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Rachel’s story, Isaac’s story and ethics

Ethics has always come up in health care, but in the past it has not seemed as complicated to me as it has become of late.

I would like to tell you the stories of Rachel and Isaac.

Rachel arrived at an hour old, I calculated her gestation to be 35-36weeks with a weight of 1.52KG. She was born in a hospital but they have no neonatal facilities. Born pale, floppy and not-crying, she was resuscitated and then transferred to us. When I was called to come and see her she was in her mothers arms, pale and cold, not breathing, heart rate low. With the help of our visiting student doctor I resuscitated her with bagging and cardiac massage and put her on oxygen in an incubator. Her temperature rose well, her heart rate was good and strong, blood sugar was fine, but her breathing was still laboured, she continued to grunt.

After an hour her oxygen saturation began to drop and, despite increasing oxygen, it continued to drop, then her heart rate began to drop too. I recommenced CPR and, after 20 minutes of effort, finally brought her back to a point of stability, but I could no longer ignore the issue I faced.

Rachel's condition of respiratory distress leading to respiratory failure was going to kill her. The only way I could possibly prevent this would be to provide respiratory support in the form of CPAP as oxygen therapy was obviously not enough. We have one CPAP machine and Maureen is on it. Maureen is a tiny premature baby who has been with us for a week, she is fragile but doing well. To remove Maureen from the CPAP would mean her death, but to not give it to Rachel would be her death.

How do you choose who dies? from an emotional perspective? from a logical perspective? When both choices seem wrong, what is the right choice?

 

Isaac has been with us for a week now. When he arrived he was five days old. Born at home premature, his family believed he would die so kept him at home, they fed him a tablespoon of expressed breast milk twice a day but otherwise left him to die. After 5 days he was still alive, so they brought him to us.

The fact that Isaac was alive when he arrived was a miracle in its self. He was cold and weak and had respiratory distress. On top of this he had a severe umbilical infection, abdominal hernia, distended loopy abdomen and a loud heart murmur. His facial features were abnormal indicating the presence of a chromosomal abnormality. I was certain that Isaac would die in his first day with us, but he defeated the odds,  survived and stabilised. He is now stable, his infection settled. He still required 1.5L of oxygen and is tube fed. On assessing Isaac I have found that while he has some natural reflexes, his moro (startle) reflex is weak and he has no suck reflex. His pupils also do not react as I would expect them to. I suspect he may have brain damage.

Isaac has been unable to cope without oxygen, he is feeding through a nasal gastric tube as he cannot suck feed. If we can wean him off oxygen he can go home tube feeding but without health care readily available for severe disabilities he will likely die in the months ahead. If we cannot wean him off oxygen he will be unable to survive outside of our medical centre.

In God's eyes all life is precious, no matter the age, condition, ethnicity or context. Both Rachel and Isaac are precious in his eyes.

As much as these decisions torture me, I think God would be glad they are torturing me because it means that Rachel and Isaac are precious in my eyes too. The day these decisions become easy is the day I should walk away, because then I will no longer care.

God give me the strength to do everything that I can, the wisdom to make the decisions that I must and the comfort of your love to cope with the consequences.