An Incomplete Birth

In the crowded hallway of the emergency department, she lay quietly on the overflow gurney. She answered each of our exhaustive questions, showing us pictures of the clots she passed with her smartphone. As she outlined her frequent visits to the ED and hospital for this miscarriage, her brave armor revealed slivers of weakness with occasional tearful glistening in her eyes. I grabbed some tissues when the resident finished up her questions, and tried to offer her some comfort before we had to scurry away to delivery the report to the attending physician. When we were able to return and provide her with some more definitive information (we were able to assure her that this most likely wasn’t an ectopic pregnancy), we asked her to follow us into Room 18 for a quick pelvic examination to evaluate the progression of her miscarriage. As the two residents maneuvered with their various instruments to better visualize her vaginal walls whilst discussing their observations, I realized that they paid no attention to her response. At this point, in my short few weeks in OBGYN, experience has taught me that no woman enjoys a cervical/speculum exam. At best, it is barely tolerable.

Perhaps it was the somewhat dehumanizing position we place our patients in for a pelvic exam; perhaps it was final confirmation of this miscarriage; perhaps it was the way the residents referred to this pregnancy with such cold, medical jargon - whatever it was, the quivering of her lower lip couldn’t hold back the gush of emotions that were storming through her mind.

Deciding that I wasn’t going to be useful to the residents at all, I grabbed the nearby box of tissues and went to her side. I took her shaky hand and put a tissue in the other, quietly joking that I couldn’t get her any Five-star kleenex so this’ll have to do. The tension finally broke, and it seemed that she finally forgave herself for expressing her emotions in that moment. Feeling utterly useless, I held her hand as she gave in to the overwhelming feelings and cried as they completed the abortion. Thoughts and comforting words rose to my throat, but I chose to remain quiet instead. I was distraught by the lack of emotional response from the residents, but I suppose that they were probably used to this and were concentrated and ensuring that all foreign tissue was appropriately and safely removed.

The expression of humanity and compassion is an art that must be learnt and balanced with efficient professionalism. From my observations of different attendings and residents, I have long understood that the empathic compassion for ailing patients exists in my seniors, but they chose specific moments to reveal their humanity at the best moments. They maintain their poised, professional demeanor as they explain the medical situation and conduct their examinations/procedures for the necessity to remain efficient. Perhaps it is a protective mechanism in itself to ensure compartmentalization.

To the bystander, at first it may seem that my seniors are heartless and could care less about the feelings of the patient. The way they interact with the patients and discuss details with their fellow colleagues color them in an indifferent aura - desiring only to take the most effective route to overcome the presenting medical issue. However, I have learnt that despite this, they continue to keep the patients’ psychosocial state in mind as they devise their assessment plans. They pick up on details and provide questions and assurances that are only possible under thoughtful and perceptive eyes.

In these ways, I have become awed at the efficiency that my seniors operate under. The seamless hat-switching between competent physician and compassionate guide almost is too jarring - as if they possessed some magical bipolar personalities to present and hide at will. And as I held the hand of our patient, I hope that I may achieve the maturity and efficiency that I see exercised daily and serve my patients the same way they do.