Written by: Lynn E. Porter M.D., FACP

Trainees Hung Out to Dry – Inexperienced, Unequipped, and Undirected

Julie, a medical student on ob/gyn, loved seeing babies being born. She thought that it might be her specialty until something happened one day that changed her forever.

One afternoon, Julie and her resident were called to the ER. When they arrived, they saw Shirley, a gravely ill sixteen-year-old with low blood pressure, tachycardia, a 103 fever, a bloody, foul smelling vaginal discharge, and lower mid-abdominal pain/tenderness. Shirley denied knowing what had occurred. She was fine earlier but had rapidly declined.

The resident also noted an enlarged uterus, and tests were ordered, including cultures and an abdominal CT.

Together they talked to Shirley’s parents telling them that she was critically ill. They remained unnervingly calm saying God would prevail. They had no idea what had happened, but the word “vagina” made them noticeably uncomfortable and embarrassed.

Tests were reviewed, a diagnosis of septic abortion was made, and a treatment plan was developed with the attending physician who then left. Antibiotics were started and Shirley was admitted to ICU. Julie talked to Shirley who admitted to the abortion and begged Julie not to tell her parents afraid they would disown her.

An hour later, Shirley arrested and was unable to be resuscitated devastating the ICU team. The resident called the attending who told them to tell the family, making no effort to share that burden, guide them in breaking the news, or comfort the family.

Stunned by his response and feeling ill-equipped, they struggled to explain Shirley’s death to her parents. The resident revealed the abortion and subsequent infection. The father called his daughter a whore, pulled his wife to her feet, and they left, intensifying the horror of this drama . . . .

– How do we insure that attending physicians properly teach and support trainees when very difficult information must be relayed professionally and humanely to family members?
AND
– How can we insure that physicians fulfill their moral responsibilities to patients and to their families facing heartache?