Suzy: Guiding patients through tragedy

As physicians, we are often called upon to offer our best medical opinion when advising patients about treatment options and decisions. Sometimes, these opinions come easily when we can cite medical literature, or years of experience when guiding patient decision-making.

Other times however, that opinion extends outside the bounds of medicine and delves into our personal beliefs and life experience in order to best guide our patients. It is in those times I believe, when we are pushed sometimes beyond our own comfort level, that truly help shape us into being the best physicians we can be.

As an OB/GYN, I have had the opportunity to experience many of those situations where the medical information was just not enough. If that was all I gave my patient, I would have been doing them a disservice, and may have led them to make a decision that was not in their best interest.

Although it may sound corny, in order to truly help my patient make the best decision, I had to search my own heart and soul to find the best advice, which may have had very little to do with the actual medical decision making. My experience with Suzy (not her real name of course), was a perfect example of this.

Suzy was one of my patients, and came to see me for her obstetrical care. At 23-1/7 weeks, she called in the middle of the night having pain and cramping. When she got to labor and delivery she was indeed contracting and was four centimeters dilated.

We treated her aggressively for preterm labor; however, it soon became apparent that she had developed chorioamnionitis. Despite all our efforts, she was going to deliver soon, and it was at that moment that I realized we had a very tough decision to make.

At 23-1/7 weeks the fetus was right on the edge of viability, and Suzy and her husband had to decide whether they wanted the neonatal intensive care unit team to do everything in their power to save the baby, or not be aggressive and let nature take its course.

At an earlier gestation, there would have been virtually no chance of survival, and the NICU team would not have resuscitated the baby, while at a later gestation they would have done a full-court press to help the baby survive. So this situation that my patient and her husband found themselves in is actually one of the most difficult situations we face in obstetrics. Taking into account that there are many factors that affect survival, the survival rate at 23 weeks is less than 25%, and the incidence of major disabilities is high.

The neonatologist gave them those statistics, and the possible outcomes at this gestational age. Then he told them that it was actually their decision as to what the NICU team would do at delivery.

As one would expect, Suzy and her husband were a little shell-shocked at needing to make that very difficult decision, and with little time in which to make it since delivery was imminent. They asked the opinions of the neonatologist, the nurses, and me in order to help them make this agonizing decision.

NEXT: Offering advice to Suzy

I have been taught throughout my medical career that medicine is not black and white, but rather quite gray, and if you ask ten different people you will get 10 different answers. Unfortunately for Suzy and her husband, in this situation that proved to be true. They heard everything from “do nothing” to “do everything, and everywhere.” After hearing from all the other team members, the patient and her husband looked to me.

Having cared for Suzy prior to and during her pregnancy, I had developed a close relationship with her, so I knew she valued my opinion. I realized that if I based my decision solely on the medical information, I would have given her an answer that, in my opinion, would have been both calculated and cold. I felt that I had to give her an answer that was largely based on what I would do if faced with that same situation, while taking into account the statistics and risk.

I told Suzy that if it were me, I would have the NICU team do everything to resuscitate my baby, which would allow me to feel that I had given my baby every chance of survival, and not have to look back and “what if” my decision. I recommended they search within themselves, their faith, their beliefs, and make the decision that they felt down the road they could best live with.

Ultimately, Suzy and her husband opted for the NICU team to do everything to resuscitate her baby. They believed that was the right decision for them and their family.

Their baby boy weighed 1 pound, 5 ounces at birth. Suzy and her husband spent time everyday in the NICU giving love and encouragement to their son. After what could only be described as a very rocky road and more than 130 days in the NICU, Suzy and her husband finally were able to take home their healthy baby boy weighing 7 pounds 7 ounces.

Suzy came to see me after the baby went home and thanked me for all my support and encouragement both prior to the delivery and during her son’s stay in the NICU. She said she really appreciated my honest answer about what I would do if it were me, and that it helped her not only make the decision, but also feel good and confident that it was the right decision for them. 

I was both moved and humbled. I told her that right before the baby went home, I saw one of the neonatologists in the hallway and we were talking about Suzy and her baby. I told him how happy I was that everything turned out well and that our miracle baby would be going home soon.

I thanked him for taking such good care of the baby and helping the baby survive. He admitted that initially he wasn’t in favor of resuscitating the baby at such a young gestational age because of the survival rates and all that he had seen with other babies at that age.

Felicia Ann Wagman, MD is an OB/GYN in Plano, Texas