This weekend, doctors at Children’s Medical Center of Dallas spent 34 hours separating Ahmed and Mohamed Ibrahim, conjoined twins. As the pictures demonstrate, they were joined at the tops of their heads, so they would have to spend their entire lives lying on their backs but for this surgery. So far, the twins are both in critical but stable condition, in a drug-induced coma. The surgeries, as of today, were successful.
They were also expensive and time-consuming, which has led to some questions. Dr. Joe Stirt, an anesthesiologist, rhetorically asks:
Oh, and did I mention that the current procedure, in Dallas at Children’s Medical Center, involves five neurosurgeons, as many anesthesiologists, countless plastic surgeons, head and neck surgeons, orthopedic surgeons, vascular surgeons, nurses, intensive care unit nurses and respiratory therapists, all of whom are NOT taking care of hundreds, if not thousands, of poor kids in Dallas who could really benefit from this confluence of money and expertise?
Ken Womack lays out the issue starkly:
I’d hazard to guess there are plenty of children in Texas whose lives could be made significantly better if these medical resources were made available to them rather than devoted to making life better for two people from Egypt.
How about spending that “year of intense preparation” providing pre-natal care for poor women in the state? I bet there are plenty of poor pregnant women who could use “extensive diagnostic tests”.
Why not use the 10 surgeons and support staff occupied by the twins to perform neurosurgery, craniofacial surgery, plastic surgery, general surgery and oral surgery for procedures for children who need those surgeries in Texas or elsewhere in the U.S.?
I live in Dallas, and yesterday at church we prayed together for the twins. I was glad to do so. I hope that they recover safely, and that they live long and healthy lives, unmarred by health problems related to their conjoinment. I hope that Dr. Stirt and Ken feel the same way, and they’ve given no indication that they do not. But they do raise an important question: Couldn’t the $2 million spent on this procedure have gone to better use helping more than two kids?
The problem with the suggestion that the time and money could have been better spent on taking care of many children rather than just these two children is that it suggests an action. The action that is suggested by the question is to deliberately turn away these children because others could be better-helped with the time and money. The question suggests that each decision to treat or not treat any patient should be based in part on a financial equation, which is exactly the sort of thing I thought most of us hope would never be true. Aren’t doctors supposed to provide the best possible care to all patients regardless of their ability to pay? Or does that only apply to certain kinds of insurance, or certain kinds of procedures?
Besides, since these kids showed up with $125,000 in hand, this seems like it would be an odd expression of the free market!
I’ll address time and money separately. I don’t know that any kids were turned away for any condition during the time that this procedure was planned and carried out. I don’t know that any kids will be turned away as the doctors rest at home, recovering from the time spent this weekend. As far as I know — and I believe as far as Dr. Stirt or Ken Womack know — no kids or pregnant moms were turned away for any reason at all that would not have been turned away but for this operation.
In certain careers, time spent on one task is always time not spent on another. The time I spend stocking cans of peas is time lost from stacking cans of corn. But in other careers, things aren’t so clear. The time I spend surfing the web at work isn’t time lost from helping customers, it’s time lost from goofing off in some other way. When a big project comes up, the customers don’t necessarily suffer. Instead, regular customer care is handled by coworkers, and smaller projects give way or are picked up by other people so that I can focus on the big project. There is considerably more give and take than in a factory or on an assembly line. Given my limited observations of doctors, I suspect that they have even more latitude than I do, and I doubt any of the regular patients of these doctors suffered.
The team of doctors working during the 34-hour procedure included ” five neurosurgeons, two plastic surgeons, a pediatric general surgeon and an oral surgeon.” Frankly, I’m not sure what neurosurgeons do all day when they’re not busy operating on people’s brains, but I feel pretty confident that they’re not working with scalpel in hand 40 hours per week. The plastic surgeons likewise probably took more time away from waiting for patients and performing boob jobs than from helping accident victims regain their appearance. We’re talking about nine surgeons here, and I would hope that surgeons do not spend 40 hours a week in surgery. I sure wouldn’t want to be the one on the table at 4pm on a Friday if that was the case!
Perhaps it seems odd that I’m suggesting that time expanded to accommodate a remarkably lengthy exercise. What I’m actually suggesting is that the increased load was shared by many people, and so each person’s contribution was small enough to be absorbed by “free time.” If it turns out that someone was denied medical care because the doctors he or she needed to see were busy, of course I’ll change my tune on this point.
In summary, it’s not a zero-sum game. Children’s Medical Center of Dallas can take care of Ahmed and Mohamed and every other child in Dallas, and we can rejoice for all of the children who improve, and mourn for those who do not.
Money is more difficult. I believe that most of us are so accustomed to seeing insanely large numbers thrown around that it’s easy to forget that they’re insanely large. A million here, a million there — it adds up, and pretty soon you’re talking about real money. In this case, the direct costs of the surgery were $125,000, an amount presented to the hospital thanks to the efforts of the World Craniofacial Foundation. While the surgery might be expected to cost around $2 million normally, all of the people involved are donating their time, and Children’s Medical Center of Dallas is not charging anything for use of their facilities.
So the total actual cost of the entire procedure is $125,000, and that was paid. The rest is all pro bono. The problem with this is what, exactly?
In fact, the WCF does more than just handle high-profile conjoined twins cases. They are headquartered here in Dallas, and are dedicated to helping all children with craniofacial deformities, with a special focus on kids in Romania. They say, “We do not want one child to go through life with a face that was not transformed because funds were not available to the family.”
If you agree, you can donate money to help them help children at their website.
In summary, the costs are largely illusory, and even the opportunity costs are not real. What few costs were real were paid by a private foundation through private donations.
Ahmed and Mohamed
It should be noted that these children were not born to a Sultan who dropped in with his entourage and swept all others aside by waving large stacks of cash. They were born to poor parents who live in a small town 500 miles south of Cairo, Egypt. So far the WCF has paid for all costs related to the surgery, including the costs of flying the twins and their father here to Dallas and putting them up in the area for the last year. They are expected to be here at least two more years, so your donation can still help. You can even donate via Paypal at the bottom of this web page.
Given that this is a privately-funded and charitable project, I’m not sure that the nationality of the children makes a difference, but it does seem to be an issue for some that there are uninsured children here in America whose needs are not being met, while these children are being helped with a large-scale highly-publicized project. If you feel passionately about this, I suggest contact the WCF and suggesting that you would like your donation earmarked for use by American children. A good friend of mine recently had a baby boy born with a cleft palate, and I know that the procedures that they have had to take him in for haven’t been cheap. They live in the Dallas area already, so Children’s Medical Center of Dallas is just a short drive down the road, and medical insurance has covered most of the costs so far. Others are probably not as fortunate, so please, visit the WCF website and learn more.