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Editor’s note: The author’s identity has been withheld by the Editorial Board due to the sensitive nature of the article.

It is a cold February night, the car barely warming by the time I park. Walking towards the doors of the emergency department, I suspend my social media accounts and shut down my phone. In a few hours, it will be my birthday — I want this one to pass without attention.

Entering the waiting room, I see my wife has already checked in. She is waiting in triage, nervous. A man is handcuffed to a wheelchair by the double-doors, threatening the police officers and making lewd comments as women pass. Eventually, my wife is called to the desk for assessment. A few moments later, the nurse points to a door and we are back in the waiting room.

“We are busy, you’ll be seen in three to four hours.”

An hour earlier she called me into the bathroom. Inside she asks, “Is this normal?” I see a pale translucent sac proceeding from her, streaks of blood running down its surface tinting the water below. I know it is over. Our second child is not to be.

We rushed our infant daughter to a neighbor’s home and called a relative to watch her. As we drove to the hospital, snow silently fell. She had been feeling the baby move for weeks and every check up had been perfect. There was no trauma, no warning — five months of hopes gone in an instant.

My wife is bleeding and in pain, losing the pregnancy as they spoke. What did they mean she would be seen in “three to four hours”?

“Go away! Miscarry in the waiting room!”

This was the real message delivered. It is unacceptable; I approached the desk and demanded she be re-evaluated. A bed is found and we enter through the double doors. Tensions release for a moment. Behind the curtain she changes into a gown and we wait.

Soon, we meet the nurse and doctor that are to take care of her. After a look, my wife is covered below the waist by a thin blanket, calm — I’m sure she knows what is happening, but has yet to process it.

I think back on the last five months, the pregnancy was wanted and perfectly timed. I had left my summer open, one of the last I was to have during my medical training. She was due in early July, nearly a year apart from our daughter. They would be friends.

Not half an hour passes and it is over. The doctor holds a large stainless steel bowl and pulls the sheet up to shield us from the delivery. As it comes out, the reality of the moment strikes and my wife wails, crying out again and again. Tears stream down her cheeks as I hold her. I see everything, despite the doctor’s and nurses’ efforts.

Holding the dish covered by a green towel, they asked if we want to see it. There is no hesitation, “Yes.” The doctor quietly tells the nurse to clean it up before coming back.

I begin to question what would have happened had I not pushed for a re-evaluation? What if English wasn’t our first language or we had waited? This is the health care system I am entering into a few short years from now.

The blood that was trickling begins to flow. Soon, come clots and chunks of placenta. An absorbent pad is placed under her and the obstetrician is called. After consulting with the nurses and a quick examination, he explains that the placenta has been retained; it can be “sticky” at this stage of pregnancy. Oxytocin is started to help the uterus contract to pass the placenta and reduce bleeding. A new bag of saline is hung from the stand. The bleeding continues. An absorbent pad is placed on the bed.

The nurse returns with the steel dish in hand. Inside the curtain, she removes the towel and shows us a small being, nearly human. Long, thin arms and legs. Vascular. The being’s head disproportionately large for its body. “It looks peaceful,” says my wife. We both stare in silence. As the nurse leaves, my wife claims that she can tell it was a boy. My eyes become heavy.

The beeping monitors and moans of others are muffled by emotion. We wait for the oxytocin to work. Occasionally, the nurse returns to check the status of the placenta and inspect what has passed from my wife. The bleeding slows, and is then followed by contractions full of clots and a new pool of blood. The pads are replaced as needed; she lifts her hips. I help.

I look at the clock. It is after midnight. It is my birthday.

The monitors slowly change. Her blood pressure is falling, her heart beating rapidly — she’s decompensating. I rush to the nursing station. After a glance, three staff members quickly approach and begin pumping bag after bag of saline into her under pressure. She stabilizes. This is care?

The obstetrician finally returns. It has been nearly four hours since we have seen him; no explanation or apology is given. The oxytocin has failed and surgery is required. They will dilate the cervix and remove the retained placenta to stop the bleeding. She is wheeled out of the emergency department and I follow. We meet a small older gentleman standing beside a gaunt giant. They calmly review the plan and assure us that things will be all right.

As she disappears from view I am directed down a hall to a waiting room. Two other people wait by an unmanned check-in counter, one reading an old magazine, the other listening to music. Beyond the counter there is an alcove with a window. The lights are off; I sit in the corner and cry.

Someone is calling my name. It is faint. I respond and see the small gentleman approaching. Crossing into the darkness he sits beside me and calmly explains that the surgery went well. I ask what had happened, but there are no answers — only speculation. He hands me his card and mentions he is available to speak with us to try to figure out what happened.

I am alone again. A phone rings in the distance, over and over. It goes silent. Again it rings and I approach the check-in counter. The waiting room is now empty. I answer and they ask me by name.  It is the recovery room; my wife is awake and wants to see me.

“I didn’t want to, but I had a transfusion. How else can we try again?”

My wife is in a bed, head propped up, squinting to see straight. She weeps. It is an acceptance of defeat. The bleeding has slowed and she is stable. I hold her hand and stroke her hair, telling her things will be all right.

We return home and her body slowly recovers. She has become numb to the world. I continue my medical training barely present, mind shattered, my emotions scarcely concealed.

I recount the issues in painstaking detail in a letter to the hospital. Months later, I receive a phone call followed by a patronizing letter. I’m told the complaint was temporarily lost due to an “administrative change.”

I feel ashamed of my profession.

Life continues and our daughter brings us joy. We try again, this time prepared. Despite all efforts, tragedy visits us again late in the second trimester. No perfect timing or summers remain. My birthday, an annual reminder of loss.

Photo credit: Image by aogs47777.

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  • Christoph

    It’s rare to see something so terribly sad be so beautifully written.

    However, I don’t know exactly what it is that he’s so disappointed in the medical profession for from what is written. It sounds like she may have been initially mis-triaged (an imminent abortion certainly deserves a room sooner than 3-4 hours), but it sounds like this was corrected quickly and she was given a room. Everything else sounds like it was handled appropriately. The only other thing he expresses displeasure in is the fact that a nurse only checks on them every couple of hours and that their OB was gone for 4 hours while the treatment ran.

    The article sounds like it is coming from a first year medical student– he mentions a “free summer” and entering the field “a few years from now”– so he probably isn’t familiar with how the hospital works. This essentially means he’s a layperson. That isn’t to say that his experience isn’t valid, of course, since almost everyone we treat is a layperson. I do think, however, that this speaks to something that surrounds a lot issues with dissatisfaction in the hospital–patients almost always subconsciously assume that they are the only people being treated in the hospital or that, even if they aren’t alone there, that they are the sickest.

    Enough isn’t done to show the realities of hospital treatment. Your nurse on the floor probably has a minimum of 4 other patients to look after, all of whom want his or her undivided attention, along with treatments and paperwork to be done for all of them. In the ICU or step-down you ideally have 2 patients per nurse, but that ideal is often not met due to staffing shortfalls. In the ER, your nurses are being stretched across multiple beds with spanning multiple levels of acuity. The OB being gone for 4 hours is also understandable from a logistics standpoint– there are other patients he is seeing as well and, since this is apparently occurring around midnight, depending on coverage and call-hours, he may be grabbing sleep as well so that he can properly function when needed. All-in-all, it simply is not feasible for a provider to be at your side for the entire duration of your stay, and even if it were, many patients in this situation would rather grieve alone with the one’s close to them than with a stranger present.

    In the end, I’m afraid that the writer is projecting his frustration and sadness with the miscarriage on the hospital and the profession. What happened to him, his wife, and unborn child is terrible and is one of the things I dread seeing in the ER the most because there is simply nothing that I can say or do to change the reality of what is happening to them. Even if I could personally stay by their side through the entire process, their child is gone and my presence can’t fix that.

  • Abraham Khan

    This was a beautiful piece and stuck with me for several days. The weekend after I had read it, an OB/GYN at the Gold Humanism Foundation Conference shared stories of how he provided empathy after miscarriages. It nearly brought me to tears not only because his was a touching story but also because your story was so fresh in my mind. I’m sorry this happened to you and your wife and I’m sorry that the experience was made worse by a florid lack of empathy.

    Here is another story about a mother who endured miscarriage and had to endure a several hour wait around other pregnant mothers and children after she found out. http://www.bmj.com/content/352/bmj.i10

    Frankly, before hearing all of these stories over the past few weeks, I never realized what a monumental tragedy miscarriage was. These stories have opened my eyes and my heart. Thank you