Did you know that urine pregnancy tests are routinely performed on all females before every surgery. No exceptions. The Children’s Hospital here in Buffalo, tests 9 years and above. Don’t know if a parent or a patient has a right to refuse the test, but I do know that the anesthesiologist will refuse to give anesthesia, except for a life-threatening emergency.
I have never paid much attention to these tests. The nurses let you know if there is a problem. I have never had such a “problem” with the “kids” in my practice. Well, not until last year.
Tonsillectomy planned. 16 year old young woman. Huge tonsils. Couldn’t swallow. Throat hurt all the time. We had our pre-op chat. I was all set to go. Or so I thought.
The head nurse pulled me aside and said, “Her urine was positive.” Amazed I said, “You mean she’s pregnant?”
“Yes, but she swears that she can’t be pregnant.”
More than a few epithets went through my mind, not making it past my lips. Suspended between the prohibition from sharing this with her parents and the need to tell them we couldn’t proceed, but not why, I went to work on this very unhappy teen.
On the verge of hysteria, she swore up and down she couldn’t be pregnant. “I have to have surgery today. Nothing else matters. I can’t swallow!”
Twice more we tested her urine. Twice more the pink line appeared. We even taxied a blood sample to the main hospital from the ambulatory surgery unit. It was positive, too. She was positive she wasn’t.
She was scared. Very scared. And when I asked she told me she was scared of her parents.
“They will kick me out of the house. My father will beat me. I have to have my tonsils out today. Please, I don’t care. I won’t go home until you do the surgery.”
Now I had to worry about possible child abuse. I conferred with the nurses again. Hours had passed. I hadn’t yet spoken to the parents. Interestingly they didn’t ask what was going on.
I escorted them into our small conference room. I sighed and said, “I am sorry for the delay, but we cannot do your daughter’s surgery today. “ Very surprised, they asked, “Why?” I told them their daughter would have to tell them why, as I was not allowed to discuss the situation with them without her permission. Dad, a nurse, figured it out right away.
All I could say was that she was very disappointed she couldn’t have the surgery. I also told them she was very scared of their reaction.
I let the nurses re-unite the family. By the time I changed from my scrubs, they had left.
“How did it go?”
“Oh, they walked out in silence and in tears.”
I thought about this family for many, many days. I didn’t call, though I really wanted to know if she was okay—both physically and emotionally.
I tried to imagine why she was so afraid to tell her parents she was pregnant. Was there child abuse? Was the home too strict? Not strict enough? Was there a similar instance in another relative where the punishment was unthinkable?
I don’t know the answers to those questions. Ask yourselves. What if you were in that position? What would be your response? I only hope my daughters would be able to tell me, and I hope my reaction would be helpful. It’s a very tough place to be.
My patient finally had her tonsillectomy. The family is in counseling. She is on mood stabilization medication. And I am still wondering, what has happened to the woman/child in our midst, your daughters and mine, who cannot trust their parents to take care of them without fear, when they get into a difficult situation? With all the “open” communication, sex education, and internet information, why are we failing them?
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7 Comments
What a tough situation. Kids tend to overstate in their minds the wrath of parents. Also disappointment, shame, embarrassment play a big role in the fear of openly sharing a senstive situation. Thus the reason behind runaways and suicides. Now in my 50’s I have only recently moved past the fear of my own mother’s reaction to many of my decisions in life. There isn’t another friend, acquintance, employers, mentor, who holds the same ability to cast a look of disapproval that can shatter our inner self.
Great lesson from a tender situation - what would I do with a 16 year old who was pregnant? I don’t know. I would hope that I would be sensitive toward her obvious fear and uncertainty. Whatever I would do wouldn’t remove the dread or that child owning up to the situation and having to deal with an obviously intimate detail of life (also hard to do at such a tender age).
Sometimes dealing with finances and travel schedules is overwelming - or so I thought - until I read your blog. I don’t think I will trade. Thanks for all the real life insight and perspective!
It was the hardest case I ever had to cancel. Thanks for the comment.
Did anyone ask this young woman if she had access to birth control or was she acting in ignorance?
It’s pretty clear that teaching abstinence doesn’t work. Recognizing that teens are going to be sexually active no matte what parent does or says requires the process includes access to birth control. Unfortunately, there are those running for office on a platform that would do just that: remove access to contraception for everyone, not just their own families.
Did anyone follow up with this kid about getting her contraception?
At the time this is happening, asking her about what she might have done to prevent this (i.e. contraception) would have been unhelpful to her. Her (and our) only focus was to help her get through this fear of telling her parents.
It was neither the time nor the place to explore her own thoughts and feelings which were very complex. These were not poor people. These were not uneducated people. I don’t recall if she came back on birth control. And if she had or hadn’t that wasn’t my business. You would be surprised at how many young women who are sexually active choose not to use birth control. And it isn’t about the lack of knowledge or availability of contraception. I think my experience with 35,000 families over my career has taught me that there are no easy answers and certainly one size does not fit all.
What a difficult situation to deal wth, but I think her denial reaction was very common for young girls. I deal with a lot of teens that would react with the same pervasive denial. Most go into the automatic PDT (Please don’t tell) story. They are so afraid of letting there parents down and can’t imagine having to tell them. Guilt overcomes them and they start imagining the worst when really after the shock most parents are very supportive and willing to help.
That is exactly what happened. thank you for your insights.
If the patient reported she was afraid her father would beat her, then the medical personnel had the Duty to Report to the state social services agency that the child believed she was in physical danger. The family should have been assigned a caseworker. Despite the difficult parent-teen relationships characteristic of many families with teens, medical staff should always be open to believing the truth behind any child’s words. And this young woman, though seemingly unwise in her failure to use contraception, was certainly old enough to have her autonomy respected. Furthermore, there was also the possibility that the pregnancy was the product of a rape which she was motivated to conceal, perhaps due to the identity of the perpetrator — father, uncle, mother’s “friend”, clergy, teacher? The most disturbing part of the story was the report that the teen was put on a mood stabilizer. Before any medication is prescribed, the family system must be respectfully examined and validated as non-contributory. Mental illness in parents is often expressed in destructive ways, including the assignment of the role of “patient” to a child. Family therapy at the outset works very well to identify and intervene in these cases of distorted intra-family dynamics. Ref. Satir, Virginia - Conjoint Family Therapy. The omission of this type of intervention is symptomatic of current health care policy which favors medication management over therapy because therapy takes too much practitioner time.