Sunday, May 9, 2010

Can EHRs or Health Reform Fix This?

Some things just aren’t right. This one, this one is wrong on just so many levels.

Just after midnight today, very early Mother’s Day morning, I helped a first-time mom bring her too young son into the world. Within a very short period, I also helped her, along with this new mom's mom who had just become a first-time grandmom, deal with watching their brand new pride and joy die.

Too young and too small, at just over 21 weeks of gestation and an exact one pound birth weight, he stood no chance of remaining in our world beyond his birth day, Mother’s Day.

Wrong enough.

Before he was born, I assured mom and grandmom that he would be held for as long as it took for his final heart beat to occur. (It is amazing just how long such a tiny little muscle/organ can continue, far beyond any semblance of life or even blood flow.) I hoped they would want to hold him, but know better than to press the issue. As I have in before – fortunately, quite infrequently – I would hold their son/grandson if they were too overwhelmed or heartbroken.

The mother (at that moment, mother-to-be) was unable to even consider it and didn’t want to even see him. Thankfully, through an agonizing river of tears, mom’s mom said she would hold him.

He came quickly, with full, normal second trimester fetal development, some arm and leg movement, and a heartbeat. He was completely purple from the neck up with tissue paper skin. He was human, but somehow not. He was alive, but not fully. I suppose I’ll never know if he had awareness, on any level.

Within just a few (but exquisitely long) seconds, the only remaining semblance of life was the slowly fading, almost imperceptible tap-tap within his chest. The deep purple became all pervasive. There were no external movements as I finished wiping the blood and birth fluids away. I wrapped him and handed him to his grandmother, her tears almost a torrent.

During the next couple of hours, after his birth mom had been able to come to grips with her sorrow and decided to hold him which she did right up until I could hear his little heart no more family and friends, nurses and docs, all of us were moved in Mother’s Day ways we hadn’t could never have imagined.

The “Time of Death” was officially marked, the funeral home director was called, and the process of healing began for all of us.

Even when I was speaking to my obstetrical colleague and friend just before midnight as he told me the introduction to this Mother’s Day calamity, even as I was driving to the hospital wondering about the heart wrenching trauma to come, even as I walked away from this family I had never known and with whom I had shared one of their most intimate of family moments – through all these, I never once thought about charging for my services. I know it isn’t, but it just feels so, so very wrong.

But, as he had an official “Time of Birth,” he had to be officially admitted to the hospital. His departure was also an officially marked institutional moment. The hospital needed to bill for all they provided, sure. It just didn’t seem like I had to.

But, I remembered I am contracted with insurance companies. Those contracts state I am not allowed to charge anyone any differently (including, not at all) for any service. I am obligated to charge everyone I see just exactly the same for similarly provided services lest the payers fine me handsomely.

I am obligated to charge this family. Wrong. Just wrong.

They paid dearly enough this Mother’s Day.


From deep in the trenches...

"Sweet little flower of Heavenly birth, you were too fair to bloom on Earth." - Author Unknown


1 comment:

jeremytech said...

What a sad, heartbreaking, Mothers day. Thank you for being with that family. It is a duty beyond description.