She was a woman in her early twenties accompanied by her husband. She was a first-time expecting mother at 19 weeks gestation with twins. They had received regular prenatal care and had been doing everything as the doctor had instructed to ensure a healthy pregnancy. She made this appointment because she felt something was off, her motherly instincts already keen. She and her husband had just gotten back from their ultrasound on the floor below, and they already knew the news that the doctor would give.
It was my first day as a medical student in the office. I had a feeling that something significant was about to happen; so, even before the words were spoken, I had put a guard up around my emotions.
She had lost both her babies. Despite her strength and resolve not to cry, I could feel that she was teetering on the edge of a completely understandable breakdown. I was glad a mask covered most of my face, as I could not help but empathize with her. I felt distraught knowing such a cruel turn of events could happen to someone so innocent. Her husband held her hand as the doctor tried to explain his thoughts on what went wrong: the questionable presence of a membrane separating the twins, cord entanglement and twin-twin transfusion syndrome were presented. I looked at this young couple, and I could not help but compare them to me and my wife.
I wondered what my wife and I would do and how we would react if we were in their shoes. We foresee children in our future, and miscarriage is far too common to brush off as never happening to us. I imagined, what if my wife was carrying twins for 19 weeks? I imagined us having discussions on names and nursery themes, adding a double stroller to our baby registry. All of this, only to have the world flip and go from two babies to zero.
I watched this couple as they had an eerily calm discussion about options for removing their deceased fetuses from her uterus. I wondered how long it will take them to finally break down and cry. Will they make it home, or will they simply get in their car, lock their doors and weep? I wondered how long it would take me and my wife to weep after receiving such devastating news.
I hope that they have a strong support system. My wife has three brothers with whom she is incredibly close, and if such a horrific circumstance was to befall us, I know that they would stop at nothing to help her through her grief. Does she, my patient, have any siblings who can provide her comfort during this time? Does she have parents who will put aside their own loss of their grandchildren to be supportive? Considering the COVID-19 pandemic, what if their family and friends are unable to be proximate? Would they have to break the news and then be left longing for a hug that never comes? Or, would they discard social distancing and instead seek the support that they so desperately need right now, even at the risk of contracting the virus? I would not blame them if they do.
I think next about her husband. I worry that he will swallow his grief deep down so that he can be strong for his wife, that his anguish will go unaddressed. Will he spend the next days and weeks consoling her, all the while resenting that his loss has been overlooked? Again, I put myself in their situation and think, would I too be given the opportunity to grieve? I consider myself to be a good husband, selfless in the moments when my wife is in need. Would I swallow my grief, tell everyone I’m fine and fall back on unhealthy coping mechanisms? I do not know the answer. But, I hope that if I am ever to be in a situation like this young couple, I will have the strength to ask for help and allow myself to be emotionally vulnerable.
Returning back to the reality before me in the small physician’s office, I noted how the doctor navigated this emotional minefield. Speaking like an old friend or a paternal figure, he finished explaining the distasteful options that were available to the patient with a gentle, yet distant tone that only years of delivering bad news could allow. As an uncomfortable silence began to build, she finally let loose a thin stream of tears. The doctor slid a box of tissues her way as a single offer of comfort.
I considered whether or not he would have gotten up to hug her or put an arm around her shoulder if it was not for the pandemic. However, before I could continue to silently judge his perceived lack of empathy, I reminded myself that I have not moved a muscle since the patient arrived.
As they got up to leave, my tongue betrayed me, and I was unable to say a word of support or acknowledge their loss. Looking back, I wish I had done something to let them know I was not just a spectator to their loss — that, behind my mask, I was distraught. I wonder whether the words of a mere student sitting in the corner would have made an impact on what must be the worst day of their lives.
Is it naïve to even think that I could have made a difference that day?
I took a deep breath, and my preceptor who I had only met an hour ago said, “Rough start to your rotation here.” I only managed to muster a simple “yes” as I continued to process what just happened before me. I have not seen that couple since then, and I likely never will. Their strength, however, gave me hope that they will emerge from this tragedy stronger and that they will have the family they long for.
I hope that my wife and I never know the pain that this couple has gone through. But if we are so unfortunate to find ourselves in a similar situation, I can only hope that we are as strong as this couple.