The Mother

The Mother

It was many years ago, and I was a second year resident in Internal Medicine. Our hospital was a large teaching hospital that often received transfers of sick patients from nearby smaller hospitals.

I was on call one night in late summer.  Our attending physician called me. He told me that he had accepted a transfer from a smaller hospital and the patient was being brought in to be admitted directly to our service.

She was a young woman in her early twenties, who was two months pregnant. She was also a type 1 diabetic with very erratic blood sugars. Getting pregnant had been a challenge for her because of her Diabetes. Once she did get pregnant, her sugars became ever more unstable.

On that fateful day, she had awakened, and saw her husband off to work. Soon after, her sugars dropped to very low levels and she went into a coma. Type 1 diabetics often have fluctuating blood sugars, but pregnancy makes this worse. Added to that is the pressure of keeping the sugars tightly controlled to prevent complications for the baby. Her husband came home several hours later to find her still in a coma and called Emergency Medical Services.

At the local hospital she could not be aroused and it was determined that her prolonged time with low sugars had damaged her brain. The medical term for this was hypoglycemic encephalopathy.

After she arrived at our hospital, she was admitted to the intermediate medical service (one step above a general bed), because her sugars were so difficult to control. I was given instructions to consult both Endocrinology and Gynecology when she got in.

She was petite and dark haired. She was unconscious and could not be aroused when she arrived. The Endocrinology fellow showed up that night to see her. Normally Endocrine fellows rarely have to come in on call, but this was no ordinary case. The fellow wrote very detailed orders on her. She was on an insulin drip along with a dextrose drip and sugars were to be checked every hour.

 The Gynecologists saw her and said that the baby was ok for now. I spoke to her husband, who was very concerned for his wife. He also told me that she had really wanted this baby.

Over the next few days, we struggled with controlling her sugars. Despite the close monitoring and the drips and the frequent labs, her blood sugars would swing wildly from one extreme to the next. The Endocrinologists would spend hours with her every day. The Gynecologists were concerned about the health of the baby.

We all came to the conclusion that continuing the pregnancy was risking the life of this young woman, who by the way was still in a coma. This led to a family conference, and I can never forget her husband saying to us; "Do what you have to, but please save her. I want my wife back".

An elective abortion was planned. On the morning this was scheduled, the Gynecology resident called and told me that they had to cancel the procedure. Apparently someone from the hospital staff had complained to the hospital ethics board that this was an inappropriate abortion.

For the next two days we struggled with controlling this woman's sugars, while the hospital ethics folks evaluated the situation. They finally gave the go ahead for the procedure and an elective abortion was done on her.

The effect on her sugars was dramatic, and they stabilized rapidly. A day later, she woke up and gradually started talking and eating. We were able to discharge her to a rehabilitation facility soon afterwards.

I have often thought of this young woman when I see the abortion debates today.  I think we did the right thing for this young lady, although there may be some that disagree. I hope that she is doing well today.