Let me apologize in advance for another sad blog post. I’d much rather be ranting about my labor room mishaps or triage craziness, but such is medicine.
I had my first IUFD today. For my non-medicine readers, an IUFD is an intrauterine fetal demise, the death of a fetus inside the womb.
The couple was a lovely young Indian couple. She was 34, healthy, and had had a ridiculously uncomplicated pregnancy. She came in to Triage because she hadn’t felt the baby move all day. She wasn’t too worried. In fact, she was relaxed and calm when I met her, convinced that everything would be fine. As I scanned her belly, I noted the curious absence of fetal heart activity. I thought it was me and my novice ultrasound skills. I searched and repositioned the probe what felt like a hundred times. This had to be a mistake. Finally, I handed the probe to the Triage midwife for a second look. Unfortunately, her findings were no different than mine. The baby was gone.
The patient was understandably devastated. Her husband, awkward in his grief, tried desperately to quiet her down, to console her. I wondered how this poor man was going to cope with his own feelings of loss given how hard he was trying to be strong.
Later in the afternoon, we took her to the operating room for C-section. (She had several contraindications to delivering vaginally.) Before we started the case, my attending took me aside. She held my hands and looked in my eyes. “Okay. This is going to be a difficult case. But we are NOT going to cry. We can breakdown and cry our eyeballs out once we leave this room, but while we are operating we need to be strong for the patient. We need to focus on the case.” I quietly nodded in agreement as the tears threatened to make their way out onto my cheeks.
Delivering an IUFD is a painfully awkward and emotional experience. The OR is silent aside from the repetitive beeping of anesthesia’s monitors. The room lacks the aura of excitement and energy that usually accompanies the delivery of a live baby. Voices are hushed. The usually operating room chatter is absent. There is no iPod blasting music into the room. There are no celebratory cheers when the baby comes out. The fetus is whisked out of the room without fanfare.
A friend who understands well my recent bout of sad medicine asked me later how this experience compares to my difficult conversations with family members in the ICU (see last post). I thought about it. In the ICU, it was certainly heartbreaking to share a patient’s poor prognosis with their loved ones. But with all of these experiences, I was able to explain how and why the patient got so sick. What reason do I have to give this healthy young woman for the death of her baby? She wants only two things: she wants me to bring him back, and if I can’t do that, she wants me to tell her why he passed. Sadly, I can do neither.
The rest of the day, I wallow in my limitations as a physician.