Abandonado

Last night we admitted a patient with periorbital cellulitis - an infection of the skin and soft tissue around the eye.

Looks pretty uncomfortable but this two year old couldn't have cared less about not being able to open his left eye. Generally this infection is treatable with antibiotics but with the degree of swelling and the involvement of his right eye we thought it best to keep him in the hospital for IV antibiotics to make sure everything was being treated quickly and effectively. Hospitalizations are always hard on patients and their parents and this case was no exception. Around 10 am mom approached us at our work station and announced "Voy a abandonar" aka I'm leaving and taking my kid with me. 

While adult patients in the US are allowed to leave AMA (Against Medical Advice), it's relatively uncommon for us to have parents decide to take their children out of the hospital. This raises a number of issues given the fact that while the parents are the legal guardians and can make decisions for their child, children have a right to be protected from bad decision making on the part of their parents. In many cases all it takes is a good talk, involvement with social work and sometimes the patient resource manager before these issues get sorted out and we are all able to proceed with caring for the child in question. 

Here in Nicaragua, parents have the absolute right to remove their child from the hospital whenever they see fit. My co resident explained to me that this is actually very common. Almost every day when we are read the list of patients (who was admitted, who died, who was born), we are also told about how many "abandonados" there were. 

We explained to our patient's mother the serious nature of her son's infection and the possibility that it could affect his vision or spread to infect his brain. It's hard to have to explain these things in such blunt terms and it's even harder to do with a sobbing 17 year old mother. At the end of the day she decided to stay so he'll be getting good treatment and should get better soon :)