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What is Truth: The First Question from Raphy Rosen, a CSSR-TCC Intern

The field of medicine is concerned with life, yet life cannot be studied without an understanding of death. The CSSR’s internship with the Terence Cardinal Cooke Hospital and Medical Center allows undergraduate students to grapple with the ethics surrounding life and death. Each summer two undergraduate students are selected to intern at TCC for 10 weeks. Under the guidance of medical staff, these students conduct research projects that culminate in a final report that presents their work to the CSSR. Raphy Rosen is one of the two undergrads working at TCC this summer. He has decided to chronicle his time at TCC with a series of posts concerning his experiences at the hospital. Below is his first entry, which asks the enduring question: what is truth? But first, we must meet the author, and who better to introduce him than Raphy himself:

My name is Raphy Rosen and I am going to be a senior in CC in the fall. I’m doing a religion major and a computer science minor and (hopefully) going to med school. I heard about the CSSR internship at TCC from friends who did it during previous summers and had a mind-opening experience, to say the least. I am a big fan of the CSSR since it appeals to my two biggest passions, not surprisingly- ‘S’ and ‘R’.

The work here basically involves being mentored by the extremely selfless medical director of Terence Cardinal Cooke Health Care Center. TCC is “729-bed (read: massive) continuing-care facility with a multitude of special care units, as well as two large outpatient clinics.” Their special units include Huntington’s Disease, AIDS/HIV, Alzheimer’s/dementia, end-stage renal failure, severely developmentally disabled children and a nursing home. Basically, this is a rare example of a catch-all facility where you can see a bit of everything. The job involves pursuing projects that the medical director thinks are valuable to the facility but is personally too busy to do. While the lion’s share of our time is spent on these research/staff development projects, we also have the chance to adopt a floor and see what regular life in a facility is like. We talk to residents, aides, nurses, doctors and therapists and try to be helpful in whatever capacity we can. So far in my experience the following is clear: I will do my best to help TCC in some capacity, but they have given me far more than I can give back. The following posts are some anecdotes that I observed. Names have been changed to protect resident and staff privacy. I hope you find reading them to be interesting and rewarding- I can promise you that experiencing them is.

1. One of the things that I have learned in my short time working at Terence Cardinal Cooke (TCC) is that truth is in the eye of the beholder. This maxim comes to expression especially in disputes between residents and staff. Consider the following story:

While observing in the physical therapy room, I struck up a conversation with a female patient in her mid-50s. She told me that she had a Cerebral Vascular Accident, more commonly known as a stroke, leaving most of her left side paralyzed. She had lost the ability to walk and the use of her left arm in a matter of minutes. She described to me her tireless work over the past 3 months during physical therapy trying to regain some function in her left arm and leg. She was proud that after all of her efforts, she was showing some small improvement in her mobility. She confided in me that today was her last day that she was allowed to come to therapy since the hospital staff had discontinued her appointments. In hushed tones she told me that the reason was that she had been too vocal about aspects of physical therapy that she did not like and she was being punished by being barred from therapy. I was appalled to hear that the facility would prevent a woman who so desperately wanted to regain her former life from finishing her recovery.

At the end of the session, after the patient had left, one of the therapists pulled me aside and presented an entirely different account of the events. She said that the patient had been coming inconsistently to her appointments and was not making substantial progress. With the facility’s limited therapy resources, they need to prioritize patients whom they think will benefit from the therapy, so they were discontinuing this particular patient so that other patients could have an opportunity.

Which of these accounts is true? In all likelihood, both are true to a certain degree. If a patient comes to therapy 3 out of 5 appointments in a week, she might view that as the most she is able to do due to her extreme fatigue. At the same time, a therapist might perceive a lack of effort and motivation. While the therapists were not vindictively ending her PT sessions because she complained about their competence, it is possible that if the patient had always behaved cheerful and hopeful, the therapists would see more promise in her progress and would bend the rules to allow her to continue. So what really is the truth?

The uncertainty in this situation raises the ethical question about limiting care for practical or financial reasons. An objective outsider would agree that it is necessary to triage limited resources to favor the patients who will benefit the most. However, imagine for a moment that this patient was your mother. Especially since she is so young, you would do everything in your power for her, even if the odds of success were miniscule. You can understand the frustration of a person who is told that their odds of recovery, though not impossible, were too small to be worth pursuing. You would feel that the world has given up on you, consigned you to a wheelchair, dependency and life in an assisted care facility. So what would you do? Would you allow her to continue therapy?

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