Sunday, June 6, 2010

Will You Die for a Cause, or Will You Live for It? Ectopic Pregnancy and Ideas about Honoring Life: Part I of III

A Response to the Invited Speaker List for Vision Forum’s 2010 Baby Conference

Note:  In the summer of 2008, Vision Form started a campaign to advance their idea that pre-emptive surgery for a woman with a tubal pregnancy constitutes murder of the unborn as an elective abortion.  Individuals who were outspoken or quoted in that discussion have been included as invited speakers at VF’s July Baby Conference (which will also host the famed Duggars of the TLC/Discovery Channel).  I believe that VF will use this vehicle to further advance what I find to be their very dangerous and distorted position concerning tubal pregnancy.

My Personal Perspective

I no longer work as a nurse in intensive care, but I did so for many years.  While my husband was still in graduate school and on a meager stipend, we lived in a very depressed community with a high indigent population in the heart of the Bible belt.  Even after 25 years of experience as a nurse, I have yet to see such physically sick, fragile people as I did in that town.  The hospital was at a medical school, and the medical director of the ICU where I worked piloted and tested experimental equipment in clinical trials.  Dying people were sent to us for enrollment in these trials as the last possible measures that might save their lives.  Between the poor health of the population we served and the numbers of people that were flown in from outside the state – from places like Baylor and big city hospitals in Dallas – we saw the sickest of the sick.  Doctors who could do no more for their dying patients would send them to us.  So my experiences there at this hospital are not typical, and I saw conditions and did procedures there that many critical care nurses only read about in books.  I saw the worst of the worst of the worst-case scenarios.  That must be noted.  But, regardless, I still saw them.  And we saw many good outcomes that I consider miraculous.  That definitely should also be noted.  But the bad outcomes haunt me still.

I didn’t work in obstetrics (OB), but we received so many OB cases while I worked there, the hospital decided to open their own OB ICU.  I even helped to train those nurses in the care of critical patients.  To some extent, a predictable number of things tend to happen to critically ill pregnant women, just because of the nature of things.  We generally saw hypertensive patients, commonly called toxemia.  And we saw some other more terrible things resulting from sepsis, infection in the blood stream, something that occurs with the peritonitis that follows a ruptured fallopian tube resulting from ectopic pregnancy.  We saw other pregnant women for other critical conditions, and I cared for patients and families as they worked through the decision-making process about what to do and what was ethically right to do.  These decisions do not come as light matters for either patient or doctor, and the outcomes are not always good, even when the most virtuous decisions are made.  Care is often delayed while people try to make the best decisions, and the women often suffer the consequences.  I recall vividly in images that I wish I could wipe from my mind of two different husbands, weeping at the foot of the bed of their wives who were comatose after valiant efforts were made to save their babies.  In both these cases, the babies died and the mothers would likely never regain consciousness.

Though I have fought with everything inside me to help save some of these OB patients and witnessed a couple of miraculous outcomes, I have also cared for a great many women who did not survive their pregnancies.  Sometimes, neither baby nor mother lived.  Some women suffered peritonitis.  Others chose to be valiant and Pro-Life by refusing surgery for conditions other than ectopic pregnancy, and I would have done the same as they did in many cases.  But in the case of those who refused surgery because of a tubal pregnancy, their unborn child had absolutely no chance of survival, and such deaths were not virtuous. 

We have no technology to enable us to remove a baby and placenta from a fallopian tube to place it on more suitable tissue so that the life that has already begun has the opportunity to grow normally.  There is just no way to do it.  Even if we could, the confinement created by the tube deprives the baby of nourishment to such a degree that those babies do not grow and are not healthy enough to survive such a procedure, even if one could be done.  When the baby’s tissue is examined after surgery (as is done with anything that is removed from the body during surgery), pathologists/histologists find that there is little to no placenta because it cannot develop normally.  The baby is not normal but is more often trophoblastic, something more like the tissue of a tumor because it was deprived of so much nourishment.  For other ectopic pregnancies, this is not always true, but the predominant number of all ectopics are tubal implantations.  There are TWO sets of rules and ethical considerations for these very different types of ectopic pregnancy.  Tubal pregnancies are different in terms of ethics.

Peritonitis and sepsis (infection that jumps from the pelvis into the blood stream in such cases) can be very deadly.  Severe peritonitis can have as high as a 30% mortality rate, even given the best available and possible medical intervention.  People who experience sepsis also face a 20-40% mortality rate.  Roughly, one out of every three people who gets this sick dies.  (And nurses count them, I can assure you.)  The bacteria produces toxins that cause deadly low blood pressure.  The infection alters the body’s ability to balance acids which drastically affects the heart and kidney.  The toxins can destroy the surface coating inside the lungs, making it nearly impossible to get oxygen into the blood.  (This is complicated when the pregnant woman also suffers pneumonia along with sepsis.)   Cellular debris from the bacteria itself can independently induce kidney failure.  More rarely, the sepsis causes a blood clotting disorder.  Small blood vessels clot causing strokes and tiny heart attacks while, at the same time, the patient is also bleeding to death from their uterine wall where the placenta was once attached.  (The mortality rate for this rarer condition ranges from 20 – 50%.)  I have seen all of these things happen to pregnant and post-partum women, and I have cared for them.  The final act of nursing care that I provided for most of these women was to wrap them in shrouds and place toe tags on them before they were taken to the morgue.  Yet I have another uncommon perspective about this as well.

When my husband first started working in post-mortem forensics as a toxicologist, we moved around a bit while he worked his way up into a lab director position.  We’ve lived in two states that had a high population of people who follow a cultic Evangelical Christian group called the “Church of the First Born.”  Like those in many circles of patriarchy today, this particular group sees home births as a religious rite, and they often refuse traditional medical care, particularly during pregnancy.  Good medical examiner offices preserve the dignity of decedents, and I have always been impressed by the great sense of holy honor that the profession shows in their care of the dead.  They are saddened and disturbed when they see people who have died who could have and should have lived instead.

It is often a hard job, and people often use humor to cope with this pain and grief that is not a show of disrespect but of frustration.  In some of these offices, because of the heartache of compassion that results from seeing otherwise healthy young women lying dead on cold metal tables in the morgue, this religious group was given the unofficial name of  “The Church of the Stillborn.”  It was not a show of disrespect for the dead but an expression of disdain over what was often a needless death, the ultimate price that was paid because some ideologue told them such measures were necessary as a show of their faith and convictions.  And there is my very devout Christian husband, feeling a flood of intense mixed emotion including a sense of shame over the behavior of some within Evangelical Christianity and the tragic results of that behavior.  The world and other Christians do not see this as virtue but as ignorance and needless death – a waste of God’s gift of life.  It was never an easy thing as he attended morning rounds, as the whole team gathered around each body to discuss each death and the circumstances of each soul, a precious and marvelous creation of God.  (I have asked him to consider writing more of his own perspective on this subject himself, something that I hope can become a new blog post at some point.)

Also of Interest:  No Longer Quivering’s Response to “The Baby Conference”