Friday, May 19, 2006

Irrational

Mom delivered at about 3 a.m. I was called to the delivery because there was some meconium (bowel movement) in the fluid around the baby, but she did fine. I briefly reviewed the mother's history, and there was something about it - maybe her age of 43 years and the fact that this was her thirteenth pregnancy - that made me ask my screening question. "Do your other kids live with you?"

"No, they live with their father." Bingo. They were placed in the dad's custody by Protective Services (P.S.) It's our hospital's policy to put a baby into the special care nursery instead of the mom's room if there is a referral to P.S., to avoid attempted abductions like the one we had last week. But this was her first baby in 12 years, meaning the other kids were taken away a long time ago, and she had three negative urine drug screens, and I just didn't have the heart to take her baby away from her, and let her stay in mom's room. The social worker gave me a little grief about it the next morning, when we moved the baby to special care, but hey, I don't always make my best decisions at 3 a.m., and frankly, the father of this baby was a really big guy.

It turns out that mom has syphilis, not treated in this pregnancy, so we have to treat the baby with antibiotics for ten days and do a spinal tap on the baby to make sure she doesn't have syphilis in her central nervous system. Mom was not happy when she heard this, and at first refused to give consent for treatment or the spinal tap. By the time I talked to her - my partner had tried first - she had consented to treatment but was adamant about not doing the spinal tap. I tried to reason with her but she was downright irrational, more than just the normal apprehension a parent understandably would have about all this. She said nobody explained anything to her, but when I started to do so, she cut me off after half a sentence. She accused us of experimenting on her baby. She said she was going to see her own doctor that day. I asked her who that was; she paused, then said, "He's an excellent doctor, and after I see him, then I'll let you know who he is." I then spoke with the dad, who said they would come to the hospital - mom had already been discharged - and discuss it further with us. By the time I left two hours later, they hadn't shown up yet.

I find myself hoping that P.S. won't send the baby to her but to foster care instead, because she really didn't seem normal. It's a terrible thing to hope for, in a way, but it's mothers like this that make us a little paternalistic towards our patients sometimes. My frustration with her is mixed with some sympathy, though, because I suspect she might be mentally ill. Parents: some can be so great, others just downright awful.

P.S. Say "hey" to Carrie at Neonursechic, a fairly new entry into the blogosphere.

8 Comments:

Blogger Flea said...

Maybe I didn't read carefully:

This baby is an automatic CPS referral?

Why? I desperately hope there was more history regarding the intervening 12 years that you haven't told us.

Flea

11:17 AM  
Blogger NeoNurseChic said...

Thanks for the link!

You will probably have the same reaction I had to this, but awhile back, I was talking to the father of a baby about an upcoming spinal tap. He told me that he didn't understand why that had to be done because he thought it was only for people with "emotional or mental problems."

It took ALL my composure not to bust out laughing...and then cry. I had one of those "shocked pause" moments with possibly a raised eyebrow, took a quick deep breath, and then said, "No....the spinal tap isn't for that. It is a test that will help us look for infection. Let me go get the NP to explain further..."

Flea,

I know on our unit, SW would automatically be involved with a patient like this. I don't know about CPS as frankly we don't refer directly to them. We refer to SW and then they make the call from there. However, G13 is more than enough to refer to SW, and I think actually SW may check on all of our families just to assess support systems and resources. At least that's how our unit works....


Take care! Thanks again for the link!
Carrie :)

11:48 AM  
Blogger Cherrie said...

I'm pretty shocked that this would be an automatic CPS referral. The number of babies a mother has had, Nor her use of informed consent should be used.
I'm with flea on this one. Unless something within the last few years was discovered, this mother deserves the same rights as all mothers deserve.
declining a test or procedure on your newborn is a right in most (if not all) states. In this case, it may not seem wise to you, but she still retains the right to excersise informed concent or refusal without fear of reprisal.

1:13 PM  
Blogger Ex Utero said...

Why HIPAA is a good thing:

I have a family that I want to blog about so badly right now that it makes my fingers twitch. But I'm not going to. Why? HIPAA and unlike you and Flea, neonursechic and I are not anonymous on our blogs. My rule is don't write about anyone you've cared for in the last two years and even then, change their sex, race, dialect, etc. Make it absolutely impossible to identify them. Still, when I read a case like the one you've just blogged about, and I have one that would go so well with it... it's really hard to follow the rule.

1:31 PM  
Blogger NeoNurseChic said...

Yes...the nonanonymous factor makes things difficult. I strive to change all the details in my stories so that it is completely unrecognizable, except by coincidental stories alone. I change genders, time frame, etc - I'm learning from Phill myself! :) A lot of times I read stories on someone else's blog and want so much to write about a similar situation, but the stories are sometimes so unique that there is no way I could ever write about it. A challenge...but I don't do so well with anonymity! haha

Now when I write about my own health stories, I speak the truth. I couldn't make up the stuff I've been through because I wouldn't have thought of it if it hadn't happened!

2:46 PM  
Blogger Ex Utero said...

Hi NeoDoc,

You've had two more medical student's crawling your blog this week. You are really making my job as an educator easy.

see here:

http://talesfromthewomb.blogspot.com/2006/05/medical-student-blog-crawl-3.html

I'm going off service so there will be fewer of them for the next 6 weeks.

5:16 PM  
Blogger neonataldoc said...

This woman had six previous children. They were all removed from her custody by Protective Services. Because of that we referred this case to Protective Services to make the determination of whether the baby could go home with mom. (Actually, our social worker did the referral.) I think it's reasonable to refer a baby to P.S. when mother has had that many children removed from her custody. Also, in our state, it's state law that we must refer a newborn to P.S. if there is an "open" P.S. case in the same family. The referral to P. S. had nothing to do with the fact that this was her 13th pregnancy.

HIPAA is a major reason why I blog anonymously. I worry about violating HIPAA sometimes even now.

And welcome to all students.

10:35 AM  
Anonymous Dr Sidharth Sethi said...

hello neonatal doc!
reading your posts always reminds me of my NICU days. Thanks a lot for bringing back my old memories
we also had a patient like this once.I was on duty that day in NICU when the sister told me that this mother was beating her preterm twins with pillow. I went and scolded her. thought she was some psychiatric female.
referred her to psychiatry. the poor twins were discharged few days later.
Now 6 months later, the father of the twins came to us with both twins having gastroenteritis with failure to thrive with sepsis with faulty feeding. the mother had left them and gone somewhere.
sometimes its difficult to manage such patients and to make them understand our things
A nice entry, neonataldoc
Dr Sidharth Sethi
www.pediatricsinfo.com

2:58 PM  

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