Why are we still failing patients despite open communication?

Did you know that urine pregnancy tests are routinely performed on all females before every surgery? No exceptions. The Children’s Hospital in Buffalo tests 9 years and above. Don’t know if a parent or a patient has a right to refuse the test, but I do know that the anesthesiologist will refuse to give anesthesia, except for a life-threatening emergency.

I have never paid much attention to these tests. The nurses let you know if there is a problem. I have never had such a “problem” with the “kids” in my practice. Well, not until last year.

Tonsillectomy planned. 16 year old young woman. Huge tonsils. Couldn’t swallow. Throat hurt all the time. We had our pre-op chat. I was all set to go. Or so I thought.

The head nurse pulled me aside and said, “Her urine was positive.” Amazed I said, “You mean she’s pregnant?”

“Yes, but she swears that she can’t be pregnant.”

More than a few epithets went through my mind, not making it past my lips. Suspended between the prohibition from sharing this with her parents and the need to tell them we couldn’t proceed, but not why, I went to work on this very unhappy teen.

On the verge of hysteria, she swore up and down she couldn’t be pregnant. “I have to have surgery today. Nothing else matters. I can’t swallow!”

Twice more we tested her urine. Twice more the pink line appeared. We even taxied a blood sample to the main hospital from the ambulatory surgery unit. It was positive, too. She was positive she wasn’t.

She was scared. Very scared. And when I asked she told me she was scared of her parents.

“They will kick me out of the house. My father will beat me. I have to have my tonsils out today. Please, I don’t care. I won’t go home until you do the surgery.”

Now I had to worry about possible child abuse. I conferred with the nurses again. Hours had passed. I hadn’t yet spoken to the parents. Interestingly they didn’t ask what was going on.

I escorted them into our small conference room. I sighed and said, “I am sorry for the delay, but we cannot do your daughter’s surgery today. “ Very surprised, they asked, “Why?” I told them their daughter would have to tell them why, as I was not allowed to discuss the situation with them without her permission. Dad, a nurse, figured it out right away.

All I could say was that she was very disappointed she couldn’t have the surgery. I also told them she was very scared of their reaction.

I let the nurses re-unite the family. By the time I changed from my scrubs, they had left.

“How did it go?”

“Oh, they walked out in silence and in tears.”

I thought about this family for many, many days. I didn’t call, though I really wanted to know if she was okay—both physically and emotionally.

I tried to imagine why she was so afraid to tell her parents she was pregnant. Was there child abuse? Was the home too strict? Not strict enough? Was there a similar instance in another relative where the punishment was unthinkable?

I don’t know the answers to those questions. Ask yourselves. What if you were in that position? What would be your response? I only hope my daughters would be able to tell me, and I hope my reaction would be helpful. It’s a very tough place to be.

My patient finally had her tonsillectomy. The family is in counseling. She is on mood stabilization medication. And I am still wondering, what has happened to the woman/child in our midst, your daughters and mine, who cannot trust their parents to take care of them without fear, when they get into a difficult situation? With all the “open” communication, sex education, and internet information, why are we failing them?

Linda Brodsky is a pediatric surgeon who blogs at The Brodsky Blog.  She is founder of Women MD Resources.

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