RATIONING AND DELUSIONS OF GRANDEUR

I just read a post at Kevin, MD by an “anonymous NICU nurse” suffering from a syndrome that occasionally appears in clinical types, an acute combination of naïveté and delusions of grandeur. The subject was the recent experience of Sarah Capewell:

Sarah Capewell gave birth to a baby son when she was 21 weeks and 5 days into her pregnancy. Her pleas to doctors and midwives to admit the newborn to a special care baby unit were rejected … if her son Jayden had been born two days later, at 22 weeks, they would have tried to help him.

NHS guidelines say a preemie is not to receive intensive care if it is ”below 22 weeks gestation.” This baby was breathing, but the bureaucratic guidelines say that’s irrelevant. Our anonymous nurse (and this is where the naïveté comes in) huffs:

Comparing not saving a 21 week fetus to rationing health care is a ludicrous argument. It has nothing to do with trying to save money.

Oh really? One would have to BE an infant to believe that the NHS apparatchiks who formulated the 22-week cutoff didn’t calculate the ROI associated with treating a 21-week preemie. Because they certainly did so, it is rationing plain and simple.

Now for the delusions of grandeur.  Our anonymous NICU nurse advises us that it was not merely OK to let the preemie die. She says that, by doing so, the NHS was actually doing the baby a favor: “Letting Jayden die was a Justice for Jayden.” On her own blog, she goes further

Because the majority of NICU nurses do not agree with the concept of resuscitating any infant born alive, no matter what the gestational age, this does not make us heartless baby killers.  It makes us realists.  It makes us compassionate.  It makes us heroes.

Here’s a clue for our nameless nurse. Whether it is right, medically or morally, to resuscitate a preemie IS NOT YOUR CALL. Neither the patients nor their parents give a rat’s ass about your pompous and solipsistic opinions. They just want you to do your damn job—provide medical care.

If I seem a little agitated about this, it is because my eldest daughter was a preemie. She is now a beautiful and healthy 28-year-old woman living happily ever after because her doctors and nurses didn’t (thank God) suffer the delusions that afflict this nurse. They just did their jobs.

Comments 4

  1. Sandy wrote:

    As a NICU nurse with decades of experience, her stance is not compassionate or heroic. I’ve seen the same heartwrenching consequences of continued aggressive efforts to save nonviable babies well after there is no hope for them. But that is a strawman argument and not the issue. THIS baby was never even given a chance. This little baby was breathing on his own, kicking and had a good heart beat… and was left to die.

    Every case is individual and no outside entity, or government guideline, can make good treatment decisions. It should be the decision of the baby’s parents and doctors. And not a nurse from halfway around the world with an agenda, either. Sadly, the reality is that NICUs and NICU nursing staff in UK are in short supply and underfunded by NHS, and costs were undeniably a factor in this case. The best answer to this story I’ve read came from a mother:

    http://newledger.com/2009/09/rationed-care-and-the-most-vulnerable-among-us/

    Posted 28 Sep 2009 at 7:12 am
  2. Catron wrote:

    Amen.

    Another point I neglected to make: At the 4 hospitals where I have worked (where I have known many nurses and nurse managers), I can tell you this person would get yanked off the floor in a NY minute if she espoused such views aloud.

    Posted 28 Sep 2009 at 8:30 am
  3. James Lansberry wrote:

    “If I seem a little agitated about this, it is because my eldest daughter was a preemie. She is now a beautiful and healthy 28-year-old woman living happily ever after because her doctors and nurses didn’t (thank God) suffer the delusions that afflict this nurse. They just did their jobs.”

    You’re more than within your rights to be agitated. I’m just as agitated and have never had my wife give birth to a preemie. Saving lives is what medical professionals are paid to do, not play God.

    Thanks for the post.

    Posted 28 Sep 2009 at 11:05 am
  4. Fourier wrote:

    Yes, and the NHS was so omnipotent that it could tell the exact date of conception.

    Posted 30 Sep 2009 at 12:36 pm

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