Tonight my heart cried. I diagnosed two miscarriages and told a little girl she was beautiful despite what the mean school bully said. Emergency medicine is sacred in that we see our patients at their worst moments, at their most vulnerable, and yet they open up and talk to us, complete strangers, and tell us everything, and trust us with their secrets.
This little eleven year old girl felt sad. She was being verbally abused at school by a bully who accused her of being fat and ugly, which blew my mind because she was gorgeous. After assessing her risk in a roundabout way, she was not a danger to herself – our first priority in the ER – I turned on my dad mode. “Sweetheart, you are beautiful and wonderful. Sometimes this happens in our world and it’s complete nonsense. Some people believe that it’s ok to be mean and evil to other people, and they are completely wrong. Often these people have insecurities that they are compensating for by being cruel. You know deep inside who you are, and you are beautiful. Sometimes it hurts, but remember who you really are, and you are not anything that she says.” She smiled. It broke my heart thinking about my own two girls, and other little girls around the world who will one day be treated so savagely and unjustly. Next, I arranged for close followup with our pediatrics psychologists, and mandated the dad to fix things at school.
The next room held a lady who was 18 weeks pregnant with vaginal bleeding. After further exploring the story, I grabbed the ultrasound and placed the curvilinear probe on her belly. “Ma’am, let me just get a few standard views before we look at the pictures together and talk.” That minute immediately felt like hours as I scanned her uterus and stimulated the baby, but there was no fetal movement, no pixelated rhythmic flicker indicating a heartbeat. And usually at this gestational age, everything is easy to see. I tried not to furrow my brow or look too serious, but it was impossible. What usually was a moment of joy, turned to horror. After what seemed an eternity, but was likely only a few minutes of searching in vain, I had to say something. It was true awkward silence. “Ma’am, I wanted to make sure before we talked that I knew what I was looking at, but usually at this age it’s a lot more clear. Usually when I push on your belly the baby starts moving around, and usually I’m able to easily see a heartbeat, but something’s not right. Ma’am I’m concerned about a possible miscarriage. But let me send you to radiology for a formal ultrasound, they have much bigger and better machines and will be able to see a lot more clearly.” I procrastinated, put off what I knew was inevitable. An hour later she returned, the radiology read confirming my suspicions, and I knew I had to broach the terrible news. “Ma’am, did they mention their findings in radiology?” “No sir.” “Well, I reviewed their images and their interpretation, and their findings were the same. They could not identify a heartbeat. And their dates measured at 15 weeks, so it is likely that your baby died a few weeks ago. I’ve already spoken with obstetrics, and they will talk to you soon about what to do. Ma’am, I am so sorry for your loss.” She held her emotions so well until that point. She was so strong. But at that moment she broke down and wept. My eyes teared slightly. I felt myself shrink in my doctor’s stool, as I felt so small and inadequate. Usually we were showing moms their babies bouncing around in their bellies, but today I showed a mom her dead child. And there was nothing I could do for her. There was no emergency medicine treatment or lifesaving procedure I could offer. I was useless. I slipped out of the room as the couple cried. Later that evening I diagnosed another miscarriage in a lady that was not even aware she was pregnant.
Occasionally our job is exhilarating, we ride the high of the saves, or the adrenaline of resuscitations. But sometimes our job sucks. We tell families that their loved ones died, or we diagnose a terrible terminal disease. And sometimes we tell a mother that her unborn baby has died. And then we drive home in the dark, and drink a glass of wine, and watch a sappy movie with our families, and hide our tearing eyes, and then head to bed. But not before we kiss our sweet kiddos on their foreheads and soft cheeks, and whisper “I love you” in their dreaming ears.