Sunday, June 08, 2008

Hold on

Clinic is a roller coaster.

In one room, you have a scrawny four-year old in full Spiderman regalia flexing his little biceps telling you to look at his muscles while awaiting you in another room is a social worker from children's services telling you that she needs to remove two children who are currently in the clinic from their father's custody and she wants your help.

NewFNP chooses the first room. She'll take a pass on the second. Alas, the second room chose her as well.

NewFNP has sympathy for people who have addiction problems. But it is hard to have sympathy for parents who cannot get it together to find help for sobriety while they are pregnant. When your newborn screens positive for cocaine, that is - frankly - bad. It's just bad. There is just nothing good about the fetus-cocaine combination. NewFNP received a phone call from the hospital letting her know that she would be seeing this baby for her newborn exam and that the children - the newborn and her 18-month old sister who shares a name with a slang term for marijuana - were in the custody of their father under the supervision of the department of children's services.

She was unprepared for the social worker to appear in clinic, to tell her that the dad's tox screen was positive for marijuana, and to tell her that she would be taking the children into protective custody after newFNP did her newborn exam. And, oh, by the way, would newFNP help her?

This is where newFNP is a huge spineless jellyfish. She has this frigging affliction of wanting to make life easier for others, all too frequently sacrificing her needs in the process. What she should have said is, "No way. NewFNP will do the exam, but you call the police and you do not put newFNP in the position of betraying her patient." But the social worker had already stated that she didn't want to call the police and escalate the situation, a point of view to which newFNP is not entirely unsympathetic.

So newFNP did the exam and - it pains newFNP to say - lied to the father and told him that she needed to re-weigh the six-pound baby to ensure accuracy. She exited the room, baby in hand, and deposited the newborn in the hands of social worker #2. She returned to the room, laden with guilt, with the social worker and the clinic manager. The social worker explained to the father why the children were entering temporary protective custody. As the shock wore off and the reality set it, this young man - covered in gang tattoos - wept. He cried. He hit the wall. He lifted his shirt to dry his eyes, revealing even more gang tattoos.

NewFNP knew that she was betraying the implicit trust of the provider-patient relationship the entire time she was participating in this shady operation and she felt appropriately guilty about it. But when she saw all of the tattoos, she, for the first time at work, actually felt scared. She has seen National Geographic Lockdown and she knows that one doesn't get initiated into a gang by knocking mailboxes over or kneeling behind your buddy while another friend pushes him and makes him fall. No, gang initiation generally involves a more illegal activity. Like killing. And the time when one's children are taken into protective custody is generally not the time when one is thinking clearly. NewFNP isn't given to paranoia, but she did feel like she had foolishly placed herself and her clinic in potential danger. She called the social worker the following day to talk with her about this, but she just got a voice mail.

NewFNP went for a beautiful bike ride in a nature preserve after work yesterday. It's all single trails and fire lanes and deserted bunkers and really, really, really long hills. Fun going down, not so much going up. She got to the top of the hill and stopped. She looked out over the ridiculously beautiful view below her and attempted to prevent her heart from exploding and the lactic acid from melting her quadriceps and thought, "I am so lucky. I love my life."

NewFNP is sure that she is overreacting and that this guy will do nothing to further jeopardize his custody of his children, who he quite clearly adores. But she will listen to her gut if she is ever in that shitty position again. The answer will be no. Sorry, but no. No, newFNP will not aide and abet. She will wait to do the exam until the police arrive, but she will not take a child off the exam table and away from her father ever, ever, ever again.


Bradley said...

Thank you for telling this story. Every time you share a clinical scenario that you learned from, all of your readers learn from it as well. Especially readers like me who one day may be in your situation.

npsusan said...

would it help if I pointed out that the newborn was your patient, not the dad. You did good for your patient by removing him from harm. It is up to the dad to get him back.

Anonymous said...

I agree with NP Susan. You are the patient's advocate. If things escalated while dad had the baby who knows if he would have tried to escape the clinic, baby in hand. You did what was right for the patient.

Anonymous said...

I'd also like to disagree with myself. Lemme preach to you what the freakin' book says from the comfort of my armchair.