Simone, a 15 year old patient with sickle-cell anemia walked into the specialty clinic today. She was not yet due for a follow-up, but her condition had changed. She was now 2 months pregnant.
As I performed the history and physical, critical thoughts ran through my mind. "What was she thinking? Teenage mothers are already at increased risk for premature birth, hypertension, and low birth weight. The additional burden of sickle-cell anemia may prove fatal for mother or baby. How did this happen?" I worked hard to remain non-judgmental, and tried to focus my interview to pertinent health issues.
After discussing the situation with a colleague, I came away with a different point of view. I expressed my worries of the teen mother and child. He coyly asked me to remind him of the life expectancy of patients with SCA. Based on current statistics, most never reach the age of 50. I immediately realized my error.
Considering this young woman's life, she has most likely had several bitter tastes of mortality. Living with sickle-cell anemia has probably brought her to many emergency departments due to "pain crises"-- severe pain in her extremities, abdomen, and chest caused by the stiff, sharp edges of her red blood cells occluding her delicate capillaries. She may have developed gallstones in her short lifetime, and may already experience declining kidney function. The threats of blindness, heart attacks, and strokes remain with her. Young Simone will probably endure numerous surgeries to save her organs, with lengthened post-op recovery time.
As I began to delve more deeply into Simone's situation, the picture broadened. As a young black female in an urban southern city, chances are that she has known victims of violent crime. She may have buried classmates, neighbors, and relatives by this point. She is also most likely bombarded with images of mortality on a daily basis; bleak news reports of war casualties, drowning victims, suicide bombers, celebrity overdoses, murder-suicides, bizarre accidents can all take their toll. In fact, it is quite challenging to open a news web page without viewing an article involving death. Simone may feel the underlying need to experience as much life as possible before she passes on.
Perhaps this issue is not limited to young sickle-cell anemia patients. Perhaps the idea of impending mortality is pervasive among all young adults. Graphic media coverage of the Columbine shootings, the 9/11/01 attacks, Hurricane Katrina, the Haiti earthquake, Osama bin Laden's death emphasize the fragility of human life, and drive the urgency to live life to the fullest. Like Simone, young people may subconsciously strive to become adults prematurely and experience as much as possible, pressured by impending doom.
How can I best inspire these patients? Is there any way to infuse hope?
Death twitches my ear.
''Live,'' he says, ''for I am coming."
''Live,'' he says, ''for I am coming."
Hmm thats a tough one. I like the way that you think like a human and a doctor..:)
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