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First impressions... - Nobody wears a white coat any more... — LiveJournal
...a tribute to becoming a doctor.
First impressions...
P is in the NICU. It is day of life twenty-something for him; he was born at 3 weeks and weighs less than five pounds. He has a patent ductus arteriosus (or PDA) and he doesn't want to eat. That's the least of his troubles. You see, P drew the short stick in the parent lottery, and so in addition to being force-fed through a tube and rounds of indomethacin to close his PDA, he's also hanging out in the NICU until he finds a home. His parents, who are less than twenty-five, have lost custodial rights and aren't allowed to visit. Child Protective Services has made him a ward of the state, and are attempting to transfer wardship to the state of Michigan - so that he can be placed in the same foster family as his other five siblings. Mom and Dad's parental rights to those five have been legally terminated.

According to my attending's admit note he is the result of pregnancy number eight, baby number six. Previous deliveries were all preterm and less than 30 weeks. His mother is in her early twenties and reportedly is illiterate. She and the baby's father came from another state, apparently to fulfill prejudices about that state, but can't remember the town they were living in. They reportedly went to Michigan to take care of the mother's ailing father - and at admission, told our NICU attending that the other children were staying with "Grandpa". In actuality, they had nowhere to live and were camped out in our Ronald McDonald House or our NI parent rooms. I can't decide what to think about them - clearly, this is a woman who is lacking some of life's advantages, someone whose social situation is so far removed from my own as to be almost incomprehensible to me...but I was feeling much more sympathetic before she called the NICU and threatened to kill the nurses for complying with the court-ordered "no parental visitation" document.
And I won't lie, O Best Beloved: it's hard to feel empathy for this woman. After having a chat with one of my single moms just today in the clinic about CPS and their roles, I am reminded that it is not an easy thing to have a child removed from a home - and there are statutes to clearly define when parental rights should be terminated. (look up your state here) The overriding principle in Child Protective cases is to act in the best interests of the child. There's no information on the chart about what happened to the previous five kids - but in the court hearing it was determined that removing P from his parents was in his best interests, and that worries me. What's going to happen to baby number seven, in the inevitable next chapter to this saga?

Do I think this woman cares about this child? Yes. She visited, she fed the baby the tiny amounts he'll take, she brought pictures - until the order came through, I knew what every single one of his siblings looked like, as well as his parents, though I'd never met them. But, O Best Beloved - and this is the opinion that's going to get me in trouble - loving your child is not enough. You have to also provide for his needs. It's cold here in northern Indiana, and even colder in Michigan. You can't live in the Ronald McDonald House forever - there has to be a place for him to go home to. You have to be ready, willing, and able to handle the kind of care he's requiring - and you have to be able to understand the difference between eating well and not eating well. You have to have both emotional and material resources to provide for a baby, and I'm not talking about expensive baby gear. So we're waiting for him to be placed where someone's equipped to take care of him - eventually, possibly, with his siblings - and we're waiting for him to heal.

But I come into the NICU every morning and I listen to the machinery-murmur of a wide-open PDA, and look at the plexiglass no longer decorated with pictures, and I can't help but wonder where - and who - the system failed.

Tags: ,
Current Location: $emergency_room
now feeling:: thoughtful thoughtful

6 whispers echo . o O ( ... ) O o . whisper a word
waifofthenorth From: waifofthenorth Date: April 6th, 2007 06:27 am (UTC) (etched in stone)
Poor baby...

coanteen From: coanteen Date: April 6th, 2007 06:34 am (UTC) (etched in stone)
After 6 kids taken from parental custody, I'd wonder less about the system failing her and more about her personal responsibility, or complete lack thereof. At some point in life, even the disadvantages people have to contend with are no longer enough to excuse their actions.

Sounds like they left their home state to keep #6 from being taken.
ayradyss From: ayradyss Date: April 6th, 2007 06:49 am (UTC) (etched in stone)
It's enough to make one wish that *not* getting pregnant were the default state.
coanteen From: coanteen Date: April 6th, 2007 04:11 pm (UTC) (etched in stone)
Definitely, or a "one strike, you're out til you prove yourself" thing.

But of course breeding has become a human right, apparently. For the parents, that is - nobody seems to do much about the rights of the kids brought into neglectful or abusive conditions because mommy and daddy decided to exercise their rights.
turnberryknkn From: turnberryknkn Date: April 6th, 2007 10:19 am (UTC) (etched in stone)
I can understand how you feel.

Long bone x-rays with spiral fractures. Opthamology consults to document retinal hemmorages. Head imaging to evaluate epidural hematomas and parenchymal damage. Psych consults to document PTSD. Providing sworn dispositions to badged detectives. Paged consults to Legal because the caregivers are suddenly attempting to manipulate the staff into suggesting (on hidden recorder) that maybe there's an alternative explanation for the injuries their child is presenting with -- or want us to conduct rounds with their lawyer. And loving foster parents trying to do their best in the years to come with a child whose mind, whose body, was wrecked by a single moment of temper or irresponsibility.

Know how you feel.

smallstar From: smallstar Date: April 6th, 2007 01:25 pm (UTC) (etched in stone)
It's cases like this that make me ponder the ethics of compelling long-term contraception or sterilization on people who are demonstrably not able to care for the babies that they keep having. Those poor kids. The parents, at least, have some ability to make choices for themselves, but the babies are innocent and helpless. It's not fair.
6 whispers echo . o O ( ... ) O o . whisper a word