Suzy: Guiding patients through tragedy
Medical Economics is proud to unveil the honorable mention entries in our 2015 Physician Writing Contest. We believe the essays exemplify what connecting with your patients is truly about, and demonstrate the levels of heart, determination, and empathy you strive to bring into every exam room, every day. Thanks for reading.
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.
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