Before the quiz this afternoon (someone decided to spring a 40 question test on us when we were expecting a 10 question quiz; which is all of a piece, since we can’t even figure out who is evaluating us; clinical evaluations are 40% of our grades, and as far as we can guess, the chief residents, who barely recognize our existence, do the grading) – before the quiz there was an hour-long “ethics discussion,” led by my old friend the cheerful ethicist who is always surprised by my radical ideas.

We decided that the best case to discuss would be that of the 30wk baby delivered by emergency Csection after his 18yrold mother came in the ambulance with massive placental abruption (later supposed to be related to physical abuse by the patient’s own mother). The girl told the staff that she had named her baby after Satan (giving it a demonic name out of folklore); she also stated that she worshipped Satan, that Satan had congratulated her on the baby, and many other frightening things. The staff was especially alarmed because (as I just learned this afternoon) a few months ago another Satanist came in and had a stat Csection. Afterwards she was furious with the residents, saying Satan wanted her baby delivered vaginally; and she cursed the resident who had done the surgery. When the resident went home, she found her previously healthy dog dead on the floor.

So the “ethics discussion” wandered around the issue of how to tell when someone is psychotic, and when they are participating in a weird religion, and when does you being uncomfortable with the religion turn into, the religion is actually threatening the baby (mother was wanting to arrange some kind of ritual, which raised concern over the child’s safety). Although this without acknowledging that one religion is any more valid than another.

The nurses’ solution was to unilaterally decide that the baby was too sick in the NICU to see his mother, and to rename the baby Mark, to their own satisfaction. My solution was to suppose it quite possible for the girl to have given her self and her baby to Satan, and to have heard from him in return. So I prayed a rebuke against Satan for the mother and especially for the baby, who couldn’t have any choice in it, and for myself in being around them. I think that far more efficacious than social work consults, or discussions with chaplains who are forbidden to make absolute statements.

The second half of the ethics discussion was on abortion, inevitably. The professor cheerfully and firmly declared that the law says that the mother has the right to abort a pre-viable infant, but once it is viable, the mother is obliged to protect its life, to the extent that she can be forced into a Csection if it is thought to be medically necessary. I threw caution and discretion to the wind, and interrupted her to say that it’s ridiculous to say that personhood depends on the feelings of another person. If a woman wants, she can kill her 19wk old fetus; or she can come to the hospital in distress, and we will go to all lengths to help her maintain the pregnancy till the baby is viable. Does the worth of a 19wk old fetus depend purely on how the mother feels about it? When we were starting the quiz, one of the guys leaned over to me to whisper that he personally thinks it’s silly for personhood to depend on viability either; I was very encouraged that he would say that, as he usually tries to stay very distant from any controversy, especially those fringing on religion or politics. He is quite right. In the 1970s, a 35wk old fetus would barely have been viable. Today, they routinely go home after a few days, while we frequently save 28wk old babies, who would have been completely hopeless when Roe v Wade became law. Has the essential nature of a 28wk old fetus changed, in the last 30 years? It’s absurd. God grant me to see the day when we no longer accept the routine murder of helpless babies!

I had the greatest time in clinic this morning. A lady came in for a postpartum checkup, and her mother was there too, holding the little baby girl dressed in pink. By the time we got to see them, the grandmother was saying her arms ached from holding the baby, and she shouldn’t have left the car seat outside. So I got to hold the baby while the doctor did the exam. I love babies. Too bad the nurses in the nurseries are very protective, and act like all the doctors and medical students think of nothing but how to harm or kidnap “their” babies. I almost got in a fight with a tech, not even a nurse, this morning, about moving the babies for circumcision. Crazy.

So, I’m on call tonight, and so far there are no patients for the residents upstairs. It’s deadly boring.