BY: JOSÉ SANTIAGO, MD
Dr. Santiago is corporate medical officer, Carondelet Health
System, Tucson, AZ.
In November 2000, a group of physicians and health care leaders
gathered to explore the foundational values of Catholic health care at the Physician
Leaders' Forum, held in Amelia Island, FL. Participants agreed that a highlight
of the forum occurred when physicians came forward to relate experiences at
their institutions that exemplified, in a tangible way, what is special about
Catholic health care. Dr. Santiago's talk from the Forum has been adapted for
Health Progress.
One afternoon, I received a call from the intensive care unit
of the hospital I worked in at that time. They said, "We have a case you might
find interesting and we need your help." Because they called me, the corporate
medical officer, I knew what they really meant was, "We have a terrible case
and we want nothing to do with it."
This patient, a 22-year-old woman who had taken an overdose, had been admitted
from the emergency department. She was on life support and, according to the
neurologists, was in a vegetative state. Her condition held no hope of recovery.
Complicating matters, she was 16 to 18 weeks' pregnant.
The staff had called me to talk to the patient's mother, who was at the hospital.
The mother had three other children at home, was working two jobs, and hadn't
seen her daughter in approximately five years. Before that, they had had a poor
relationship. According to the staff, nothing could be done for the patient.
Social Services was looking for a long-term care facility where the mother could
send her daughter; the mother was contemplating ceasing life support after transfer.
I met with our hospital president — a sister — and our first action was to sit
and pray about this case. We, of course, wanted to respect the wishes of the
mother; we didn't know what the wishes of the patient were. We wanted to create
some options — not hope. We were not so grandiose to think we could create hope,
but we wanted to identify some alternatives. We then consulted our ethicists,
who agreed we had a problem.
The president and I discussed the situation further and agreed we could offer
16 to 18 weeks in the hospital. We asked an obstetrician to assess the fetus;
it was healthy, the heartbeat was strong, and all vital signs were good. We
then gave the mother her options. We recognized her choices were unfair: she
could try to take care of her daughter, her other children, and work two jobs;
or, she could choose to disconnect life support. We also offered transportation
to and from our hospital so she could visit her daughter and wait to see what
God would decide. She chose that final option.
To everyone's surprise, a few weeks later the patient began to wake up. After
a few more weeks, her condition improved, she started talking, and we removed
life support. Eventually she delivered her baby.
What we learned is that much is unknown. I can tell the story, but much of
it I do not understand. In medicine, I was taught that "when in doubt, do something."
This idea needs to be revised to "when in doubt, do nothing." He who hesitates
may not be lost. Although a mother may give life to a child, in this case a
child gave life to a mother.