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On Being a Doctor |6 December 2011

Who Lives, Who Dies

Alexander G. Truesdell, MD

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Author, Article, and Disclosure Information
Requests for Single Reprints: Alexander G. Truesdell, MD, Warren Alpert Medical School of Brown University, Division of Cardiology, 593 Eddy Street, Providence, RI 02903; e-mail, atruesdell@lifespan.org.
  • From Warren Alpert Medical School of Brown University, Providence, RI 02903.
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Requests for Single Reprints: Alexander G. Truesdell, MD, Warren Alpert Medical School of Brown University, Division of Cardiology, 593 Eddy Street, Providence, RI 02903; e-mail, atruesdell@lifespan.org.
For centuries, soldiers and physicians have pondered the apparent random nature of life and death in battle. Does fate alone dictate who lives and who dies? Step to the left, and you survive the mortar strike. Switch convoy vehicles, and the IED devours your friend instead of you. Are such events predetermined? Or do our choices decide these outcomes?
Across several combat deployments that followed the events of September 11th, every time I went to work I knew with reasonable certainty that someone would not come home. And not just “someone,” but a patient who was also a colleague or a friend. In my career, I've been present at the point of wounding, on the medical evacuation flight, in the aid station, and at the memorial service—a complete arc of care that made each experience of death and dying more rich and more raw. I also often bore some responsibility for every medical outcome in advance. Someone I knew might live, or not, because my duties as a trainer, logistician, planner, leader, or clinician were fulfilled, or not. I wondered whether I could successfully ensure a level of care as close as possible to prevailing peacetime standards and follow the principles of best medical practice in a tactically challenging and unforgiving out-of-hospital environment. Would life and death become more or less random based on my decisions and my efforts?
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Truesdell AG. Who Lives, Who Dies. Ann Intern Med. ;155:790–791. doi: 10.7326/0003-4819-155-11-201112060-00013

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Published: Ann Intern Med. 2011;155(11):790-791.

DOI: 10.7326/0003-4819-155-11-201112060-00013

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