The Value Of A Medical Service: III

I returned to my office, one afternoon, to a phone message that a doctor whom I didn't know needed me immediately. An abortion at a local surgical center had serious complications. The patient was bleeding.

At the center, I saw an unconscious bleeding patient in shock on the surgical table. The OB-GYN explained that the procedure had been without incident until suddenly she bled from every orifice. He told me that the patient had been in excellent health prior to the procedure and that there was nothing else unusual about her case. We both knew that the situation had progressed beyond his skill level and that the patient was facing death.

She had experienced an amniotic fluid embolism resulting in disseminated intravascular coagulation ("IVC"), an uncommon complication of term deliveries and early termination of pregnancy. Sometimes IVC, in which blood abnormally clots throughout the vascular system, exhausting the body's supply of clotting factors, is self limited, but not in this case. There was no time to waste. Lab tests were quickly drawn, massive amounts of red cells and platelets provided by the American Red Cross were available and administered, and supportive intravenous fluids and medications were given. The patient's bleeding ended.

The OB-GYN and I had a few moments to talk. He now told me that the patient was a sixteen year old whose parents did not know she was having an abortion. He told me that she was a member of a religious group that did not approve of abortion or blood transfusion. He told me that she was a Medicaid patient.

I wrote my consultation note, decided that there would be no charge to the patient for the time I spent with her that afternoon, and after evidence that her vital signs were stable - that she was no longer at risk of bleeding to death - told the OB-GYN that I would be leaving but would remain available for emergent care. He told me he had a social engagement in a nearby city and asked if I would take over the patient. I told him that the patient was his responsibility and that he should cancel his social engagement.

I never heard from him or the patient again.