One of my sonographers came out of an exam room the other day with a vaginal transducer (ultrasound probe) held out in front of her, still sheathed in a lubricated condom, and lightly streaked with old blood. The expression she had on her face is one that I have seen hundreds (probably thousands) of times over the years and so I simply preempted her report to me with the simple question, “How far along was she supposed to be today?” Not surprised at all by my ‘insight’, she responded just as straightforwardly, “Well, she is supposed to be 12 weeks, but the baby is only 8 weeks size and does not have a heartbeat.” “Does she know?” I asked (thinking wishfully, but also anticipating the response). “No,” I was told, “All they wanted to know is if it is a boy or a girl, and I told them the doctor would have to talk with you about that.” My sonographers do their jobs and know their roles all to well. The MD after my name means that I am the one responsible for the Morbid Discussion that has to take place to inform a couple that they have a pregnancy that didn’t make it through the first trimester.
I went into the room, introduced myself, and picked up another transducer to ‘lay my hands’ on the patient before giving them the bad news. They were a young couple, neither one more than 19 years old, and had “just gotten married the week before,” probably because of the unplanned pregnancy. But, they were also very excited about the prospects of being parents, and almost immediately asked me the same question they asked my sonographer, “Is it a boy or girl?” I told them that “I can’t tell because the baby is too small” and at that point, as so often happens, they opened the door with the question that almost always inevitably follows, “Does that mean there is something wrong?” Then, in a routine I have had too many opportunities to rehearse through the years, with the transducer focused on the tiny embryo so that they could see the baby on the viewing screen, I told them, “You are supposed to be 12 weeks by your last period and the baby appears to have stopped growing at about 8 weeks. Here (using the pointer) is where we should easily be able to see the baby’s heart beating, even if the baby was only 8 weeks, and there is no heart beat. I’m so sorry.”
At that point, also as so often happens under these circumstances, she sat straight up in the bed, the tears streaming out of her eyes and, hoping she had misunderstood my words, she asked, “Does that mean there is something wrong with my baby?” “Yes,” I responded, handing her the box of tissues we always keep in close proximity to the exam table, “The baby is not alive, you have lost this baby, and we are 100% certain of that diagnosis. I am very sorry.” Since most patients are in a ‘state of shock’ after hearing this news, and are not receptive to any kind of ‘input’, I also said at that point, “Let me give the two of you a few minutes alone together and then we can talk about all this…”
I left the exam room, still within earshot of the heart-wrenching sounds of anguish that I have never gotten used to after all these years; the conversation we had when I returned will be continued in our next post…