It was 1:00pm and the usual throng of patients were pouring into Labor and Delivery triage. Some were in labor, some not. Some had real problems, others were just anxious and needed reassurance. But the one that moved me the most yesterday was a woman who was only 19 weeks pregnant with twins and was having contractions and vaginal bleeding.
For those of you who don’t know neonatal statistics like the back of your hands, 24 weeks of pregnancy is the point at which infants are considered “viable” if they are born early. This means that they have at least a 50% chance of survivng on the outside. Below this week of pregnancy most infants have a very, very grim prognosis. At 19 weeks, most infants are not even born alive.
The nurse practitioner had seen this woman in her Ob/Gyn’s office just an hour earlier and told her that her cervix was just a bit dilated, so she should come to us for further evaluation. When I walked in the room she looked mildly uncomfortable and scared. I took a complete history, looked at her contraction monitoring strip, and prepared to do a speculum exam.
As soon as I began the exam I knew that I had bad news to tell this woman. Not only was there no longer any visible cervix, but her amniotic membranes had prolapsed almost all the way down into the vagina. A further test revealed that her membrane sac had already begun to leak. Delivery was inevitable and most likely to occur within the next twelve hours.
As I finished the exam, the woman asked me: “What did you see? Is my cervix dilated?” “Yes,” I nodded.
“A little or a lot?” She asked.
“A lot,” I said sadly. “And your water seems to be broken as well. I’m so sorry.”
I spent the next few minutes explaining what this meant and then promising to speak with the woman’s attending physician immediately. As I did this, the nurse swiftly placed an IV in the patient’s hand and connected it to fluids, anticipating the impending delivery.
She was moved to a labor and delivery room, made comfortable, and given emotional support. The woman and her husband alternately cried and seemed stoic, forging ahead to the next difficult hours.
I left at 7pm and the woman was 6 centimeters dilated. By the time I came into work this morning she had been delivered for 7 hours. Both babies expired before they even made their entrances into the world.
I have been involved in many of these sad cases over the past year, and I never know which patients will want a visit later and which will not. I spoke with this woman’s nurse and she thought that a visit might be just the thing.
When I walked into the room the woman was sitting on the bed with a box of tissues, her face red and swollen from the hours and hours of crying. Old episodes of “Saved by the Bell” played quietly on the TV across the room. Her husband was out getting breakfast before they went home.
I offered my condolences, said how unfair all of this was, and gave her a hug. We spoke for a long time about death, loss, and the ways she might find to cope. Before I was about to leave, the woman asked if I would take out her IV, as it was making her uncomfortable. I put on a pair of gloves, prepared a bandaid, and pulled out the one last piece of evidence that she had spent such a harrowing night in the hospital. I covered the small hole in her hand. I said goodbye and walked out of the room.
Life can be so very full of loss.
