Here's the first segment.
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Sunday, July 26, 1998
SUNDAY REPORT
A Baby's Death, A Town's Pain
Dr. Eugene Turner decided to end the suffering of a baby on
the edge of
life. What a beloved pediatrician did has split a Washington
state community
and raised questions about how far a doctor should go for the
sake of mercy.
By BARRY SIEGEL, Times Staff Writer
ORT ANGELES, Wash.--Monday, Jan. 12, unfolded for
Dr. Eugene Turner as did most of his days.
Between 8 a.m.
and 5 p.m., he saw a stream of patients at the
Peninsula Children's
Clinic here on the northern edge of Olympic National
Park. All left
feeling safe and cared for. So did their parents.
Turner, a
pediatrician who'd practiced in Port Angeles for 27
years, had that
effect.
With his tear-shaped eyes and white thinning
hair and craggy
features, the 62-year-old doctor conveyed boundless
concern.
Fifteen minutes alone with him left you feeling you
were the only
person in his world. He spoke in an animated but soft
way. He was
excitable but easygoing. He was passionate but didn't
roll over
people like a freight train.
Above all, Turner talked directly to the kids,
not at them, not
over them, not through their parents. They trusted
him. When
grown, many returned with their own toddlers. Some
put Turner on
school consent forms as the person to call in
emergencies. One
wanted to list Turner as the person to decide when to
pull the plug if
he fell gravely ill.
Turner's day at the
clinic ended shortly before
dark on Jan. 12. It was
unusually cold. Ice had
formed on one of the
ponds at the local park.
Turner, who served as
''foster grandfather'' to
disadvantaged and
disabled youths, had
planned to take a
14-year-old boy ice-skating after work.
Snow had started to fall, though. It was Port
Angeles' first and
only snowstorm of the year. Roads were slippery, cars
were
spinning out. Turner's wife, Norma, called to say she
thought
ice-skating was probably not a good idea.
Turner reluctantly agreed. He came home instead.
He was on
call that evening--''second call,'' actually, as
backup for a pediatric
resident--so he and Norma ate dinner at the house.
They never
went out on such evenings.
Near 8:30 p.m., the phone rang. It was an urgent
summons to
the Olympic Memorial Hospital's emergency room--a
3-day-old
infant had stopped breathing while nursing. Conor
McInnerney, one
of Turner's own patients.
Turner put down the phone. The snowstorm had
deepened now.
Furious, wind-whipped flakes obscured the sky. Turner
reached for
his jacket and headed for the door.
What followed that
night in Olympic Memorial
Hospital's emergency
room is not a matter of
much dispute. It's
what to
make of those events that
has so roiled and
polarized this small,
insular
community.
Did Gene Turner, as
always, do the best he
could, the best for the
baby, the best for
everyone? Or did Turner
make a mistake, as any man might, as any man has? Or
did Turner
intentionally hasten the death of Conor?
To answer such questions requires weighing
intimately personal
judgments, sorting through imprecise definitions of
brain death,
imagining another man's intent and thoughts. Yet this
much can be
said with certainty: Near midnight, in a private
treatment room in the
hospital's ER, Dr. Eugene Turner gently pinched
Conor's nose shut,
covered his mouth, and stopped forever his faint
gasping breath.
By this act, Turner has thrown the Port Angeles
region into an
anguished debate over the meaning of futility and the
ethics of
euthanasia. He has done even more: He has threatened
the very
assumptions by which his community lives.
One of those assumptions is that Turner is a
good man, a saintly
man, a man worthy of their trust and love. It is not
an assumption
many here are willing--or able--to relinquish. With
each new
revelation in the local newspaper, with each new
menacing
comment from the police or county prosecuting
attorney, Turner's
supporters rally with greater fervor to his defense.
They denounce
the Peninsula Daily News for ''sensationalism,'' the
prosecutor for a
''political vendetta.''
There is no unanimity, though. A good number on
the peninsula
now condemn Turner with equal vigor, protesting the
''elitism'' and
''arrogance'' of one willing to ''play God.'' So a
letter to the editor
from one camp inevitably draws responses from the
other. Lines
have been drawn; neighbors across fences are either
at odds or
bound together in isolating certainty. The Port Angeles
region--18,000 in the town, about 40,000 across the
north
peninsula--has fractured. The divisions promise to
continue, as both
a prosecutor and a state medical board struggle to
assign their
particular meaning to the events of Jan. 12.
To those who know Gene Turner, none of the
arguments and
judgments matters. Their stance reflects not a
verdict on medical
ethics but an unwavering demonstration of belief.
''None of us were there in the hospital ER,''
says Patti Filion,
who watched Turner care for her son during a losing
seven-year
battle with leukemia. ''But whatever he did, I would
trust the man's
judgment on anything. You must have faith in
something.''
Paramedics Find Pulseless Newborn
It was just past 7:30 p.m. when Michelle
McInnerney, holding
her nursing infant to her chest, looked down and
realized he had
stopped breathing. Her husband, Marty, dialed 911. The
paramedics, arriving within minutes, found a
pulseless newborn.
They inserted a breathing tube and performed CPR on
Conor en
route to the hospital, but when they reached Olympic
Memorial, the
baby still had no heartbeat. It was about 8 p.m.;
Conor had been
without breath or pulse for about 20 minutes. He was
flaccid; his
pupils were fixed and dilated. To one nurse then he
looked ''dead,
blue, poor color.''
Yet efforts to revive Conor continued. A ''full
code'' team
assembled. An IV was inserted in Conor's arm. Cardiac
drugs were
administered. Ten more pulseless minutes passed.
Finally, 39
minutes after the initial call to 911, Conor's heart
began to beat.
The baby still could not breathe on his own.
Conor remained on
life support, being ''bagged'' constantly by a
hand-squeezed manual
respirator that forces air into the lungs. Yet he had
a satisfactory
level of oxygen in his blood; he was ''pinking up.''
He also had good
blood pressure. Conor most likely was clinging to an
uncertain,
nearly incalculable edge of life that perplexes even
the most
experienced neonatologists.
At 8:50 p.m., Turner arrived in the ER. Conor
was signed out to
him.
Under normal circumstances, there would have
been little for
Turner to do. Because Olympic Memorial lacks the
equipment and
specialized personnel to handle extremely ill infants
such as Conor,
its protocol is to stabilize them, then airlift them
to Children's
Hospital in Seattle. The snowstorm was still blowing
though; all
aircraft had been grounded.
So Conor remained in Turner's care. It was
hectic in the ER just
then: Snowbound families were milling about; one
patient was
suffering a heart attack; a woman with an ectopic
pregnancy had a
Fallopian rupture. Turner's presence in such a
situation was greatly
valued, both by the baby's parents and hospital
personnel.
Turner was a former chief of staff at the
hospital. Others at
Olympic Memorial regarded him as a steadying force.
When Tom
Stegbauer, the hospital's administrator, pulled
together a group to
consider significant medical or ethical issues,
Turner was always on
it. Turner told them what was right to do.
There are neonatologists who would have gone
through the
motions, then quickly given up on a newborn who'd
been without
breath for 39 minutes. Yet Turner continued to labor
over Conor,
with help from the hospital staff. More than 40
minutes passed.
They couldn't get the baby to breathe on his own.
Conor still was
flaccid, still had fixed dilated pupils.
His parents met with Turner. At best, Conor has
massive brain
damage, they recall the doctor saying. At worst, he's
already gone.
By ''gone,'' Turner would have meant brain-dead,
which is
defined as the irreversible cessation of all brain
function, including
the brain stem. Yet there's no certain, accepted,
validated way of
diagnosing brain death in infants under 7 days. The
usual criteria and
guidelines, including measuring brain waves with an
electroencephalogram (EEG), which Olympic Memorial
didn't have,
just don't apply to babies that young. Even the most
knowledgeable
specialists find newborns difficult to evaluate after
insults to the
brain. They can find it hard simply to tell whether a
3-day-old is
dead or alive. Turner's bedside judgment would have
derived not
from an instrument reading or fixed criteria but from
his general
knowledge and experience.
Conor still had fairly good blood pressure and
pulse. Some
doctors might keep trying in such a situation, but
others would, as
one neonatologist put it, ''let the baby go to
heaven.'' After all, even
an anencephalic, born with nothing more than a primitive
brain-stem, could have good pressure and pulse. Such
signs do not
by themselves reflect a viable being. After five
minutes with no
detectable pulse in a baby such as Conor, it's known
you have
significant brain damage. After 20 minutes, chances
of survival are
virtually nil. Conor had been down for nearly twice
that long.
It was 9:45 p.m. The situation, the McInnerneys
recall Turner
saying, was dismal. The part of Conor's brain that
controls
respiration is no longer functioning. Conor can't
breathe on his own.
The parents sobbed. They were barely adults
themselves.
Michelle was 20, Marty 22. They'd met the previous
March and
married in August. She'd quit her job at a print shop
before Conor
was born; he was an unemployed construction worker
with a bad
knee and a GED degree. They lived on public
assistance, about
$400 a month.
Michelle stroked her baby's feet. ''Come on,
Conor,'' she
begged. ''Wake up, Conor. Open your eyes.''
Soon after, the parents agreed to cease advanced
life-support
measures. A chaplain was summoned; the baby was
baptized. Then
the hospital staff ''called the code.'' Taken off all
life support, Conor
appeared to have neither breath nor pulse.
Nurses wrapped the baby in a blanket and gave
him to his
parents. ''We will miss you,'' they cried. In their
arms Conor was
pronounced dead at 9:54 p.m. A nurse put the infant
back on a
warming cart, with the intent to later prepare the
body for the
morgue. The parents and medical staff left the room.
Minutes later, at 10:06, an Airlift Northwest
dispatcher called
Olympic Memorial. The weather had cleared, he
reported. Did they
still want that baby airlifted to Seattle?
No they didn't, he was advised. The baby had died.
Had it, though?
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CONTINUED IN THE NEXT MESSAGE