Because all the cancer patients don't want to talk to me...

I'm filling my time posting here because (A) I'm waiting for return phone calls (don't they know that I'm important?) and (B) once those calls get back to me, I have hours of SITTING ON MY ASS to do today.

Anyhoo...

Periodically, the INANE student meetings that we have at the hospital bear thoughtful fruit. I should've bought a lottery card yesterday, 'cause it seemed to be one of those good days.

One of my fellow students is following a case that I saw months ago in the Ethics Committee. Without violating HIPPA regs, I'll sketch just the barest bones: a young woman (19) is pregnant with her second child. In early November, she began having some sort of bizarre brain issues and is now in a persistent vegetative state with slim recovery chances. At the time of the Ethics Committee meeting (mid-November), she was 15 weeks along (well within the state guidelines to perform an abortion) and her mother and sister came forward saying that she did not want to have the child and asked to have the fetus aborted. The patient is not married and the father is currently in jail serving an indeterminate amount of time for...something. The docs refused to abort the fetus, pointing to some mysterious (and unsubstantiated) rumor that there was some documentation from her prior hospitalization (at a small, Catholic hospital in Trenton) that said she wanted to keep the child. As it turns out, there is no such documentation (it was actually just a misread nursing note that soapboxed about the evils of abortion). So, the Ethics Committee advised that the docs perform the abortion and move on.

They still didn't. In fact, they asked legal to investigate the situation further. And they did. Slowly. Here's the legal situation: the docs need the mother's consent to perform the abortion, which they can't obtain because she's unresponsive. Typically, they would turn to the next of kin who, according to PA law, is the mother, but the docs insist on ignoring her because she "can't be trusted" and has a "history of noncompliance and difficulty." In order, therefore, for the mother to legally make decisions regarding medical care, she would have to file for guardianship, which takes about 4-6 weeks to even file, let alone arrange a court date. This was in January. Currently, the mother is 24 weeks along, just a week over the legal limit to perform an abortion. Now, the fetus is viable, no abortion will take place, and the mother has to make decisions regarding the quality of care that the docs must provide (i.e., will there be an emergency Cesarean if the mother codes?).

I. Flipped. My. Shit.

First: So, now the mother is capable of making medical decisions whereas previously she wasn't? Second: According to the docs, the fetus has been exposed to possibly terratogenic medications that were sustaining the mother's life. There's little hope for the mother's recovery and, if the fetus is carried to term and makes a successful entry into the world, its grandmother may be asked to take care of a potentially cognitively and/or physically impaired infant for which she may be grossly unprepared to do. What systems are in place to educate the grandmother on how to care for this infant? Is she financially capable of doing so? ALSO, she has to care for the 2-year old whose mother is in a coma and has to explain complicated life/death/coma issues. Who's helping her with that? Third: Maybe the mother has a "history of noncompliance and difficulty" because she's been dragged through the institutional hellhole that is a hospital. Why would she trust and/or follow up with people who haven't listened to her throughout this ENTIRE ordeal? Has anyone attempted to reach out to her and build trust/a positive relationship? It sure don't sound like it 'cause we're just a willing to write her off as an (another) poor, ignorant black woman. Fourth: THERE WASN'T A LEGAL ISSUE BEFORE. WHY WAS THERE SUDDENLY ONE? What checked the "OK" box that justified this sequence of unnecessary action? The mother, by law, was the next logical health care representative. Why couldn't we just trust that she knew what her daughter wanted? Couldn't that have avoided all this nonsense?

I was told to get off my soapbox. Clearly, I'm still on it. I leave those questions to you all.