Case
Bianca Lynn has been an inmate at the Greenville correctional facility for women for the past two months due to a parole violation. She has had several convictions for forging bad checks. Bianca has not been feeling well in the last few weeks. After vomiting twice last week, she was finally seen in the prison clinic. The prison doctor determined that she was approximately four months pregnant and that her uterus seemed small for dates. He sent Bianca for an ultrasound at a perinatal center located close to the prison. During the ultrasound, the perinatologist detected fetal heart abnormalities. He referred Bianca to you, the genetic counselor working at this perinatal center. You have a copy of the ultrasound results and Bianca’s prison medical record. The ultrasound showed the pregnancy is 21.5 weeks gestation but that fetal growth is delayed by approximately two weeks. There is also a large ventricular septal defect in the fetus. The prison record indicates that Bianca was intoxicated at the time of arrest and that she has a history of drug abuse.
Personal Reflections
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What is your first instinct in this situation?
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Have you ever been in a situation like this?
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What is your past experience working with patients who are prisoners?
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What do you know about the health care services in prison?
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Has anyone close to you been incarcerated?
- How do you feel about counseling this patient?
Perspectives
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What does Bianca know about genetic counseling? What has been Bianca's experience with counselors of any type?
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What benefits might Bianca derive from genetic counseling? How is Bianca's case different or similar to other cases of abnormal ultrasounds you have seen?
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How do you think Bianca will react to the news of the abnormal fetal heart development?
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What thoughts does this case evoke related to power? Authority? Directiveness/non-directiveness? Providing patient-centered care?
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As a prisoner, does Bianca have the same rights and options as other women carrying a fetus with a heart anomaly? Is terminating a pregnancy an option for a woman in prison?
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What emotions does Bianca demonstrate? How will you explore how she is feeling and coping?
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How will you assess if Bianca has any support?
