Wednesday, 20 October 2010

Loco Parentis

The door is opened by a middle aged woman, cigarette hanging off her lips, her attitude delighting us almost as much as the smoke in our faces.

"You take this bag, and I'll bring her out in a minute!" She dumps a pink hold-all in my surprised arms, and shuts the door almost completely, leaving us in the pouring rain. The inch of artificial light shining between the door and the frame means the gap is just wide enough for us to hear our patient and her cries of pain. Our requests to be allowed in to at least see and start to assess the patient are met with defiance.

"You stay out there. I don't want your muddy boots in my house. I told you she'll be down in a minute."

The tirade changes direction and is re-aimed at the patient.

"Come on already. They're here. And you make sure that you don't have any of that gas stuff they're gonna offer you. You don't need it!"

A minute or so later, Mina appears. 18-years-old and a week overdue with her first baby, she looks just about ready to pop. She has a look about her that's a mix of excitement and anticipation, as well as fear of the unknown.

We invite Mina into the back of the ambulance, and ask her whether she'd be more comfortable sitting on the chair or lying on the trolley. She chooses the chair, and as she sits down, another contraction begins. I write the exact time down on my glove, ready to time the frequency and length of each contraction.

Her pregnancy notes suggest that all has been well for the duration, that the health of mother and baby is satisfactory, and even, from just the day before, that the baby was head down and ready to be born. Her vital signs are normal, and contractions now two minutes apart. She seems to be at the stage of labour that makes most ambulance staff nervous about a BBA, a baby Born Before Arrival at hospital, and start to think about the mess they're going to have to clean up.

I offer Mina some entonox, the magic pain relieving gas. She takes the equipment in her hand, only for her mother to snatch it away.

"I told you, you don't need that rubbish. I never had any when you were born, and you're certainly not going to have any with your baby either!"

Mina looks downtrodden.

"I'm sorry", I say to her mother, "but you're not the patient in this case. If Mina decides she wants the gas, then she is more than welcome to use it".

"You. Are not. Her mother", she spits through gritted teeth, "And you're not going to make the decisions. She's MY daughter, MY responsibility, and it's MY decision!"

"You're absolutely right, it's not my decision. But it's not yours either. It's Mina's. She's old enough to make her own decisions. If she wants to use the entonox she uses it. I understand you're almost as anxious as she is, but right now you're not the patient. Mina, would you like the gas?"

She's terrified, struggling with the conflict between the pain she's in and her mother's overbearing presence. She nods an almost imperceptible "yes", and I hand her the entonox once again, just as another contraction starts.

"Well, if she keeps using the gas, then I'm not going with her to the hospital!"

Shocked looks are exchanged between Mina, her mother, and the crew.

"That's your choice! You decide! Yes gas, no mother!"

Another contraction starts, and I tell them both that we're leaving, as this baby wants to make an entrance, sooner rather than later. Mina screams with the contraction, takes another few lungs-full of entonox, and her mother storms out the back door and back into the house.

"You do it on your own then!" she screams, as she slams the door behind her.

Mina's resolute, and tells us to go, as her partner should be at the hospital within the hour anyway.

The transport is relatively uneventful, other than the contractions strengthening and becoming more frequent, causing us to move Mina onto the trolley. Just in case. We arrive at hospital, and Mina moves across onto the delivery suite's bed. As she does so, her waters break, and a baby's head appears.

"Stay with me", she begs the two of us. We do.

A minute later, her baby boy is born, and in loco parentis we witness her joy.

"Thank you, both of you. And don't worry about my mother. She'll be up here apologising soon enough. Stubborn cow that she is."

We congratulate Mina, refuse to have our photo taken with her and the baby, and head back to the ambulance to pack away the trolley.

As we sit back in the front completing the call, a car races into the car park, its driver rushes straight past us and into the department, begging to be allowed to see her daughter.


oneunder said...

Shame the car was not able to bring both, a bit earlier.

Anonymous said...

Agreed with the above comment. You've blogged before about being a taxi service, and I think that this is more about that than about being there for the new mother :) Dr Abuse :)

Anonymous said...

Whilst I would not want to go by ambulance, who would want to go with such a mother? A rock and a hard place.

Jeremy said...

I don't see this as using an ambulance as a taxi service. She had a medical emergency that needed to be attended to that wouldn't have been able to be held in the other car. What if the baby was BBA? What if there were complications?

InsomniacMedic said...

To be honest, this post wasn't really meant as a comment on whether this was appropriate use of the ambulance. For the record, in this case at least, I think it was. She was very close to delivery - so I see no reason not to call.
In any case - my question is - who do you listen to? Mother or daughter???