Kareem Goldson - Patient-centered Ethics: Pathography

Jul 16, 2022 at 04:10 pm by pj


I assisted my fourth delivery on the twenty-first day of the rotation, and it went better than I expected. Mom was a middle-aged, G2P1, recovering addict; her C-section was planned, and I could tell that Mom was extremely determined to meet her long-awaited son. Mom and I made acquaintances in clinic a couple days before, an encounter that I can attribute some reduction in procedure-associated anxiety to. It was at this encounter that I learned some important pearls to keep in mind about doctor-patient relationship, and more specifically Mom and baby: my attending was noticeably excited for Mom, affirming and encouraging her history of drug abstinence; when mom got a chance to speak, she touched on themes of having “come a long way…” and being “proud of herself”. At this encounter, I gained an appreciation for the patient’s struggle and resonated with my attending’s attitudes. If I had any fears for mom or baby, I think that they were quickly pacified by her outward determination to nurse a healthy newborn – she seemed sure she’d do just that.

I had some time to interview mom before surgical staff wheeled her off to the operating room. It was during this interaction that I was privy to hear of how she had untoward feelings associated with invasion of privacy: Residents and well-meaning nurses “show up like clockwork”. She explained that sometimes her room “seemed full of people, 7 or 8 at a time, in 3 or 4 batches”. I put myself in her shoes and thought “lots of people got to see my 12-inch incision, all my tubes and wires, and my bare breasts and butt – though they TRY to keep me covered, who are they kidding? They see all anyways”. She thanked me for listening.

Now Mom is under anesthesia and the attending is making her first cut. Taking stock of the moment, I remember the OR staff being pleasant, the room – cold, suction – suctioning, my mind – racing. The procedure seemed so routine, so methodical, with reasonable but anticipated room for deviation: controlling bleeds. I thought the procedure was nothing short of controlled chaos. I recognized, during the surgery, being at a pivotal crossroad in my medical training that dangerously paralleled a mother and baby’s tightrope between life and death. At the same time, I started to think of the history I gathered from mom back at clinic. I always make it a point to learn from difficult cases and questions, and to study a patient’s presentation and identify connections that evidence the fluidity of their physiology.

 

  1. PMH: Patient denied any past medical, surgical, or obstetric problems. Patient denied taking any prescriptions and non-prescription medications. Patient also denied allergy to known foods, environment, and prescription medications.
  2. PPH: Patient reports being under the care of a Psychiatrist and Therapist in the past. Patient denies ever taking psychiatric medications. Patient reports greater than 5 suicide attempts but denied harm toward others. Patient denied current substance (alcohol and recreational) abuse.
  3. FH: Patient does not live with the baby’s father. Patient lives with mother and father, brother, and a pet. Family history is otherwise noncontributory.
  4. SH: Patient identifies as heterosexual. Patient denies any legal issues, felonies, and warrants. Patient endorsed a history of recreational substance abuse.

 

After delivery, I explored the idea and belief that it's important for a Mom to have support during postpartum and beyond, from friends and family, as well as professional support, including support from a ‘doula’. I was keen to recognize the relationship between Mom and others in the room; and I say the aforementioned because I observed mom being wheeled away separate from baby – and acknowledged the emotional and psychological effects that must have had on Mom immediately after delivery. Lastly, through my observations and the relationship I developed with the Mom and her family, I developed one manner in which I plan to practice: through individualized, personalized, and meaningful communication. I’m impassioned when taking on the role of a patient’s advocate and identify patient’s unexpressed needs by listening, effectively communicating, and attending to detail.

 






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