“Are you really prepared to see this?” the doctor asked staring intensely at me, his arm blocking my way to the patient’s room.
“Yes,” I replied hesitantly. “You prepped me on the patient already.”
“Kid, I didn’t ask if you were prepped. I asked if you were prepared.”
I knew that a scheduled delivery for a miscarriage would be a traumatic experience. I knew that it required the utmost sensitivity and compassion. Dr. A had prepped me extensively on the patient’s history and circumstances—a G3P2 at 29 weeks gestation with uncontrolled diabetes had a routine prenatal appointment and an ultrasound that revealed an absent fetal heartbeat. She was devastated and had cried for hours in the outpatient clinic, but eventually agreed to a scheduled induction. Her family accompanied her to the delivery.
And I was here to assist my attending. I was, as much as any medical student could possibly be, prepped.
I was also undoubtedly, completely and woefully unprepared.
Nothing could prepare me to see those fingers, those ten unimaginably tiny fingers, with knuckles and wrinkles. Nothing could prepare me to see those legs, curled up, with toes delicately pointed downward. Nothing could prepare me for the stillness of the image. No textbook, lecture slide or photo will ever tell you how much stillness there is. And how difficult it is to see those fingers, the toes, the mouth, the stomach … without writhing and without warmth.
Nothing will prepare you for the silence. After witnessing and assisting over a dozen full term deliveries, the sound of a baby’s first cry becomes one of the most anticipated, expected and automatic events after delivery. It is the promise of independence and the signal of life. The silence of a miscarriage is one of the loudest, most haunting sounds I have ever heard. It was deafening. Empty. Hollow.
At the time, Dr. A was comforting the patient and her family. He spoke of faith, of love, of grace and of acceptance. He touched her arm and led a prayer for the family. He gave them time to decide if they wanted to see their departed son. As I stood to the side, in my oversized scrubs and ill-fitted mask, I could not help but think how unprepared I would be to lead such a discussion, how utterly clumsy I would be in any attempt to comfort them. My textbook guidelines regarding physician empathy had no example boxes on how to comfort the family of one who has suffered an unexpected miscarriage. There are no practice board questions on how to respond to a patient when she blames herself for the death of her son. There is no footnote advisory on how to hold back that stinging feeling in your eyes or the painful lump in your throat when you hear a grieving mother’s sob.
Dr. A left the room shortly after and I followed. “How do you do that?” I asked him, untying my mask.
“Do what?” He ripped off the boot-covers in one swift tear.
“Talk to the patients like that. This was the saddest thing I have ever seen. How did you know what to say?”
He rubbed hand sanitizer over his forearms and grabbed the patient chart from the door. “It’s always sad. But this isn’t my first time. And over time, you learn what to say and what not to say. These experiences are always hard. But you learn to cope with them better, help the patient as best you can, and move on.” He signed another document and closed the chart. “We have two more procedures this afternoon. Are you okay to see them?”
I blew my nose and nodded.
Two weeks later, I was in Dr. A’s office, writing up a progress note for a gynecological visit when Dr. A’s nurse walked in with a bouquet of white roses. She handed them to him, along with a card. “She sent them to you,” the nurse said quietly. Dr. A opened the card and read it aloud. It spoke of love, of grace and of acceptance. It spoke of how much faith she had in why things happen the way they do. It spoke of how lucky she felt to have had the beautiful experience of carrying a son for twenty nine weeks. It spoke of how grateful a mother could be when a good doctor helps her through the darkest time in her life. It spoke of how she hopes her doctor does not feel sorrow any longer.
Dr. A did not finish the card aloud. And he sat in that office quietly for a long time after I left. As prepped as he was to deal with a grieving patient, as experienced as he was in his field, I’m not sure anything could have prepared Dr. A for a moment as humbling, as full of grace as this.