Sunday, January 10, 2010

The Things They Don't Teach in Med School

There are many schools of thought on how “professional” physicians should be with their patients. Is it appropriate to call a patient by their first name? Is it appropriate to pat the back or squeeze the hand of a patient? Is it appropriate to cry with a patient? Many people will say a doctor should keep their distance from patients, for the sake of maintaining an aura of professionalism. Others will tell you that staying human is the most important aspect of doctoring. Particularly when I’m dealing with bad news, I learning that I prefer the latter...

Her name was Y.L. She was a sweet, chubby, Puerto Rican woman in her early twenties. She and her boyfriend had been trying for 2 years to become pregnant. By the time we met, she was approximately 7 weeks along. I met her in Triage, where she had presented with some vaginal spotting and cramping. I wasn’t overly concerned. Contrary to popular belief, many women have spotting throughout their otherwise normal pregnancies. I bring her to the ultrasound room and set up for a speculum exam. There were about 3 tablespoons or dark blood in the vagina. “What is it? What do you see, Doctor?” Y.L. was anxious. “Just a little blood, I’m still looking,” I respond. I use large cotton swabs to clear my view of the cervix, but the vagina continues to fill up with blood. I use a pair of ringed forceps and sterile gauze to soak up the blood instead. And then I see it. Shit. Fetal tissue protruding from her cervical os. I pull the tissue with my forceps knowing now that this woman is miscarrying and the only way to stop the bleeding is to help her pass the fetus. I keep pulling, slowly, to evacuate the tissue completely. She asks again, “Doctor is the baby alright?” At this point, I have to tell her. “Y, I’m so sorry. It looks like you are passing the pregnancy. You are having a miscarriage”. Before I finish my sentence, she starts to wail. The pain in her voice is piercing. I try desperately to finish retrieving the fetal tissue as her body shakes with tears. Her partner, a stoic young man, looks down at his shoes. A tear falls to the floor.

Finally the pregnancy is out. The bleeding stops. I do a quick ultrasound to make sure her uterus is completely empty and then I leave them alone in the room.

Upon heading back to their room, I was at a complete loss of what to say or do. The “doctor-ly” thing to do would have been to give the couple a little Miscarriage 101 – why it happens, what to look out for, risks that it will happen again. But that picture felt wrong. It felt cold. Devoid of empathy. When I headed back into that patient room, I knew there was no real “doctoring” I could do. There was nothing I could say or do to bring her pregnancy back. So I took off my “doctor hat” and walked in as myself. I hugged her. I let her cry on my shoulder. I reminded her that this was not her fault. Was I appropriate? Was I professional? I don’t know. But I do know this. I was human. Between women, sometimes this is all we need. When she looked up at me afterward and whispered "Thank you. God bless you" through her tears, I knew I had done the right thing.


  1. That made me cry.I knew medicine was the field where you needed to be; people need you :)


  2. That was a gripping story. Thank you for sharing it gave a lot to think about.

  3. There's always time later for Miscarriage 101 but never a better time to show compassion.