Wednesday, February 20, 2008

monster

i recently read quite an interesting post on one of my favorite blogs. it had to do with religious zealots. it reminded me of two experiences i had, both of which i found disturbing.

i was rotating through paediatric surgery. the prof operated a 7 year old child for obstruction. intraoperatively we found intussusception in the ileocecal region with a golfball sized leading segment. we did a resection. already intraoperatively, the prof suspected a lymphoma (lymph node cancer). and histology proved him right. the child was referred to the chemotherapists for treatment.

during treatment, the child developed pancytopaenia (all blood products were low, including red blood cells) and became dangerously anaemic. at about this stage i discovered he was in foster care, because his biological parents suddenly crawled out of the woodwork. due to some legal technicality they still had a say over him in the legal sense. they then proceeded to refuse to allow a blood transfusion on the grounds that it was against their religion. i felt like i was watching a horror movie unfold before me. i could watch no more. i left it to the chemotherapists and didn't enquire about the child anymore.

the second incident was in some respects less dramatic. i saw an 8 year old girl who had fallen out of a tree onto a cast metal fence. the fence had sharp spikes and she had been impaled. when i saw her, she had four stabwounds in a row about ten centimeters apart running diagonally across her abdomen. omentum was protruding from one and she had an acute abdomen. fortunately she was stable.

i informed the mother that an operation was essential. she nodded. then she asked,
"will you be giving her blood?"
"i hope not." i replied.
"good, because our religion doesn't allow us to receive blood."
she didn't ask about the condition of the child or the nature of the operation or the chances that it would be successful or anything. she just told me that i was not allowed to give blood.
"i would only give blood if it turns out to be a matter of life or death." i replied.
"no, you may not!" she retorted.

i asked her if it was worth gambling her child's life (not her own life but the life of her child) on a religious ideal. but the blinds had gone up. she wouldn't even talk to me. she just kept repeating, as if in a trance, that no blood was to be given no matter what the circumstances.

the operation went well. one of the spikes had missed the aorta by about 2mm. slightly more medially and she would have been in dire need of blood to survive. while closing the multiple bowel perforations, i thought about her blase gamble with another human being's life. i also thought about the very difficult situation i would have been in had the aorta been injured. maybe the mother was willing to stand by idly while her own child expired, but it would not have sat well with me.

my feeling is that if an adult makes this sort of decision about their own life, who am i to go against it. but the children in these stories had no say. their lives were gambled with by others. they probably were too young to make decisions about religious ideals, and yet they were both being expected to possibly make the ultimate sacrifice in the name of religion. in fact they were going to be sacrificed by their own parents in the name of their religion.

it was monstrous.

22 comments:

sterileeye said...

In 2001 a new law was passed in Norway dissallowing parents to refuse blood transfusion for their children in acute situations.

It is the doctor's decision alone.

In not so acute situations the parent's wish can be overridden by a medical board.

A wise law.

rlbates said...

These things have always troubled me too Bongi. Fortunately I don't have any stories (personal involvement) like these.

SterileEye--what is the legal age in Norway? Here in the US for voting and medical decisions, it is 18 yo. For legally drinking, it is 21 yo.

Samson Isberg said...

In Norway, the legal age is 18 - except for buying and drinking liquor, then it is 20.

The legal situation as to Jehova's witnesses is however a little more difficult than sterileeye said. There are in fact several laws on the subject, and they are not congruent at all. The "Health personel act" § 7 gives every doctor a legal obligation to give emergency, life-saving aid, even when the patient refuses. The "Patient's rights act" § 4.9 on the other hand, states explicitly that you can in no way push blood products on anyone.

So the question for me and other doctors in this country, is whether you want to go to jail for manslaughter (by refusing to give blood) or go to jail for battery (by giving blood). As the jail time is longest for the first one, I give blood to every mother's soul who needs it, as long as they are under a general anaesthetic.

And if they're not, they're going to be real quickly.

Ms-Ellisa said...

I am too horrified to comment more articulately exept:

For Cryin out LOUD what kind of mother would...?!???

Couldn't you just give the blood, and then "apologise"?

sterileeye said...

Samson: Doesn't the Patient's rights act state that you have to be over 18 years old to refuse blood transfusion?

This article seems to say so.

sterileeye said...

Sorry. I think I misunderstood you, Samson. Reading your comment again I see you're not talking about children.

A Jehova's witnesses mother can't refuse blood transfusion to her child in Norway, right?

sciencekid said...

on the other hand... If the mom/ parents believe that "consuming" blood can lead her child to go to hell...
These parents are probably grieving over their injured child to begin with. Death, inevitably will enter their minds. Most parents would probably want their child to go to heaven. In a situation where death seems imminent to these parents, I can understand how they may think that avoiding blood transfusion is the best way to go. Of course this is not rational. These parents are trying to cope themselves.
Just thought I need to give the other side the benefit of the doubt...
By the way, some Jehova's witnesses are very knowledgable on blood substitute transfusion. Maybe offering that will make them feel better (obviously not for the pancytonemia).

Bongi said...

in the trauma setting, if the aorta had been nicked, no blood substitution product would have been good enough. blood is not good if you don't need it. but if you really need it, there is nothing better.

ladyk73 said...

I am a strong supporter of self determination, not guardian determination.

If it was a child on the table...I would give the blood. I would lie through my teeth and say I did not give it. Actually, if I was a social worker in the hospital, I would scrub up and hook the blood to the iv and take the hit myself.

I don't think parents have the right to kill their children.

I think...think....in NYS it might be child abuse to withhold medical treatment for the child due to religious matters.

Who the hell am I?

I remember one strange incident when I was the finance manager at a clinic and some weird thing where as the "right thing to do" was somewhat illegal or something.

I just told the NP..."she had management approval."

Little old me...

ladyk73 said...

Oh...but as a future social worker, I would have all of the paperwork and legal documents ready!

amanzimtoti said...

You know bongz, when i started reading this post I thought I'd agree with you whole heartedly as I've seen many Jehova's witnesses refuse blood and once even managed to convince one to take a blood transfusion (yey!). I've always believed that if an adult makes that choice, it's their own indaba, but that a child shouldn't have the decision imposed on it . But as I read this post (and Sid's) I realised (even before sciencekid's comment) that it's actually about self preservation (or rather 'soul' preservation).

Religious people will do what they feel they need to to get themselves (and their children) into heaven (or rather, to stay out of hell). These parents probably believe that it's better for their child to die and go to heaven than to damn their child's soul to hell. You and I may not believe this, but if they do, then it's probably more vital to them than anything else. If that is the choice they feel they have then I actually feel sorry for them.

TeacherLady said...

When does a situation such as this fall under the "child abuse" or "child neglect" categories? I've always wondered that...

Bongi said...

amanzimtoti (schweet name by the way) you have touched on an important point and that is belief. i semi-understand their belief that death is better than hell etc. but i felt my beliefs were being infringed upon. i believe it is not right to sit by and let someone die when i have the ability and means to save them. that is what that mother expected me to do. and she was flippant about it. it's all good and well taking her beliefs into account, but why doesn't she get someone with similar beliefs to do the operation then? it is not acceptable that she expect me to just stand by and let her child die. It was a gross violation of my belief system. this she didn't even consider she was so wrapped up in her selfish thoughts. she thought of noone but herself. i can't expect someone who doesn't even consider her own child to consider me i suppose.

but i digress. yes, conflicting belief systems is actually what this post is about.

amanzimtoti said...

But now you're touching on a dangerous topic - when your belief system and the patient's belief system clash, who's takes priority?

amanzimtoti said...

I'm not saying you should ever leave a child to die, what I am saying is that you'll never convince these parents that they're wrong because when something is rooted in someone's believe system, they will not waver. They believe there's more at stake. You and I would want to save their child's life. They would think they're saving their child's soul.

Anonymous said...

Our duty as doctors is to do the best for our patients at then end of the day, if our patients are too young / of unsafe mind to make that decision, it is our duty as health care professionals to do the best we can to save their lives.

If that means over-riding a parents belief system in sumtin that very mite well not even exist (god, heaven, hell)...then so be it.This child has not chosen his religion,it has been forced upon him/her.who says that this child may grow up to be an atheist/catholic/etc..?

in that situation i will def give the blood (even if that means been taken to court )...until sum1 can prove that heaven and hell exists...why risk an innocent childs life based on sumtin that very well mite just be a fairytale??

bean said...

Eh, do they believe they will go to hell if they are forced to take blood? If not, then the fact they refused is enough? and then we can give it over their objections (in case of children>) Seems too simple a solution.

Bongi said...

(mr) bean, that does seem a simple solution. but i think the belief has to do with the actual blood of another person being in you. the blood itself defiles you, i think. the act of refusing, although it may show good faith on their part, does not save you from the 'soul defiling' effect of the blood itself.

Cathy said...

This is a sad topic. Even if this were my religion, I know I could not with hold blood for my own child, who would die without it. I guess as a parent, I would allow it and then spend all the rest of my days asking God to take me to hell, and leave my child, who had nothing to do with the decision, alone.

Sid Schwab said...

It's among the most frustrating and difficult things we face. I wrote about it, too. Thankfully I was never in the position of having to give blood to save a life when it had been refused. But came close.

Medically Brunette said...

Its very troubling. For the ones that are meant to protect us, our parents will see us die. But their intentions are not evil...

I did read a book once where a child needed organs, it was against the parents beliefs and wishes. The doctor did it anyway. The parents killed the child(to save his soul).

Only a story, but I wonder without the legal protection how many would go that far?

Buckeye Surgeon said...

It's just mind boggling to listen to a parent assert unequivocally that they would refuse potentially life saving treatment for their own child. I just don't get it. I think in the US the law protects doctors from watching a kid die; I can give the damn blood if I need to.