One Doctor's Crusade Twenty Years Ago, Loretta Finnegan First Became Aware Of The Agony Faced By Addict Mothers And Their Babies. And She Set Out To Do Something About It.

Posted: November 19, 1989

It's not merely crack, Dr. Loretta P. Finnegan is trying to explain. That might make things easier, and nothing about what Finnegan does is easy.

"You have to understand, we don't have women coming in here just using one

drug; they're generally using three. Sometimes it's more," says Finnegan, shaking her nest of copper-colored hair. "The heroin users are also using Valium. A third of the methadone patients are also on cocaine. Fifty percent of the cocaine users are also smoking pot; an even larger percentage are using alcohol. And 96 percent of these women smoke nicotine."

Finnegan is not just speaking of drug users. She is speaking of pregnant

drug users, the women and their children whom she has helped for the last two decades lead happier, better lives. For her efforts, she received the MCP/ Gimbel Award last Thursday; it is given annually to a woman, usually from the Philadelphia area, for outstanding humanitarian achievements.

"I recently gave a seminar on the effects of drugs on infants," says Finnegan, director of Thomas Jefferson University Hospital's Family Center for

drug-dependent mothers and their infants, which she founded in 1976, "and it took seven hours because it took an hour to explain the horrible consequences of each drug. Each one separately is bad enough but when you combine them, it's like hemorrhaging."

The center now treats about 450 clients - all mothers - a year. The number treated depends on available funding.

When an addict has a baby, about everything that can go horribly wrong for the infant does: punishing physical disabilities, severe mental disabilities, tremors, seizures, heart disorders, sleep disorders, digestive problems, malnutrition, strokes, fevers, drug addiction.

Or the babies just die - either at birth, or during the first few months of their brutal little lives.

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Sometimes a great notion is born of one small incident, an event that others might easily dismiss in passing. Finnegan experienced one of those moments 20 years ago, and it simply altered her life.

She was then a young pediatrician at the old Philadelphia General Hospital, working in the intensive-care nursery, interested in infant respiratory problems. "We always had very sick babies," says Finnegan, 52, sitting in the Family Center's conference room. "Thirty percent of the mothers never had prenatal care. We would often deliver the babies and notice they had withdrawal symptoms from heroin. That was the drug then."

Finnegan suspected one woman in labor of being an addict. "Check her arms for track marks," someone told Finnegan, and, sure enough, the woman's skin was a mass of bruises and scars. "Two hours after the woman delivered, she was gone," Finnegan recalls. "I couldn't find her anywhere."

A veteran nurse shrugged and said, "She went out to get a fix."

This was beyond Finnegan's comprehension. How could anything be so powerful as to make a woman get up and leave her hours-old child? "Having children myself, I couldn't imagine getting up and leaving after two days, let alone two hours," Finnegan says.

That set Finnegan off. She then went to read all the available literature on the effects of the narcotic on infants. "There was absolutely nothing," she says.

She asked a physician if it was possible to take the then-novel approach of administering methadone to a pregnant heroin addict. He didn't see why not. The more Finnegan investigated and thought about the problem, the more she began to see drug-addicted mothers and their babies as a psychological and social problem, as well as a medical one.

And the addicted women kept coming in.

They kept having sick babies, babies who, in many instances, could be guaranteed a wretched life.

"I realized then and there that we couldn't start with the birth," Finnegan says, that care had to begin during pregnancy. It wasn't a baby problem, she realized, it was a family problem that most likely started with the mother's family.

TREMENDOUS ODDS

Yet for all her good work, the 100-hour weeks, the success stories of healthy mothers and children, the myriad lectures and research papers, Finnegan can do little in battling the overwhelming odds that her patients face, for the war on drugs has a frightening number of casualties:

* Seventy percent of all Family Center patients have been sexually abused before the age of 16.

* Eighty-three percent of these addicted women have at least one chemically dependent parent. Many have two.

* Seventy-five percent of those parents were alcoholic.

* Ninety-five percent of the patients are on public assistance.

* Sixty percent of Family Center's patients are former heroin addicts now on methadone; 40 percent use cocaine, for which there is no known medical antidote. A radical detoxification program is usually out of the question

because it can often induce premature labor or severely harm the infant.

Each year, more than 375,000 babies are born in the United States with some illegal substance in their bodies, according to the American Council for Drug Education, a private, nonprofit, Washington-area organization. That's one out of every 10 babies, and usually the illegal substance is crack. Through experience, the Family Center has learned that drug abuse is not a racial problem: On the average, 55 percent of the patients are white, 45 percent black, and 5 percent Hispanic.

HEALTH CARE IS NOT ENOUGH

Finnegan knows that good medical care alone is not enough to help these women and their children. "I quickly realized we had to offer these women a lot of services," she says. "They had to have perinatal care, a gynecologist-obstetrician. We needed neonatal care for the infant.

"For the psychosocial problems, we had to have social workers, psychologists and counselors. And then there were the addictive aspects of their condition. But it doesn't stop there. Many of these women have endocrine problems. Some have cancer. They have seizures, heart disorders, diabetes, asthma, poor diets. And dental problems. Some of these women have never been to the dentist." The Family Center's staff includes a clincial supervisor, four social workers who serve as counselors, a nurse, a pharmacist, a developmental psychologist, a financial assistant and two secretaries; for medical problems, patients are sent to specialists at Jefferson.

The litany of patients' troubles leaves Finnegan almost breathless, but it won't end. "Now, many of them are turning up HIV-positive (for AIDS-related diseases). And there are parenting issues. We're talking basic safety of the children, nutrition, proper child care. Some have never had a book read to them. They have to learn how to do that for their children.

"And there's vocational training. Most of these women don't have the resources to get a job, so many have dropped out of school. People are always saying, 'Why don't they get a job?' Well, they can barely make it from day to day. They get so upset trying just to survive, and now they've got a baby, some have several."

Finnegan pauses for a moment, and sighs. "And we have to provide follow-up care because you have to expect the women are going to (have a) relapse."

And people wonder why Finnegan is exhausted.

She has always been an overachiever. Her updated resume, printed in tiny type and without paragraph indentions, fills a page. She's done Donahue. She's a big talker on the local shows. These days, she's picking up awards at a steady clip. She saves every last one of her nametags from conferences, which now fill a plastic grocery bag. If she does something, she wants to do it well, and doesn't mind telling you about it. Shyness is not her problem.

Finnegan does everything in a big way - after all, she didn't have kids: She had KIDS, five in all - and tends to do things at Mach 3. If you ask her a question, she can take a half-hour to answer, going off in several directions, not all of them related to the subject.

She admits to practicing little medicine these days. She lives more the life of a busy executive, meeting with her staff, giving speeches, attending seminars, traveling incessantly. She clearly loves this.

"Let me give you the month of October," Finnegan says, her legs stretched out on a tufted leather sofa. "On Oct. 2, I went to Venezuela for seven days. On Oct. 12, I went to Athens, Greece, for another seven days," she says with a proud smile. "Two hours after getting off a plane, I had to speak to the Medical Society on Addictive Medicine. The following Monday I had to address a conference in New York City for 2 1/2 days. Then I had to go to Houston for a task force meeting on pregnancy and addiction. I came home for two days, then I had to fly to Boston, took a limo ride to Worcester, spoke to a perinatal organization, and then flew back."

And even on those constant plane rides, Finnegan doesn't waste a minute. She writes light, rhyming verse - "simplistic poems," she calls them - that she loves to have others read.

"I only get four or five hours of sleep a night. If I get six, it's a really good night," she says in the Family Center's rose-colored offices that are overwhelmed with posters, paintings and sculptures of women and babies. ''The problems of these women and their children are so immense. You have to work this hard. I do the work of 2 1/2, maybe three individuals."

She can keep these hours, she says, now that the children are grown. Mark, Matthew, Michael, Maureen and Martin are between the ages of 23 and 28: Three are doctors or in medical school; one son sells medical supplies; the youngest - the rebel against a life in hospitals and labs - is in law school. She is also the grandmother of twin 18-month-old boys.

It also helps, she admits, that she is now divorced. "My former husband, also a doctor, traded in the doctor wife for a younger nurse," Finnegan says, with a wry smile.

These days, "my workweeks are getting worse, longer. Of course, Jefferson is making it harder because they're closing the doors on 10th Street at 9 o'clock." That doesn't stop her: She just takes the work home.

Loretta Podolak - "a 100 percent Polish princess," she crows - grew up in Burlington, the only child of a meat cutter and "a great homemaker." First, she thought of being an actress. "I loved performing in the theater and was very musical. I played violin in the New Jersey all-state orchestra and clarinet in the New Jersey all-state band."

Later, she thought about becoming an artist "because I loved drawing and was quite artistic." Her father shook his head when she told him these dreams: "Loretta, an actress, an artist? How are you going to support yourself?"

Then, she says, "sometime around the age of 12, I decided I was a very fortunate girl who was smart and very good at school. I was good at art and music and good at sports. And I had these two absolutely wonderful parents."

So she decided, for all her good fortune, she should give something back to society. "I should do something to help other people. I should become a doctor," she says.

So she told her parents. "Loretta," her father said, "you're a girl. You should be a nurse or a teacher."

And she answered: "I don't want to do that. I want to give the orders."

And her mother said: "You should be a schoolteacher, that way you could have the summers off."

No, Loretta told her, "I'll be a teacher of doctors."

Eventually, her parents proved supportive, though they never understood why she had to move to the big city and work in busy hospitals. "Do you know that for years," Finnegan says, laughing, "they kept this plot of ground next to their house hoping that I would come back and open my office there?"

No, the Family Center was not what they had in mind.

There are some happy stories at the center. A former heroin addict who has a healthy child, finished her college degree and found a good-paying job. There is the mother of four who got off drugs, then made her husband come into the center to kick the stuff so she wouldn't be tempted. Now, he's working three jobs to help support the family.

Even though she is an optimist, Finnegan can do little to fight the numbers. Every few years brings a new horror: heroin, then crack, now AIDS.

"Motherhood is still the key issue. Most women see (themselves) getting a fresh start as a result of being pregnant. In a way, it's a good time to make a change," she says. "Every mother - every one of them - wants a healthy baby. I don't care who she is. Nobody wants a severely ill child."

This is what keeps her hopeful. Finnegan stresses every day in her work the power of motherhood, the strongest cure she has found so far in staving off the horrifying ravages of drugs.

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