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269 14 PregnantWoman withaBrainHemorrhage A Case Story Mao Her, a forty-year-old woman who was thirteen weeks pregnant with her eleventh child, developed a severe headache after attending a funeral. Her husband, Toua Lee Her, massaged her head and did khawv koob, a healing ritual, which did not relieve her headache. Recognizing the seriousness of her condition, he prepared to do fiv yeem, a spiritual healing ritual that promised to make an offering to the gods of the four corners of the world in return for assistance with her headache. Before he could do the ritual, Mrs. Her suddenly lost vision in one eye, and vision in her other eye began to blur.Mrs.Her’s family called 911 for an ambulance to take her to the hospital. Her husband reported that once they were in the emergency department, they waited between thirty and sixty minutes before anyone looked at his wife. Finally he prevailed on a nurse to come look at her. The nurse noticed Mrs. Her’s unequal, nonreactive pupils and called a doctor. Mr. Her and his family were angry about the lack of prompt attention in the emergency department and the absence of a Hmong interpreter. They wondered whether they received poor and slow care because they were Hmong. A CT scan of Mrs. Her’s head revealed an intracerebral hemorrhage with a massive swelling that was putting pressure on the brainstem. The doctors showed the family the CT scan and recommended a cranial operation to release the pressure and remove the intracerebral blood clot. They predicted that without an operation, she would surely die, and with an operation, she would have only a 50 percent chance of living. Her husband and her husband’s male relatives (some of whom spoke English well, but none of whom had any medical training) listened to the doctors, considered their options, and decided to permit the operation, feeling that only “technology” could help her now. Once she was taken to the operating room, her husband called more of his family members and his wife’s brothers to tell them about her grave condition and their decision to allow the doctors to operate. The operation proceeded without complications .The neurosurgeons found no explanation for the cause of her hemorrhage; there was no evidence of an aneurysm, a tumor, or a vascular malformation, and she 270 End-of-Life Care had no hypertension or clotting disorder. They did send necrotic brain tissue to pathology for analysis. In the ICU Mrs. Her did not regain consciousness and continued to need mechanical ventilation. The next day a repeat CT scan showed a stroke in the opposite hemisphere from the hemorrhage. The physicians showed these findings to the family and explained her poor prognosis during the evening hours when an interpreter was not present. That night she became hypotensive and required medication to maintain her blood pressure. Her family wanted the “technology” to save her and did not refuse or contest any of the nurses’ or physicians’ actions. During her two-day hospitalization there were usually about 50 family members and friends in the visitor lounge and a steady stream of well-wishers to Mrs. Her’s bedside. The nurses repeatedly described the ICU policy of no more than two visitors at the bedside at a time. The family tried to comply with the nurses’ requests, but often ten or more visitors would cluster around Mrs. Her. An obstetrician did a fetal ultrasound that showed evidence of a pregnancy but no fetus. He surmised that either she had had a miscarriage or was less than seven weeks pregnant,and he ordered blood tests twenty-four hours apart to determine the viability of the pregnancy. Mr. Her was mystified by the ultrasound picture, as his wife had definitely been pregnant for more than three months and had had no signs of miscarriage . The family had several ideas about the possible causes of her illness. Her husband and others said she had been under a lot of stress. She had many family responsibilities in both her large nuclear and her extended family. Her teenage children were not being respectful to her; they were having trouble in school and were acting out. Also, she was pregnant again from a contraceptive failure and did not want to have another child; she already had had an abortion from a previous contraceptive failure. When she became pregnant this time, she and her husband had discussed their options, and rather...

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