“Stacey, I’m afraid this doesn’t look like a good pregnancy,” you said.
For some reason, I’d had a couple second’s premonition that you would say something like that, but your words hung in the air so final, and for a moment, the world stopped.
And for some reason, while tears flowed, I thought how amazing language is. We say and hear the same words, over and over again. Place them in one context, then another, place them in one sequence, then another, take out one word here, add another there–the possibilities of meanings are endless. And the emotions those meanings can extract feel almost as varied.
This probably makes no sense to you, because you don’t know me. You don’t know I love words and I love to write, how finding the perfect words to express what I’m feeling inside gives me relief, makes me feel heard and validated. I guess that’s what I’m doing right now, in writing to you.
After you said those words, I thought how I’d spoken each of them so many times myself before. I’d heard each one of your words so many times before. But never together, in that sequence, directed at me. And my immediate reaction was a feeling almost foreign: instant heartbreak. But not like the heartbreak caused by that boy long ago who was obviously never really mine anyway, but the heartbreak caused by losing something that seemed so within my reach, it was literally embodied within me. The heartbreak of a dream come true, of so many prayers answered, only to have them snatched away in an instant.
But you don’t know me, Doctor, and you certainly don’t know my struggles.
I knew you wouldn’t have said those words if you, in all your wisdom, didn’t believe them. As tears flowed down my cheeks, a hand gripping my forehead, the other to my heart in devastation, the world started again, and you continued.
“There’s no heartbeat. At ten weeks, we should be able to hear a strong one. This dark area is obviously the gestational sac–there’s not much to see inside, just this little white area. That could be the yolk sac or fetus remains. I would guess it stopped developing at least four weeks ago. Your uterus is tilted, so we’ll check transvaginally to be sure.”
You began to stick something inside of me, since you’d done a pap smear just several minutes before, and I’d been lying there naked from the waist down besides a crinkly sheet of paper ever since. These procedures usually make me uncomfortable, but this time I didn’t notice. My mind had just barely caught up to the words that had been spilling from your mouth.
“A tilted uterus? What does that mean?” It actually seemed rather unimportant, but I was grasping at whatever I might presently have the capacity to comprehend.
“Oh, it’s nothing to worry about. It just means things are harder to see in a normal transabdominal ultrasound.”
I don’t know why, but I snatched at that bit of information and clung to it, like it offered some semblance of hope. I held my shaky breath in anticipation.
But moments later you removed your tool inside of me and said nothing about what you’d seen or felt, so my brief feeling of respite turned to uncontrollable sobbing. You began talking about options.
“You have two options for miscarriage. You can have a D&C, a brief surgical procedure that dilates the cervix so we can remove the uterine tissue. This is the fastest and least painful option, that is if it’s covered by your insurance–you’ll have to check on that. Your other option is [some pills] (you had a name for them obviously, but I don’t remember what it was) that we would prescribe to you, and you would take at home. They would cause uterine contractions, which could become fairly painful, and you would experience a fair amount of bleeding for several hours up to a number of days.”
You stopped then, apparently noticing that I was still crying. You asked the nurse, who’d been standing silently behind me all this time, getting a few good views of my bare bum, to hand me the tissues. I accepted and said “thanks.”
My son, sitting across the room by his dad, piped up for the severalth time, pointing to the screen displaying my womb. “Where’s the baby? I don’t hear bum-bum, bum-bum, bum-bum.” We’d all ignored his previous inquiries, but this time in the silence, my heart broke even more. My husband then took the opportunity to ask you a question. “So what exactly happened? Is it possible that there’s still a healthy baby in there?”
I don’t exactly dislike you, Doctor, but I can’t help but remember the slight smirk and pursing of your lips before you answered, as if it was… a stupid question, perhaps? “I’m 95% positive that this is not a good pregnancy and the fetus has stopped developing. Of course, there’s a slim chance that the pregnancy is much earlier along than you believed and that is why we can’t see or hear anything, but based on when Stacey had a positive pregnancy test and her last menstrual cycle, that is very unlikely. As for the cause, it was most likely simply chromosomal abnormalities. It’s quite common. 30-40% of pregnancies actually end in miscarriage.”
You must think that your numbers and percentages, big words and facts are important. I suppose they are. You are a doctor, after all, so I guess it would be hard for you to impress or seem legitimate if you couldn’t spew such things, even if they are all used to ensure your patients’ hopelessness. But, just a thought, perhaps you could add a little feeling and compassion, as if you were talking to a relative–even a distant one would suffice. Granted, you did tell me the situation was common, and that was probably to make me feel better. But instead I felt like I was silly for being so upset, like I was overreacting, because this happens to women all the time. I should have come to my appointment with you 50% expecting good news and 50% expecting bad news. Better yet, 40/60, because it’s always easier to be surprised by good news than bad. If I had had the chance to talk with you weeks ago, I think that’s what you would have recommended.
You turned back to me. “We’ll have you take two blood samples, one today and one in two days. They will each measure your pregnancy hormones (you had more technical words for this that I don’t remember); if the numbers go up between the two days, that would mean your pregnancy is still progressing. But most likely, the numbers will go down, and that will let you know for certain that this pregnancy must end in miscarriage. If you’d like, we can schedule the D&C in the afternoon, two days from now, after we will have received the second blood results. Or should I go over both options again?”
I stared at you, blinking away blurry tears. There seemed like so much to consider, why did you keep asking me to make a choice between the two options of miscarriage? And somewhere in the back of my mind, I felt like there was a third option. Don’t women frequently go through natural miscarriages all on their own? Why didn’t you mention that? At this point, when your initial words hadn’t sunk in even a little bit, it felt like you were asking me to choose between options for having an abortion. A very unwanted abortion on a baby that had been alive to me for almost two months, that might still be alive–you even admitted the 5% chance in your condescending way. I was not holding to this hope at all consciously; I do not like emotional rollercoasters. But my happy anticipation had turned to heartbreak not even ten minutes ago. This baby did not feel dead enough to talk about it’s forced evacuation.
“I…don’t…know.” I murmured. “I’m not really sure I can decide right now.” Finally, a chance to relieve some honest feelings. “I mean, it’s not like we just conceived the first month we tried. We’d been trying to get pregnant for a year. Who knows how long it will be before I’m back here with an actual good pregnancy. I just…don’t really know how to think about this clearly right now.”
You placed your hand on my shoulder and looked at me with kind eyes. That really meant a lot. “I’m sorry. That isn’t easy. You certainly don’t have to decide today.” You stood. “I’ll give you a chance to get dressed. I wish I’d had better news for you both.”
I dressed, and I cried. I sat back down as my son came to give me hugs, and I cried. My husband sighed heavily, mentioned how unexpected this was, and how he’d been unimpressed with you as soon as we met. How you were young, inexperienced, only been working as a doctor for a year–that’s why we never met you with our first pregnancy–and we should have waited to meet with our usual doctor; this visit might have gone much differently. And I cried.
We thought we were waiting for you to come back; you’d never actually said goodbye or given any real instructions. But finally the silent nurse re-entered, asked if there was something else we needed, and handed me a paper that I was to take to the hospital where I would have my blood drawn. I realized it was silly to have been waiting for you; you’d already spent over ten minutes with us. There were many more expectant mothers to be seen who would not be crying as they ducked their heads, avoiding watching eyes from round-bellied women, on their way out.
But it was still a shame we didn’t see you again; you had just barely started to become personable. You might have still convinced me to see you again someday. So in farewell, a word to the wise: try to get to that personable point sooner with your next patient. Of course I speak with your best interest, i.e. chance at highest career success, in mind.