Tuesday, December 16, 2008

A Story From Work

I met a girl today. She's about three weeks old now, weighs about two pounds and has been in the NICU [Neonatal Intensive Care Unit] since birth. Let's call her Elizabeth - and this is her story which I feel compelled to write.

Elizabeth's mother is a crack addict with a $300 dollar per week habit. She's also an active prostitute working in the Bronx and she's got the likely slew of active infections that inevitably go along with that. Elizabeth's mother is 38 years old but looks like she's a senior citizen. Her mother realized for the first time that she was pregnant three weeks ago and came to the public hospital where I work to seek an elective termination of the pregnancy. And with a mother as unfit as she clearly is and a pregnancy as clearly unwanted as it was, nobody on staff seems to even think to object.

As you likely know, elective abortion is only legal in America up until the end of the second trimester or 24 weeks. What you may not know it that estimation of the fetal age can be done by ultrasound by taking measurements of different fetal anatomical features. It is well known by any competent obstretrics staff that by the second trimester these estimates can easily be as much as two weeks off. It can also be somewhat subjective since it depends on the ultrasound's operater to determine where to measure from. This technique's main purpose is just to show that the fetus is growing appropriately over time, not to age the fetus with a great degree of accuracy. Obviously the mother did not have even a single visit of prenatal care and so nobody knew how old the fetus was. The chief resident instructed the intern, "Go find out if the fetus is less than 24 weeks old." Then with the pressure to find a young fetus, the intern returned with a reported estimate of 23 weeks and 5 days.

With that factoid in the place, the team started to induce an abortion. The goal was to deliver the 23+ week old fetus intact and alive and then, since it being woefully premature and unprepared for the outside world, refrain from providing neonatal care with the expectation that nature would take its course and it would soon die. This is all permitted by current US law. And so this is what they did. They delivered the fetus and laid it on the crib in the delivery room under the warming light which was not turned on. She laid there for a full 7 minutes - losing body heat and not breathing while they dealt with care for the mother. At seven minutes, the attending physician walks in and sees that that fetus is still alive! She immediately calls in the neonatal pediatricians who manage to resuscitate the baby and Elizabeth is whisked away to the NICU, where she still lives today. After examination, it turns out that the baby weighed nearly 900 grams - a weight more consistent for a fetus of 27 weeks than of one of 23.

Think about what this means folks. What happened here was that these doctors were so jaded about bringing another unwanted crack-baby with hepatitis into the world that they fooled themselves (I'm being generous) into believing it was less than 24 weeks old, delivered it prematurely and then were willing to sit back and do nothing while it died right in front of them. When I saw poor Elizabeth in the NICU with tubes and probes going every which way and I heard this story I was absolutely floored. What the FUCK! I had previously worked with these people and I cannot believe that their judgement could be so absurdly screwed up on all moral, legal and medical levels.

Granted, a baby born - even at term - with a sustained cocaine exposure in utero and a number of serious infections is unlikely to have a great outcome, but delivering her prematurely and then allowing her to lie there freezing and anoxic for seven minutes surely didn't help her situation one bit! The neonatalogist treating her told me that she has good expectation to survive but zero expectation to do so without severe neurological consequences. I find it difficult to even find words to describe my enraged reaction to how the selfishness of the mother and the collaboration of her doctors lead to this horrible outcome for an innocent baby girl. It sounds like a sick joke, but she's an abortion survivor.

Of course her mom who tried to abort her did not give a damn and within one day of delivery she slipped out of the hospital and has not been heard from since. What tops the icing on this shit pie is the likelihood that if the mother had the inclination to, she probably has standing to sue for malpractice even though they were doing exactly what she asked of them and she's as, if not more so, culpable morally as any of them.

Update: 12/20/08

So I did some more sleuthing on Friday and I think I need to give those doctors an apology. Not entirely, but I think they were definitely more within their scope of practice than I had initially been told. What had actually occurred was not that the mother came in seeking an abortion, but came in with a story of abdominal pain, preterm premature rupture of membranes and likely chorioamnionitis. She hadn't wanted the pregnancy and had intended on a termination (she had had ten (TEN!) previous terminations on record) but that wasn't the reason she came in. The sono showed anhydramnios AND with their estimation of a previable fetus they decided to follow the course they did. If they hadn't induced labor then the fetus was likely to die anyway given the anhydramnios and the likely chorioamnionitis, and thereby also offer a serious risk to the mother.

What they still did wrongly though (imo), was in performing a poor estimation of the fetus' age - she was still significantly more than 24 weeks old and was indeed (obviously) viable - and then not having pediatrics in the room to perform a proper and timely resuscitation. So here it's less of a moral/legal issue and much more to do with simply poor management. All the same though, a terribly sad story all around.

Monday, December 15, 2008


LNM writes: "I think a big part of this was that philosophically I had tied "doing mitzvos" directly to "serving god". For decades my attitude about Torah and Mitzvos was that everything we do is in the service of god. Light menorah? Because god wants us to. Shake the lulav? See god. Tie your shoes in the opposite order you put them on? god again."

My perspective:

Doing something in the mindset of "avodat Hashem" doesn't necessarily imply that "God wants us" to do anything. Think of all the times you do an act in honor or in respect or in memory for something or just to show your allegience to an ideal without a conception that the 'something' wanted it to be done.

The simple understanding of mitzvot is indeed 'commandment,' but there's also a strand in Chassidic thought (see Likkutei Torah, Parshas Bechukosai 45c) that it's related to the word 'tzaveh' - which means 'connection.' Jewish observance can therefrom be understood in part as a human-based effort to 'connect' with the transcendent.

So yeah, it depends completely on your approach and mindset, but shaking lulav for example can indeed be an attempt to connect with the divine by using it as a vehicle to raise your consciousness towards those ideals. This isn't to say that Jewish observance doesn't have it's great value as social activities and a cultural heritage, but I think this is a nice vort to put a little kavanah back into your actions.