The Gift

Every July, the newly minted second year residents in my training program inherited some patients from the residents who had left to go
into the real world. Among those I inherited was Maria Sanchez (not her real name). My first visit with Maria, a woman in her early thirties, was a pre-natal visit. She was 8 weeks along and was very excited. This would be her second child. As I reviewed her past history, I saw that she had had surgery to repair a large ventriculo-septal defect at about age 12. Despite having it repaired, she had persistent pulmonary hypertension – Eisenmenger’s symdrome. At this first visit she said she felt fine.

I had never heard of Eisenmenger’s syndrome. After learning the pathophysiology, I researched what effect it might have in pregnancy. I couldn’t believe my eyes. 50% maternal mortality at the time of - or shortly after - delivery! My heart sank. I got her previous delivery records and they made no mention of Eisenmenger’s. She had a normal delivery without intervention or problem. It looked like her doctors at another hospital dodged a bullet they didn’t even know existed. 50% mortality, and I was caring for pregnancy number two.

The next time I saw her in clinic, I performed her OB check, unsure if I could communicate the real potential for disaster she faced. I wanted to help prevent a bad thing but I wasn’t sure I could. I explained everything. Finally I told her the grim odds of dying while she had her baby. For the first and last time in my career, I said “You should consider an abortion.”

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Other Important Information

Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain (pdf)

Electronic Death Registration

Electronic Health Records: Case Study Analysis and Evaluation of Three Local Practices (pdf)

Principles of Medical Ethics and Opinions and Reports of the Judicial Council (pdf)

SCMS By-Laws, Approved March 12, 2008 (pdf)

Personnel Handbook - October, 2007 (pdf)

Guidelines on Retention of Medical Records (pdf)

WA State Dept. of Health Sanctions Guidelines (pdf)

"Dirt Under the Rug: The Canadian Health Care System Exposed," by Jeff Nacht, M.D. (pdf)

"Oh, Canada: Comparing single-payer health care with practice in the United States," by James C. Shaw, M.D. (pdf)

WA State Medical Association 2008 Business Plan (pdf)

© Spokane County Medical Society, 2008
Site updated by George McAlister