April 6, 2011
In the wee hours of the morning, Patricia Garcia took her last breath and made her transition. Her death was not a total surprise, she had almost died before. Garcia was 39 years old and the mother of an 11-month old son name Josiah who had made his entrance three months earlier than expected because he had stopped growing in his mother’s womb. During her pregnancy, Garcia was concerned that she might die before Josiah was born because of her complications of having a stroke, obesity and failing kidneys. At barely 5 feet, Garcia weighed 261 pounds and was decidedly obese with a basal metabolic index (BMI) of over 40.
Obese pregnant women are plagued with almost every type of complication imaginable from miscarriages, higher rates of cesarean deliveries, birth defects, pre-eclampsia and sometimes death. Garcia received general anesthesia during the cesarean birth of Josiah. It would have been technically challenging to attempt to give her an epidural or spinal anesthesia. Because she was put to sleep, the surgical team had to move quickly to remove the baby so that it would not receive excessive amounts of the anesthetic. Garcia’s procedure was unfortunately prolonged by several minutes, again due to technical difficulties.
Obesity is a national epidemic with 26.7% of our population affected. Garcia was considered the smallest person in her family because her brother weighed 700 pounds prior to receiving a gastric bypass. Obese patients often face discrimination and humiliation from within the medical community. Diagnostic procedures have been cancelled when it is determined that the patient is over a certain BMI for fear that their equipment would not sustain the additional weight. Patient safety experts propose that “obesity centers” for pregnant women be established to provide nutritional counseling, emergency cesareans as necessary and neonatal intensive care units.
Garcia promised her physician that she’d lose weight after she was discharged home. She didn’t. Although Josiah is now more than a diminutive 1-pound-11 ounce baby, he is still very small and was recently diagnosed as having dwarfism. He will be raised by his sixty-something year old grandmother who is also taking care of Garcia’s mentally disabled brother. Obesity is not a benign disorder. Until Americans make better lifestyle choices, tragedies like Patricia Garcia’s will continue.
December 15, 2010
When a pregnant woman goes to work and ends up with a dead baby, something is terribly wrong. Lissedia Batista was a 27 year old Spanish teacher who taught at Exploration Academy in the Bronx and was sixteen weeks pregnant. Given today’s economy, I’m certain that Batista was grateful to have a job with the New York City Board of Education. As a native New Yorker I am keenly aware of how competitive it is to land such a position. Working for the Board of Education traditionally meant job security; a pension and a strong union that took care of its members.
Like many young teachers, Batista had compassion. She attempted to stop a fight between two male students, was pushed out of the way and subsequently fell to the floor. She was taken by ambulance to the hospital but unfortunately experienced a miscarriage. She refused to press charges against the students for fear that they would become incarcerated. Batista’s union, the United Federation of Teachers has called for an investigation; the Deputy Mayor offered condolences and condemnation but it still doesn’t change the facts – Batista’s baby is dead.
At some point in the future, Batista will draw the line and set limits as I did as a resident ob-gyn physician. I was on call one hot summer night and summoned to the Emergency Room at an ungodly hour of the morning. When I arrived, I encountered a woman who alleged she couldn’t remove a feminine hygiene product. Upon examination, I discovered that the product was already gone. The nurse had stepped out of the exam room leaving me alone with the patient. When I told the patient that her condition wasn’t exactly an emergency, she spat on me and attempted to provoke me into a physical altercation. One misguided action could have ended my career and possibly my life. The nurse returned to the exam room not a moment too soon. I had escaped bodily harm this time. The next time I might not be so lucky. I filed a formal complaint with my union and program director and refused to work in the emergency room again.
It was not Batista’s job to stop a student fight. Where was Security? Did teachers have a panic button? Our place of employment should not be hazardous to our health. Perhaps a legal consult is in order.