An Incomplete Solution

02 Oct 2019

By Elizabeth Lim

As a medical student and an aspiring surgeon, I enjoy when there is a definite solution or an answer to a problem. The level of satisfaction knowing that something is fixable is immense, especially when it comes to patient outcomes. The ability to help and provide care to a patient by resolving their health issues is one of the most rewarding feelings one can experience. However, I realize that is not always the case, whether it’s in surgery or any other specialty.

During my very first rotation of third year of medical school, I quickly learned about the difficulty of incomplete solutions. One particular issue comes to mind-the issue of emergency dialysis in undocumented patients with end-stage renal disease (ESRD). This issue became a hot topic for me as it tends to spark a spectrum of emotions that ranges from anger to helplessness. I will never forget seeing patients come into the Emergency Department (ED) on the brink of death with severe electrolyte abnormalities, and all we could do was give them a few rounds of dialysis before sending them back home. The most difficult part was that we would discharge them despite being fully aware that they would be back in a couple of days or weeks. This wasn’t fixing the problem, it was putting a band aid over a gushing, open wound.

However, in the majority of the states, relying on emergency dialysis is usually the only option available for undocumented immigrants with ESRD Even though studies have demonstrated that emergency dialysis compared to scheduled dialysis is associated with a higher mortality rate, higher hospital costs, and increased emotional distress for both the patients and the doctors who take care of them, state funding for scheduled dialysis for this population remains either very limited or nonexistent. Relying on emergency dialysis is a lose-lose situation, no matter the point of view. One of the most frustrating things about this situation is that there is a clear solution to the problem. In fact, a handful of states like California and Arizona have already taken action by redefining emergency care and extending state Medicaid funds to cover regular dialysis for undocumented immigrants.

This issue, amongst many others, seems to be an uphill battle. But, as I leave this rotation and head into the next, I am reminded of the importance of patient advocacy, not only in the hospital but also in outside settings such as governmental instances. In addition, I am reminded that patient advocacy isn’t restricted to just one lane but can (and should) involve doctors, residents, and students from multiple specialties. Lastly, I am reminded that the mental and ethical challenges of incomplete solutions should inspire us to keep searching and fighting for a better answer, especially when they have the ability to evoke such strong emotions.

Elizabeth Lim received her B.S. in biology with a minor in French from Texas A&M University, and is currently a third year medical student at The University of Texas Rio Grande Valley School of Medicine. She has a passion for the surgical field, as well as for research. She is currently involved in research regarding endocrine surgery and diabetes. Elizabeth strongly believes in and tries to emphasize the importance of women working together to support each other, and will be the founder of the AWS chapter at her medical school. In her free time, she enjoys exploring new restaurants and cities, as well as spending time with her family and dog.


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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