Every day I notice more and more how in medicine ethics is not just something you talk about-- I have to decide daily how to interact with patients and in situations that are tough and force me to decide where I stand on important issues.
Yesterday I told an 18-year-old she was pregnant. For her, this was not good news. She was completely shocked. She already has a 1-year-old, a little boy she feels she struggles to care for. Part of me wanted to scold her or say to her, "Well, that is what happens when you have sex outside of marriage." But when you have an 18-year-old crying in front of you, you realize that is not the place for scolding. Or judgment. Then the discussion begins on what to do. One of my attendings (a very nice, good teacher who is at church every week with us) believes that as doctors we should let a person know of all their options. ALL of them. Even the ones we are completely and morally opposed to. I, on the other hand, do not think that I should have to make referrals or even discuss something with a patient when I am so strongly opposed. At the same time, though, I want this patient to feel she can trust me, and want her to know I care about her.
What did I do? Well, first of all, I got our ultrasound machine and did an ultrasound. Thankfully, I could see the baby really well, along with a perfectly beating heart. I tried to mention the word adoption. I gave some phone numbers to several crisis pregnancy centers here in town. She brought up abortion. And I didn't know what to say. I just said that while that was legal, there were serious effects associated with it, both physically and mentally. I tried to mention adoption again. I'm praying that this week, as she has more time to think and talk with her mom, she will make a decision for life.
After tough encounters I always rerun through my mind all of what I said. I'm not sure I did the right thing or that all of what I said was helpful. I feel like maybe I pressured her too hard, too soon. I still feel completely overwhelmed at the thought of having another conversation like this, and still feel somewhat clueless about knowing how to say the right thing and use the right words to reach my patients. I realize more and more that I need the Holy Spirit to give me these words I need. I hope I am listening to him enough.