Here’s a statement that could be a set up for a high school debate team or one of those shows on cable news: “The US has the best healthcare in the world.” I have debated this with myself many times. The pro argument emphasizes the role of research and technology, the availability of tests and treatments that may have seemed like science fiction not too long ago. But I usually land on the con side, thinking of our dismal overall statistics on life expectancy, child mortality and health status, coverage, and costs.
Sometimes, though, anecdotes trump statistics, as I learned the other day when I had the opportunity to spend the morning rounding in our operating suite. First, I observed the set up in OR 3 for a Norwood procedure, a now standard operation for an otherwise fatal congenital heart condition, hypoplastic left heart syndrome. They were getting a heart-lung bypass machine ready for a 1 week old infant. Although it is done in many centers now, our hospital has one of the highest volumes, and literally some of the best outcomes in the world. For a condition that was once uniformly fatal – standard treatment at most centers when I was a resident was hospice – today at Children’s Hospital of Wisconsin about 90% of children survive.
Next, I went to OR 6, where an EXIT procedure was being performed. EXIT stands for ex utero intrapartum treatment, and it’s an acronym that actually has some intrinsic meaning. It was developed for when a mother is carrying an infant with some kind of anomaly (in this case, a giant cyst in the neck) that would make it impossible for the infant to breathe after birth. A Caesarean section is done, but only the baby’s head and shoulders are brought out – a partial exit, if you will. A team of ENT and general surgeons then works to establish the baby’s airway before delivering the rest of the baby. Technically, the baby is being operated on before it is actually born (the moment of birth is when the cord is cut), and the mom serves as a type of heart-lung bypass machine. This is a highly complex, technically difficult procedure, requiring enormous coordination (there were at least 20 people involved), and only done at a handful of institutions, including ours. Even at that, this is only the fourth one we’ve ever done.
But wait, not done yet! As I was leaving the successful EXIT procedure, I passed OR 8, where a team of neurosurgeons was doing our first ever, apparently oxymoronic “minimally invasive neurosurgery,” to treat a young child with a brain tumor that might otherwise have been inoperable. Using a specialized guidance device in the OR, the neurosurgeon placed a laser-tipped catheter into the child’s brain. The patient is then moved to MRI, where the tumor can be zapped with the laser. MRI guidance allows the surgeon to see exactly where the laser is, and to monitor the temperature of the surrounding tissue so that only the tumor is targeted. And get this: at the end of the procedure, the catheter is removed, the wound in the scalp is closed with a single stitch, and the patient can go home within 1-2 days. After brain tumor surgery!! This isn’t exactly Dr. Leonard McCoy with a tricorder, but it’s darn close.
Three children who when I was in training would almost certainly have died – three families left with an unfillable hole – who instead will all go on to soil thousands of diapers, enjoy kindergarten, create adolescent havoc, and perhaps have their own children. On the one hand, this was thanks to Star Trek-type technology that really highlights our value of innovation. Yet I was also struck by just how routine, how normal it all seemed. A casual observer might not have been able to appreciate how groundbreaking some of this was, because the physicians and staff were just so – I guess “controlled” is maybe the best word.
I, on the other hand, was floored. Three children saved from fate. Yes, we still have too many children who do suffer or die, many from things that are easily prevented. And the kinds of things I witnessed are very expensive; having them is wonderful, but if only a small handful of those who need them can get them, that’s not good enough. Yet the look of hope and joyful anticipation I saw on the face of the mother about to undergo the EXIT procedure forced me to acknowledge that the answer to the question of whether the US has the best healthcare in the world is an ambiguous one. The debate goes on.