"If It Is Given Me To Save A Life"...One Doctor’s Commitment to the Oath

Photo By Petty Officer 1st Class Benjamin Lewis | 200508-N-TR141-0003 NAVAL STATION ROTA, Spain (May 8, 2020) Cmdr. Javier Agraz, Internal Medicine Physician at U.S. Naval Hospital (USNH) Rota, Spain, and Expeditionary Medicine Director, poses for a photo in the USNH Rota courtyard, May 8, 2020. (U.S. Navy photo by Mass Communication Specialist 1st Class Benjamin A. Lewis)  

ROTA, SPAIN

05.20.2020

Story by Petty Officer 2nd Class Eduardo T Otero  

Naval Station Rota, Spain

"I swear by Apollo Physician, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture."

This is the first line of the original Hippocratic Oath according to one translation from Greek. Usually attributed to the ancient Greek physician, Hippocrates (though the real author is still in question), the oath is believed to have been written around the 5th century B.C. It was a document physicians of the time swore upon, dictating their responsibilities as far as their profession was concerned. It informed their expected behavior, their duties in the practice of medicine and the ethical standards required while doing so. It also reinforced camaraderie among the professionals in the medical field and regarded the practice of their craft as an art as much as a science.

Back then, the oath was binding, with real consequences should it be broken. Today, it is more tradition than law. And although not a requirement in all medical schools, it is still recited by most medical graduates in one form or another with some modifications having been applied across different time periods. All versions however, retain the original core values and the promise to act in the best interest of whoever happens to become a patient.

More than 2,500 years after the original text was conceived, Cmdr. Javier Agraz, Internal Medicine Physician at U.S. Naval Hospital Rota, Spain, and Expeditionary Medicine Director, was presented with a test to live by this oath.

In the morning of May 2, 2020. Agraz was driving through Chipiona in the province of Cadiz, Spain. He was on his way home when he saw a number of Spanish police officers blocking the road.

"When I approached what I thought was a check-point, I realized that there was someone doing CPR on a person on the side of the road," said Agraz.

CPR--standing for cardio-pulmonary resuscitation--was a sign that whatever was going on was serious.

"I speak fluent Spanish and immediately introduced myself as a physician from the American base and offered to assist if needed," said Agraz. "The police officers readily said that my assistance was appreciated."

This began Agraz's involvement in the fight for a person's life, a fight that he would be part of for more than an hour.

"The only PPE (personal protective equipment) that I had with me was a cloth mask but I was handed gloves by a police officer," said Agraz. "After I parked my car, I ran to the scene where the patient was laying on the ground."

The concern for PPE arose from the fact that the very same day this incident occurred was the first time adults had been allowed to perform physical activity outside their homes during the Coronavirus disease (COVID-19) global pandemic lockdown in Spain. The person lying on the ground, who appeared to be a cyclist in his late fifties, according to Agraz, could've potentially been sick and easily endangered Agraz and anyone else in contact with him.

"Another gentleman which was another local physician was already doing chest compressions," said Agraz. "I took over the role of protecting the airway."

Agraz was told that an ambulance was called and on its way. He asked if there was any other PPE, first aid kit or any way to get a defibrillator, and received a first aid kit from one of the police officers. From the kit, he was able to get an oropharyngeal airway--also known as a Guedel pattern airway--a medical device used to maintain or open a patient's airway. He performed the emergency procedure on the man. Agraz was also given a CPR mask.

"We continued to do several rounds of CPR until we were handed an external defibrillator by one of the paramedics that had arrived on scene," said Agraz. "Using the defibrillator we realized that the cyclist had a shockable rhythm and the patient was shocked 3 times in the middle of performing rounds of CPR."

By this time, Agraz and his makeshift team had more assistance, including another physician, and a nurse among others.

The battle for the patient's life went on. An intravenous line was started, the man was intubated on scene, emergency cardiac medications were used and finally, after 40 minutes or so, the team got a pulse and appropriate blood pressure with proper oxygen saturation, according to Agraz.

"We decided that air transport was needed and hence we called for assistance from an air ambulance," said Agraz. "The helicopter arrived shortly after."

But the team of medical professionals who had banded together to save the patient's life on the side of the road would not be allowed to claim victory just yet.

"Unfortunately, the patient deteriorated soon after and we had to once again start CPR," said Agraz. "But we were able to stabilize him and get an appropriate heart rhythm and blood pressure safe for transfer."

After that last-minute scare, the team assisted with loading the patient onto the helicopter which was able to take the patient to a hospital intensive care unit in Jerez de la Frontera. All in all, the team worked on the patient for over an hour.

But why did Agraz even stop to help at all? He was on his way back home and the police were already there at the scene when he found out what was going on.

The world is facing a deadly pandemic even to the time of this writing. As of today, there have been almost 5 million confirmed cases worldwide. COVID-19 has taken the lives of more than 300,000 people. As mentioned before, the man on the side of the road could've been sick. Offering his assistance was a risk that Agraz had no need or logical reason to take. But according to him, the decision to help or not wasn't a matter of choice at all.

"People have asked me why I assisted and I have said time and time again that it was my duty as a physician and was a true honor to have worked with my Spanish colleagues to assist our patient," said Agraz. "It was truly my job."

He was later informed that the patient tested negative for COVID-19.

Agraz said that his role here in Spain has offered him the privilege and honor to get to know the Spanish medical system and that he's truly grateful for it.

"Here in Spain, the Spaniards have taken care of our American active duty members, retirees, dependents and Department of Defense contractors," said Agraz. "And I believe that this was a very small way to show our host nation our gratitude for all of the support."

Agraz said he performed his duty as a physician. Probably everyone else on the team that saved the cyclist's life would have said the same if asked. It seems to be a case of human empathy and a willingness of some people to put others before themselves. This can also be seen in the countless others--not only medical professionals--who continue to work on the frontlines during this pandemic so others can stay safe at home.

And it may also come back to the Hippocratic oath.

"I have been a physician now for 15 years and I can tell with 100% certainty that the Hippocratic oath has played a role continuously since I had the honor to take it, May 5, 2005," said Agraz. "This belief was the reason why I handled the situation the way I did with our patient in Chipiona. During this pandemic, the Hippocratic oath continues to play center stage."

Thousands of years have gone by since the Hippocratic oath was first swore upon by a physician, yet the tradition and devotion to the profession seems to have stood the test of time.

And Agraz and the many other medical professionals working every day for the life and health of their patients can be seen as living proof of the following excerpt of the physicians' timeless oath:

"If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty."

• Date Taken: 05.20.2020
• Date Posted: 05.20.2020 06:51
• Story ID: 370373
• Location: ROTA, ES