Dean's Update
January 24, 2025 - Aron Sousa, MD
Friends,
This has been a remarkable week filled with fragments of news about funding and changed rules at the federal level. I know many of our people are worried about federal support and actions. I am worried as well, and both university and college leadership are paying close attention to events. These are, literally, early days, and we will know more as subsequent actions in the executive and judicial branches of the federal government become known.
When we know more, we will share any next steps the university plans to take. At this point, we focus on our work and the mission of the college as we always have and always will. As you might imagine, we are assessing which grants and finances are at risk, so we can better plan for bridging and contingency. We will talk about these challenges in our standing meetings, and, know this, we will continue to serve the people.
A few months ago, our chair of medicine, Chaz Hong, MD, PhD, rushed off to his mother-in-law’s bedside. From my texts with him, I knew this was a painful and difficult experience for him and his family. It quickly became clear this was also a frustrating situation for Chaz as a physician. As time passed, I thought it would be interesting to ask Chaz to write about his experience. Here is his update:
I’ll never forget the text from my wife: “What is this?” Attached was a photo of a "No CPR" sign above her mother’s hospital bed. Just days earlier, my mother-in-law had fallen at the gym, suffering a subarachnoid hemorrhage, subdural hematoma, and cerebellar stroke caused by undiagnosed atrial fibrillation. Remarkably, she recovered and was set for discharge to rehab—until her alertness suddenly declined, and that morning, she began seizing. My wife called, feeling the doctors weren’t doing anything.
When I spoke to the trauma chief resident, he explained the situation was grim and claimed my wife had agreed to make her DNR/DNI. My wife, an MIT-trained health data scientist, was stunned—she hadn’t realized what she’d consented to. When I demanded the decision be reversed, the resident was indignant: “You don’t want to put her through this. You don’t want us to put her on an artificial breathing machine.” I cut him off: “I’m a cardiologist. Intubate her now and move her to the unit. Please take care of her.”
That moment sparked a two-week ordeal, exposing the deep challenges within our medical system. Here are some hard lessons I learned:
Lesson 1: A code is not the time to debate code status. In emergencies, patients and families are often too overwhelmed to fully understand the situation. When in doubt, proceed with full code until there's clear instruction otherwise.
Lesson 2: Ageism is real in medicine. A few minutes later, the trauma attending called me, “She’s 84 with a Glasgow Coma Scale of 3.” I replied, “I don’t care. If I gave up on every 84-year-old with a STEMI, I won’t have many patients. Please hold off on these decisions until I get there.” Then I booked the next flight to Dulles.
Lesson 3: Patient’s family can read electronic health records. Through MyChart, I reviewed my mother-in-law’s notes. Per protocol, she’d received blood thinner Lovenox for DVT prophylaxis. The nursing notes subsequently raised alarms about her declining alertness, but there was no physician acknowledgement until the next day, when a CT scan was ordered. Her “non-hemorrhagic contusion” noted few days earlier had “blossomed.” Now, I have no idea what that is. Apparently, neither did the trauma team. Other than discontinuation of Lovenox, there was no note detailing her decline despite nursing notes documenting concerns raised by her daughter. Then my mother-in-law started seizing. Generic attending attestations surfaced a week later - after I arrived. There remains no attending note for the day she was made DNR/DNI.
Lesson 4: One size does not fit all. In the trauma ICU, I was alarmed to hear they planned to restart heparin per DVT prophylaxis protocol! I told the resident, “No!” This made me question strict adherence to protocols, especially given significant knowledge gap for minoritized populations, like elderly Asian females. Clearly this represents an important research opportunity.
Lesson 5: System flaws are rampant. During rounds, we agreed my mother-in-law wouldn’t receive heparin. Yet, the very next day, she got a dose because the order was only held—not canceled. Ugh.
Lesson 6: Ethics consults often reflect communication failures. Weeks into her ICU stay, still unresponsive, a family meeting was held with a Korean translator and an ethicist. Ethics consults are often for "difficult families" resisting medical advice. We agreed to attempt extubation and make her DNI instead of a trach—to the apparent shock to the team. Clearly, no one had asked us what we wanted, instead labeling us as “that crazy Asian family.” When the team kept repeating “let nature take its course,” I replied, “There’s nothing natural about any of this!”
Lesson 7: Doctors often don’t listen. My wife noticed her mother was more responsive in the evenings and told everyone, including me, but this was dismissed—until an ICU nurse confirmed, saying, “Your wife is right. She’s more responsive at night.”
Lesson 8: An experienced ICU nurse is worth their weight in gold. The same night the nurse mentioned that Keppra could affect alertness in the elderly, so together we reviewed my mother-in-law’s medications, discovering she was also on melatonin, which could further sedate her. I requested holding both. The next morning, the attending, who was unreachable the night before, was irate, stating, “I am the attending here!” I didn’t care because my mother-in-law finally seemed more responsive. However, she kept failing spontaneous breathing trials, so I asked to delay extubation until my eldest arrived from San Francisco. Meanwhile, we prayed with other families in the waiting room with whom we had bonded. Miraculously, a few days later, she became more alert. With the same night nurse on duty, we extubated her. She breathed on her own for an hour, then a day—and she continues to breathe to this day!
Lesson 9: Medicine without hope is just applied science. My mother-in-law has made an extraordinary recovery—she’s now talking, eating, and undergoing intensive PT. As a physician-scientist, I like to say, “Medicine without science is witchcraft,” but this experience taught me that Hope is what truly sets our profession apart.”
I really appreciate Dr. Hong sharing his family’s remarkable experience and the lesions in our system exposed by their experience. It is no surprise to any of us that being on the patient side of the patient-physician relationship exposes the defects and inadequacies of health care in America as well as the incredible importance of a nurse or doctor who listens. In truth, each time I have a family member who is really, really sick, I wonder how people without a physician in their circle get their needs met. My deep thanks to Chaz and his family for letting us learn from their experience, and how wonderful that his mother-in-law has made such a recovery.
Serving the people with you,
Aron
Aron Sousa, MD, FACP
Dean, Michigan State University College of Human Medicine