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Fault Lines

Coerced by hospital administrators, a Christian nurse reels from the choices of a fateful hour

Twice in her life, Cathy DeCarlo has felt the foundations tremble. 

Twenty years ago, in her native Philippines, a 7.8 earthquake collapsed her high school around her. She watched, dazed, as emergency teams pulled other children from the rubble, and stared, fascinated, as doctors and nurses turned a playground into a medical triage, performing life-and-death procedures – even amputations – before her eyes.

It wasn’t the horror and terror of that day that stayed with Cathy, in the years to come. It was the swift, deft teamwork of the medical personnel. Marveling at their skills, at their uncanny ability to read a patient’s symptoms and respond in an instant, she knew to the deep places of her soul that this was what she wanted to do with her own life – serve side-by-side with fellow professionals in heroic efforts to save lives.

Sooner than she imagined, the dream came true. It carried her halfway around the world to find professional success and personal fulfillment beyond her fondest dreams. 

Until the day the teamwork failed her … and Cathy felt the earth move, again, shaking her to those same deep places of her soul.

Cathy grew up in the kind of small town where, as she says now, “It was hard to do anything bad because everybody knew you.”  Her tight-knit Catholic family was faithful to the church and fond of each other. Everyone took some hand in the family business, and it was generally assumed that one day Cathy would, too. 

Her parents, then, were dismayed to realize that their daughter wasn’t outgrowing the interest in medicine she brought home from the rubble of the earthquake that day. Still, if they didn’t exactly encourage her career goals, they didn’t stand in her way, either.

img--CathyDeCarlo-scarf-3-2 In college, many of her nursing professors came from the U.S. “I was exposed to such wonderful teachers from the states,” she remembers, “and I was so inspired.”  Later, working as an operating room nurse in Manila, she moved quickly beyond the simpler procedures to assisting with transplants and vascular surgeries. “It was a sink-or-swim thing,” she says. “I found out I have a knack for it. I liked it so much.”   

Cathy often worked alongside Americans who brought their technology as well as their expertise to the OR. “I saw how people from the States could save so many more lives with the equipment that they had, compared to what we had.”  She wanted to see if she could help save lives in the land where the professors she admired had come from. In 2001, an agency found her a job in New York City, and within three years, she was working as a surgical nurse at Manhattan’s prestigious Mount Sinai Medical Center.

From the beginning,” she says, “the people at Mount Sinai saw the potential in me. I did everything. Now I’m proficient in all surgeries. Not all nurses are fortunate enough to have this experience.”

“It’s such a caring community,” she says of the Mount Sinai staff.  “The doctors – I have such respect for them. They are unsung heroes sometimes. And I have seen the life-saving work these nurses do … the sacrifices that are made.

“I don’t think you go into medicine to make money. You go in first and foremost because you care about people. You give your whole life to the service. It’s a vocation, a calling.”

The staff was just as impressed with Cathy. Doctors and fellow nurses alike gave her consistently exemplary performance reviews, citing her outstanding skills in every operating room procedure, including specialized and very difficult surgeries. She soon became the “go-to” nurse to fill in for other nurses’ on-call shifts.

On one procedure, though, Cathy drew the line. 

“From the very start,” she says, “I told them that I don’t do abortions.” Cathy even filled out official forms, prior to her hiring, affirming that she would not assist with such procedures. To her, every life is sacred from conception, and every child is made in the image of God. Administrators expressed no concerns about that position, showing her written materials affirming their support for the conscience rights of their staff members.

"From the very start I told them that I don't do abortions."

For the next few years, life was good for Cathy. Her work felt challenging and fulfilling. She met a caring Christian man, married, and had a little boy. New management took over Mount Sinai, but the impact of that seemed minimal enough in her area. So Cathy’s world still revolved around serving patients and enjoying teamwork with her peers.

On Sunday, May 24, 2009, Cathy came on at 7 a.m. to fill an on-call shift over the Memorial Day weekend. She was told she was scheduled at 8 for a “D&C” (dilation and curettage), a common follow-up to miscarriages, with which Cathy often assisted.

She began preparing the OR, and the case cart arrived with instruments for the procedure. Cathy immediately recognized some of the instruments as the kind used in abortions. She looked again at the paperwork, then called the resident on duty, who confirmed that the surgeon would be dismembering and killing a 22-week old preborn child. 

Horrified, Cathy told the resident she didn’t do abortions, and asked the doctor not to send the woman to the operating room until another nurse could be found to assist the surgeon. That last part was critical – unless her managers authorized a substitute, they would compel Cathy to see the surgery through, once she came in contact with the patient.

She quickly called the nursing supervisor to remind her that she had permission from the hospital not to participate in abortions. The supervisor, in turn, said she’d have to contact her supervisor, and told Cathy to make preparations for another nurse to take her place. 

img-snowing-outside-SinaiBuildingCathy was stunned, minutes later, when the supervisor called back to say she would have to assist with the abortion, after all. In tears, Cathy reminded her again of her agreement with the hospital, pointing out that the surgery was labeled a Category II, meaning it could take place anytime over the next six hours – plenty of time to call in another nurse.

The supervisor refused – claiming this was an emergency, and the mother’s life hung in the balance. Time was too critical for anyone else to step in.

Cathy was aghast. The case wasn’t labeled an emergency. None of the medications required for emergency patients were listed on the chart. The patient wasn’t even being transferred with oxygen, as required in a life-or-death situation. Nothing told her this was anything but a procedure urged on by the woman’s doctor, timed to suit his convenience.

Nevertheless, the supervisor told her, the doctor was calling it an emergency, the administration considered it an emergency, and if Cathy refused to assist in what the hospital termed a life-and-death procedure, she would be charged with insubordination and abandoning her patient. In other words, her career would be over.

Requiring a devout, Catholic nurse to participate in a late-term abortion is illegal and violates her rights of conscience."

Cathy still hadn’t seen the patient. Despite all the evidence, her supervisor told her that she was to yield to the best judgment of the surgeon in charge. Perhaps there were circumstances she didn’t understand, or possibly something had just been left off of the chart.

But that wasn’t the case. The moment she saw the patient, Cathy knew the woman was not in severe physical distress. But it was too late. Contact had been established.  Cathy’s managers were allowing no substitutes.  If she didn’t finish out the procedure now, they’d made it clear she would be terminated and perhaps even lose her nursing license.

She never told the patient her concerns. A consummate professional, she made certain the woman had no idea her nurse had any qualms about helping abort the child in her womb.

Outside the room, though, just before the procedure, she encountered the surgeon, who had earlier expressed anger at Cathy’s reluctance. Now, he tried to assure her that the procedure was necessary and that he was doing what was best for both mother and child. 

“But you’re going to kill this child, anyway,” Cathy reminded him.

Once more, before bringing in the patient, she checked the O.R. to make sure everything was ready. The waiting anesthesiologist and scrub technician looked up in surprise.

Everybody knew Cathy didn’t do abortions.

As required, Cathy watched the doctor remove the bloody arms and legs of the child from its mother’s body with forceps. After surgery, she put the body parts in a specimen container, added saline, and took it to the specimen area.

“It was like a horror film,” she says. “All the blood on the doctor’s gown. I see that all the time – but I see life-saving things. That baby wasn’t taken out to save the mother’s life.

“Having a child myself, and having the protective instincts of a mother, I don’t think that mother even knew what she was doing to her child. 

“But I know the baby had a soul. You can tell me that I was forced into doing this, but that doesn’t remove the pain. I was a part of hurting that child.

Following an earthquake come the aftershocks.

Cathy spent the sleepless night after the surgery on the computer, affirming what she already knew: that a preborn baby can feel pain at 18 weeks – four weeks earlier than the child she’d seen killed that morning. Reading that, the agony of what she’d been a part of was joined by a new feeling – anger. 

She felt she had been lied to, and made to doubt her own professional judgment.   Her supervisors – nurses themselves – had forced her to go against the deepest convictions of her soul. She had asked for help, and they had coldly refused her.

And a hospital that had promised to honor her religious beliefs had chosen, instead, to brutally violate them.  “This must be what being raped feels like,” she thought.  

That night, Cathy found the Alliance Defense Fund website and contacted the ministry, asking for help. Two days later, Cathy filed formal complaints with both her supervisors and the nurses union. The hospital was quick to retaliate. 

The steady stream of calls for Cathy to take extra on-call shifts seemed to dwindle, overnight, to a trickle.  Her managers initially complied with their legal duty to meet with her to resolve the issue – but refused to let her bring an attorney.  A few weeks after the procedure, hospital administrators cornered Cathy, took her into an office, and locked the door – refusing to let her leave unless she signed an agreement to perform abortions. 

“ADF is my voice. When no one else would listen to me, they were there and stood up for me.”

Cathy refused. “Why do you need me to sign these statements?” she asked. She knew, by now, that other nurses felt the same way she did about helping with abortions.

“You’re the only one who’s complaining,” her supervisor said.

“That’s when I realized these other nurses are afraid to speak up,” Cathy says. “It’s hard to fight management. It must be easier to keep quiet and turn the other way and not say anything. Some of them don’t have a support system as strong as mine.”

She looked through tears at the people she had once considered colleagues, people she’d worked with to save so many lives. “These people have labeled me,” she realized. “They have stereotyped me. And now they just want me to shut up.”

Cathy got out without signing the document, but the administrators’ actions only confirmed for her that she was right in enlisting the help of the Alliance Defense Fund. 

“There were a lot of organizations,” she says, “but ADF stood out because I saw the testimonials that said they are an organization that looks out for people like me who have no voice.”  Cathy’s case is now on appeal to a federal court.

“For Cathy, this is about betrayal,” says ADF Legal Counsel Matt Bowman.  “There’s an anger, but it’s not self-righteous.  It’s selfless – it’s about integrity.  She’s been treated with contempt by her fellow professionals.  Federal law requires that employers who receive funding from tax dollars must not compel employees to violate their sincerely held religious beliefs, but this nurse’s objections fell on deaf ears.”

“ADF is my voice,” Cathy says.  “When no one else would listen to me, they were there and stood up for me. And now they’re not just my voice – they’re a voice for the other nurses and doctors who are too scared to say something.”

Despite the ongoing lawsuit, Cathy continues to work at Mount Sinai. But she works, and she will always work, in the shadow of what happened that May morning. 

“Even now, to feel this pain after so many months – some say it’s abnormal. But I think it is normal. Nurses have come to me, telling me that [until this incident], they didn’t know they could refuse to do an abortion. They say, ‘I still remember the child – it gives me nightmares. They just don’t realize it affects us … how it affects you as a human being.’”

Down to the deep, deep places of the soul. 

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