto da escolha. Combina todos os elementos que aprecio e me estimulam na Medicina: uma matéria intelectualmente estimulante, doentes graves pelos quais se pode fazer alguma coisa, seguimento longitudinal de doentes crónicos, o que permite uma relação humana e familiar que é uma das satisfações da profissão, e o exercício de técnicas e intensivismo qb. Hoje apeteceu-me escrever sobre isto porque na minha última urgência tive uns poucos de doentes muito graves, um deles num estado de instabilidade com o qual felizmente não tenho de lidar todos os dias, do tipo em que se sente que cada gesto ou decisão, a cada 10 minutos, faz diferença. Acho que só quem tenha trabalhado em cuidados intensivos percebe bem o que se sente nessas alturas, são momentos simultaneamente angustiantes e exaltantes, pela responsabilidade e pelo imediatismo dos efeitos das nossas acções.
Ao contrário do que muita gente pensa, incluindo médicos, o trabalho numa unidade de cuidados intensivos é a maior parte do tempo bastante rotineiro e calmo, e a ausência de contacto com doentes que falam, e sobretudo a falta de seguimento longitudinal de doentes crónicos, nunca me atraiu particularmente. É por isso também que a minha especialidade me faz sentir realizado - lido com doentes graves, por vezes com as emoções do intensivismo, mas mantendo o contacto pessoal com os doentes que também me é tão gratificante. Sempre gostei imenso dos tempos de consulta, em que num período limitado de tempo se tenta orientar os problemas dos doentes da melhor forma que sabemos. E sinto uma especial satisfação ao reencontrar, ao longo de meses e anos, pessoas que vou conhecendo cada vez melhor, com as quais se estabelecem laços de uma certa intimidade e às quais sinto que faço alguma dferença, ao contribuir de alguma forma, mesmo que muitas vezes incompleta e limitada, para o seu bem estar.
Enfim, alegrias da Medicina...