Wednesday, November 14, 2012

No Excuse

If you haven't read about the death of this woman, you should:

Woman "Denied A Termination" Dies in Hospital

A 31-year-old woman presented to a hospital in Ireland in pain, and was diagnosed with a miscarriage in progress (what we call inevitable abortion - "abortion" being the medical term for any pregnancy that ends before viability). There was no doubt that she was going to lose the fetus. Nonetheless, the doctors were barred by law from removing the fetus or inducing labor because the fetus still had a heartbeat. The woman suffered for 2.5 days, and then died of sepsis.

Non-medical people might wonder whether this outcome might just be a rare, unexpected outcome. You might wonder whether the doctors could have known what would happen.

So, let me be clear: this outcome was entirely preventable. This woman should not have died. Her risk of sepsis was well-known, and predictable. Women who have spontaneous miscarriages are at risk of infection, and the longer the miscarriage goes on, the higher the risk. Women in second trimester (which she was, at 17 weeks) are at even higher risk, because the cervix has to dilate more, and because the reason for the miscarriage could easily be an infected pregnancy. Pregnant women are highly susceptible to infection, and less able to fight it because their immune systems are suppressed. When a woman comes in with a miscarriage that doesn't end spontaneously within 1-2 hours, we evacuate the uterus to prevent the development of complications - specifically, hemorrhage and sepsis.

Her death is not a mystery, and it is not surprising. It's hard to blame the doctors, as their hands were tied by law and they risked losing their license to practice, or going to jail, by intervening. The doctors were prevented from providing adequate medical care by the law. The people responsible for the law are the Irish lawmakers who created it.

If they had done their jobs, the lawmakers who created this law would have looked at the implications of it. They would have learned that the law would inevitably cause the deaths of women. (Who knows how many others have died that we haven't heard about?) In fact, women die every day as a result of pregnancy and of lack of access to safe abortion. Anti-choice individuals who argue that such outcomes are rare, people such as our recent nominee for vice-president, are lying, or they are speaking ignorantly. I think it's the former, because if you spend 1 minute googling maternal mortality, you can easily see that 800 women die every day in pregnancy from preventable causes.

When lawmakers dictate what physicians can and cannot do, they are presuming that they can practice medicine better than doctors can. If they want to pass laws dictating medical practice, then they should take responsibility for these patients' lives. Lawmakers who pass laws that prevent abortion even when the pregnancy is a threat to the mother's health or life are knowingly causing the deaths of pregnant women. This is murder, and should be prosecuted as such. There is no excuse for having a law like this.

Sunday, November 4, 2012

Unsung Heroes

I have been helping out with disaster relief the last 5 days, and working hard. The last 3 days, I was working with M├ędecins Sans Frontieres (MSF), and finding myself astounded to be doing MSF work in my own city.
I have gotten a lot of moral support from everyone, and I am grateful for that. But while I think I have done some good and helped some people, I actually think that my contribution has been minimal in comparison with some of the other people out there that get less attention. I want to take a minute to highlight these ordinary people being heroic in a time of need.

1. Sanitation Workers
The city is a mess, and can't become functional until it is cleaned up. Sanitation workers are working long hours of backbreaking work to get New York back in shape. I saw sanitation workers lifting up huge pieces of furniture all over the place, and somehow getting all of it into their trucks. They were in the Rockaways today, on the streets that are covered in piles of sand and broken crap, hauling it all away.

2. Social Workers
Everyone realizes that doctors and nurses would be needed in a crisis, but few appreciate the desperate need for social workers. These amazing people can do everything from therapy to logistics to coordination. I had social workers tracking down people's insurance information to get them emergency prescription refills, comforting people with anxiety and depression that was worsened by losing their homes and being trapped in chaotic shelters, replacing broken eyeglasses for people without insurance, and basically doing everything they were asked. One of the days I was in a shelter, I was exploding with stress until a wonderful social worker arrived on the scene, and took some of the work out of my hands, handling everything with grace and perseverance.

3. Pharmacists
So many people have chronic conditions now, and many people did not expect the storm to be what it was. They brought only a few pills with them, or they didn't refill the prescription before the storm hit, and now they're stuck with no meds. Their pharmacies and doctors' offices are under water, and their insurance information is lost in the flood. Pharmacies all over the city are accommodating the need for emergency meds by urgently refilling meds, delivering to shelters, accepting partial insurance info and figuring out the rest later, waiving copays and offering 3-day emergency refills without any insurance information whatsoever. One pharmacist, when he realized how much need we had at a shelter, drove over in his car (kids in tow) to drop off not only prescriptions, but soap, lotion and other toiletries he thought people might need.

4. Nursing Home Staff
Several nursing homes and assisted living facilities were located in areas that were evacuated. These facilities had to move all of their residents, many elderly and with chronic medical and/or psychiatric conditions, into shelters. Some of the staff from these facilities worked 12-18 hour days in the shelters to stay with the patients they know, and make sure they get the meds they need in the middle of a chaotic situation. Without the staff from these facilities, caring for these patients would have been nearly impossible.

5. Home Health Aides
In the shelters I worked in, there were home health aides staying on a cot in the shelter (sharing a room with 20-100 other people) to care for their patients - changing their diapers, checking for bedsores, requesting wheelchairs, giving them medications and staying with their patients 24/7 to make sure they were well cared for.

6. Community Organizations
In many of these communities, we are outsiders; unfamiliar with the surroundings and the people. Preexisting community organizations stepped in to collect, organize and distribute donations, as well as information about where to get food, shelter and medical care. In the Rockaways, a youth organization became a hub for donations, and got so many donations (and needy people looking for donations) that they started distributing to other donation sites. These inspiring young people (in their early 20s) were the most organized and efficient group that I saw in this entire experience.

7. Good Samaritans
People came out in droves to help. Many were turned away from several sites, only to keep traveling to other ones until they found a place to help. These volunteers became essential, and many found a very specific task that they became very good at, and helped bring a chaotic situation more under control. Most were working outside their comfort zone, or even below their level of expertise. But no one balked, everyone pitched in to do whatever was necessary. Some people triaged medical patients; others climbed epic flights of stairs to knock on doors and bring water and food to trapped people; others still cared for patients in shelters too sick or old or incapacitated to fully care for themselves.

The aftermath of this storm has made me realize how much we need everyone in our city and our community to pitch in. But it also made me realize that there are people out there who do really good, hard  things every single day, who deserve our appreciation. Please take a moment to thank them.