Monday, September 25, 2006

Too sad to think about

A note from one of our staff members. Most of us never have to think about such things. I hope it does not get you too upset:

"A small group of providers here performs above-and-beyond assistance to families that is little-known but beyond value. When a pregnancy fails and a baby dies in utero or is delivered stillborn here, clinical providers (MD's, nurses, social workers) strive to recognize the loss with the family, and to help them create mementoes of their baby. Almost always, the mementos that are most cherished by parents and famililes are photos of their infant. Our Media Services department staff go to Labor and Delivery and to the morgue to take professional quality black and white photos of these infants. Their skill, caring and attention to detail result in images that are often beautiful, despite the loss of life and occasional disfigurement, and are treasured by the bereaved families.

"When a family requests to see an infant after he or she has been transferred to the morgue, Pathology staff members locate and prepare the baby for viewing by the family. This is not a task listed in their job descriptions, and making this available to families means putting aside other pressing work, but they understand the importance of this last good-bye to some family members.

"Even for those providers whose clinical duties include exposure to neonatal death with some regularity, work with bereaved parents of infants is wrenching. Preparing the babies means handling them, and an inevitable confrontation with the tragedy of their deaths. These special efforts of the Media Services and Pathology staff are an extraordinary example of BIDMC employees giving of themselves for the benefit of our patients. "

6 comments:

Jonathan Hecht, MD (Pathology, BIDMC) said...

Thank you for the recognition of Pathology, we are often forgotten in this process because nursing and social work are more obvious participants in the grieving process.

As the chief of autopsy and the department’s specialist in perinatal and placental pathology, I want to also emphasize the importance of getting the parents’ consent for post-mortem exams.

Our reports often focus a continuing parent-doctor (OB/perinatology) conversation that helps parents to move forward from their tragedy. Not infrequently, our findings guide medical care in the next pregnancy. Even a negative examination can give reassurance that the parents can try again.

Paul said...

As our chief of Pathology likes to remind me, almost nothing can happen at a hospital without a strong pathology department. They study millions of samples per year -- from blood tests, to pap smears, to analysis of tissues removed during procedures -- and we all depend on them to be accurate and timely.

Also, as noted above, they perform autopsies that can be extremely helpful in many ways.

Patient Dave said...

Yes, this is too sad to think about. Thinking back to the birth of my (now grown) daughter, it's truly unthinkable to imagine being in that situation... yet I know it's all TOO thinkable (real) for so many people.

I've known people who went through this experience.

It's hard for us to remember, sometimes, that the people who help us in such times are just people who live in a neighborhood somewhere and have given (and continue to give) a big part of themselves to serve those of us in such immense moments of need.

One thing this blog is helping me do is be freshly aware to how much our health care workers give, and how much those contributions are appreciated.

margalit said...

Well, I beg to differ but this NEVER happened to me when I had a second trimester loss in your hospital. I was treated VERY poorly by a particular OB who is no longer a part of the BI (thank goodness) and I had to report him for negligence. I did not sue, but I had a good case. I was in your hospital for 5 days with a life threatening infection and this particular doctor never once came to see me. Not once. The female doctors on staff, who were residents but are now attendings, were wonderful, as was the nursing staff. But the male doctor. What a waste of an education.

I've never returned to the BI after that experience and I never will. Which kind of sucks for me because I do want to support a Jewish hospital, but my experience was so bad and I had such a negative miscarriage that I just can't return.

Paul said...

As I noted in my rules, I am not allowed to comment on a specific case, but I am of course sorry about your bad experience.

As a general matter, we are very upset when a patient has a bad experience: After all, we were created and exist solely to heal people and treat them well. But with 40,000 in-patients per year and an equal number of emergency room visits, things to go wrong from time to time, and there is an extensive internal review process when adverse events occur. There is also a legal requirement to report certain types of cases to the state DPH or Bureau of Registration in Medicine. Those agencies can also choose to do an independent review.

I have sat through many of the internal reviews of adverse event cases, and I can promise you that the doctors are as critical of one another's actions in these cases as are the patients and their families. It is part of their training. They know that the only way to improve over time is to conduct hard-hearted analyses and reviews of each other's mistakes. You would be impressed by the honesty in those sessions.

Sometimes, doctors make personal mistakes that are their fault and we prescribe retraining or otherremediation. Sometimes, they are disciplined severely, including loss of privileges in the hospital, or even loss of license. Sometimes, the mistake that occurs is not their fault, but is the result of system problems in the hospital. There, we work together to improve processes to reduce the chance of that happening again. Everyone is committed to a program of constant improvement.

Anonymous said...

margalit - I would like to say that I am sorry that you had a negative experience, as well.

As a member of the pathology department I can only say that I have worked with many conscientious clinical faculty members who take their patient care duties very seriously. For many physicians I know, for the vast majority, medicine is their life's work, in every sense of that phrase. I realize this is not necessarily a comfort to you, given your experience, but I wish you to know that your comment is a reminder to me that every aspect of a patient's experience at BI is important and our ultimate responsibility as care-givers. Thank you for that reminder and I wish you the very best for the future.

Madhu Dahiya, M.D.