When I was on the Medicine service 2 months back, we looked after a young 20-year old female, who was 14 weeks pregnant, and had end stage kidney disease, requiring dialysis. She was admitted because she did not attend her regular dialysis sessions, thus was becoming toxic from all the toxins that was accumulating in her.
We dialysed her while she was with us. However, the problem was finding a dialysis center for her to continue regular dialysis. The social worker and the kidney doctors worked hard to actively find her a dialysis center but she turned them all down. The reason? She had no transport to get to the center. Although her parents lived nearby, she refused to seek their help. Her boyfriend could drive her to the dialysis center but could not be depended on to do so on a regular basis due to his job.
Yes, she could have called for a cab to take her to the dialysis center, but she refused. She did not want to pay for the cab fare. It was in her opinion that someone (maybe the government?) should pay for her transport.
As a result, we couldn't discharge her as she did not have a regular dialysis session set up. Finally, she discharged herself against medical advice and said that she would find her own dialysis center. All we could do was hope and pray that she would come to her senses. If not for her own health, but for her unborn child.
2 months later, I am working in the emergency room, and guess who I see being wheeled through the ER doors. The same patient, but with one difference. She was being accompanied by her newborn baby girl, struggling in her incubator after being born prematurely at 22 weeks just 2 hours ago.
22 weeks! That is barely viable!
As expected, she continued to not attend her regular dialysis sessions, and as a result, went into premature labour. It pains me to see this outcome as even with modern medicine, a 22-week old premature baby (if she survives) will likely end up with lots of medical problems in the future.
It really boggles the mind how irresponsible some people can be.
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3 comments:
In this situation, who do you blame? The healthcare system for not providing transport? The dialysis centres for not being located nearby? The mother for being stupid? The schools for producing stupidity? The grandparents for reproducing?
While it is easy to say that the mother was being stupid, there is a reason why someone is stupid and it's not all genetics.
I said irresponsible, not stupid. There is a distinction between the two.
The healthcare system is already doing its job in *trying* to find her a dialysis center. She is being turned down by a few centers because she does not attend them. Is it fair for the centers to save her a place when she doesn't utilize them? Because of her allocated place, others are unable to use her slot, as such, they turn her away. One can argue that they are being unsympathetic but is it fair to others then, when she herself elect not to use what has been offered to her.
The dialysis center are not located in isolated locations. How nearby is nearby? 5 mins drive? 30 mins drive? 2 hours drive? Maybe the government should provide her with a home dialysis machine? Where does the buck stop? When should one start to take responsibility of their own health?
Irresponsibility and stupidity are often closely related.
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