On a busy day in the office, a patient was added into my schedule for “bleeding, early pregnancy.” She was one of my partner’s patients, but he was not in the office that day. We talked for a minute, then I examined her and did an ultrasound. As I expected, she was in the process of a miscarriage. Unfortunately, I, who wasn’t her regular doctor, had to give her this news. We discussed the option of a D&C or letting nature take its course. She was unsure and wanted time to decide. After we talked, I left the room for her to dress and check out. About a month later, I received a letter from her describing how insensitive I was, and in that awful moment for her, I did not care for her emotional needs. She suggested even just a small gesture of offering her a quiet place to call her husband or walking her to the check out would have been helpful. It hit me to the core. I was embarrassed. I thought I was a more sensitive person than that, but she was right, I missed the opportunity to comfort her in her moment of need. Thank goodness for her courage and honesty, even despite her pain, to send me this note. She opened my eyes to my impact and how I needed to change, to be more empathic and aware of my patients’ needs especially in the midst of a crisis. Despite working in a busy office, taking an extra moment with her would not have impacted my other patients, but it would have made a world a difference to her.
I had two miscarriages between the birth of my two children. I diagnosed both myself, although irrationally, I refused to accept each. A little over a year after my first daughter was born, I was pregnant again. A couple days before my 8-week visit, I sneaked into the ultrasound room and took a quick look for fun. I didn’t see a normal fetus… I should have, but I didn’t. I convinced myself that I just didn’t see clearly and there wasn’t a problem. I didn’t tell anyone, just waited for my appointment. I came to my OB’s office with my 15-month-old daughter, and watched as my ultrasound showed what I hadn’t been willing accept before: there was no heartbeat. The tears began to flow. Because I was leaving for California in a couple days to help my sister, my OB scheduled a D&C for the next day. Twenty four hours after the D&C, I was on an airplane with my daughter, going to San Francisco, with no time to process anything. Those around me, including my husband, assumed I was okay; I was an OB and understood miscarriages after all. During that time, I ignored the daily bloody reminder on my pads of a life lost, and focused on my sister’s needs. For that moment, it was a good distraction. But, returning to work after my trip, seeing pregnant women daily, it was much tougher to ignore my loss. So instead, I became numb and moved on.
Within a few months, I was pregnant again. I made it to my 8-week visit, saw a nice strong heartbeat on the ultrasound, and sighed with relief. This was a good sign. I also had my usual pregnancy symptoms, mainly this terrible taste in my mouth and craving greasy food. During my previous pregnancy, those symptoms disappeared pretty early on. So again, a couple weeks later, I sneaked a peak with the ultrasound, and again it didn’t look right. In my crazy pregnant state, I felt embarrassed for some reason, like I probably didn’t do the ultrasound right and didn’t want to tell anyone that I thought I was going to miscarry again. So I carried around my irrational thoughts for another week, until my next appointment. There I was again, in the dark ultrasound room, my daughter in a stroller next to me, the fetus on the screen too small and with no heartbeat. After I got dressed, my OB met me in her office and my tears were just pouring down my face. Not again. It was the day before the holiest Jewish holiday of the year, Yom Kippur. She scheduled the D&C on Yom Kippur, and I didn’t care about missing the holiday; I just wanted it done. I remember calling my husband from my doctor’s office and saying something like “you are probably relieved, you didn’t want this pregnancy anyway.” What a horrible thing to say. I was angry, hurt, and sad. I just wanted to lash out at someone in that moment.
I returned to work immediately, only taking one day off. I needed to be immersed in a regular routine to distract myself. I needed my daughter to have her regular routine to keep life “normal” for her. But I couldn’t turn off my irrational ruminations. I just knew it was my fault, that I was being punished for my past mistakes, that I did not deserve to be pregnant again. When others asked, I would say, “yes, I know, miscarriages are more common at my age. Yes, I know miscarriages happen because cells don’t divide right. Yes, I know there was nothing I could do to that would have made a difference, that it was not my fault. Yes, it was meant to be, the baby would not have been normal anyway.” All the things I have said to patients to try to comfort them. But deep down inside, despite all I knew, I couldn’t shake the feeling that it had to be my fault.
I’m not quite sure what got me out of my rut and to the point of accepting that these were lives not meant to be. It was not one epiphanic moment where I suddenly understood the meaning of my losses, it was not understanding medicine and miscarriages. But over time, I gradually righted myself and let the feelings subside. I did eventually have another child. I remember vividly at 8 weeks all my pregnancy symptoms again disappeared, no bad taste in my mouth, no low-grade nausea. I refused to look with the ultrasound and called my OB, who immediately had me come in. The ultrasound showed a viable fetus and this time, and my tears were of relief.
All these layers of experiences, from my irrational reactions to loss to being sensitive to another’s emotional needs, have molded me. I hope I never miss another moment to support a patient (or anyone in my life for that matter) in my haste to keep my schedule on time. I also hope that patients understand, if I am running late, that it could be because a patient before them needs a little more time or was added to the schedule because they were having an emergency. Medicine is an unpredictable field. Patients don’t fit into neat packages with predictable needs, we all are unique with unique needs. This is the challenge, but also the art, of medicine and I’m constantly learning and evolving as my patients teach me new things.