Yesterday was much better.
It was a slower day… there were far fewer patients. Not only were there fewer actual patients, though, there were also seven “no-shows”. The temporary ultrasonographer was there with me, and we kind of tackled the day together. She helped to show me some of the things that the physicians couldn’t possibly know about the machine. We did some really awesome 3D “Saline Infusion Sonograms.” I saw another pregnancy that will probably be a bad outcome. In spite of that, I’m feeling much better about it all now. I’m really excited to be working there, and to make things my own. I want to put posters on the wall (and perhaps one on the ceiling.) I want to get diagrams so I can show moms exactly what’s going on inside of them. I would love to get a page button that I could push when I need the physician to come in, so that I don’t have to leave the room.
That brings me to a question. I was asked:
How do you handle it when you do an ultrasound on a woman and
the baby is dead? I’m curious what you say to the mother, and if you’re allowed
to cry.
That question right there is the reason that I almost didn’t go into ultrasound. I didn’t know how I would handle finding a “non-viable fetus.” (That is the nice way of saying what she said.) There are a lot of times in early pregnancies where there are “bad outcomes.” Someone might have what is called a “blighted ovum” which means that the body believes it’s pregnant, but either the egg or the sperm didn’t have the correct information within to start a baby. So your pregnancy test is positive, and you feel pregnant, but when you get your ultrasound done to confirm your due date, there is nothing inside of the uterus. There are all sorts of types of miscarriages that happen. Not to mention when the baby is there, but there is something very wrong with it. There are other times where I have scanned ladies in their second and third trimesters, and not found a heart beat. That is the most reliable “sign” of fetal demise. It is honestly and truly devastating. Not just because I know what that means to the mother, and how that must make her feel, but because I’m not allowed to say anything. Nothing at all. I’m not allowed to tell them everything is “ok” if it is, and I’m not allowed to tell them anything is wrong. I have to fall back on my line, “I’m sorry, hun, I just take the pictures. It has to be looked at by a doctor before they can tell you anything.”
What this means is that I can be sitting in the room doing an ultrasound like everything is fine, but as soon as I find out something is wrong, I have to find some way to excuse myself from the room. I usually use something like, “Oops, I forgot your paperwork. Let me run and get that really quickly, and I’ll be right back.”
What I’m actually doing is giving myself an exit to go and get the doctor without giving the mother and father a chance to panic. I then have the doctor come into the room and check on us, where he can look over my shoulder and see what’s going on himself. I do not have the authority to call a fetal demise, or say that something has gone wrong. All I can do is bring in a doctor, and have them say it for me.
When you think about it, it’s really for the best. Sure, I would like to be able to tell patients that everything is OK. I would like to not have to lie, and pretend that I have no idea what is going on. But on the other hand, I don’t want to have to be the one to let them know things aren’t fine. And when things aren’t fine, I wouldn’t be able to answer all of the questions that they have about what went wrong, and what comes next. Just because I can figure it out by ultrasound doesn’t mean that I know everything that goes along with it.
Always, though, I try to keep these few things in mind. As many as half of all pregnancies are miscarried in the first six weeks, and usually the woman wouldn’t have known she was pregnant. 75% of miscarriages occur in the first 12 weeks. Miscarriages are usually the body’s way of letting us know that the baby wouldn’t have been born quite right, or that something went wrong. And every time a woman comes in to me, and I know she’s lost her baby, I have to remind myself that she’s been given the chance to try again, and make a perfect, beautiful child. It’s emotional, it’s not an easy job, but I love it all the same.
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EDIT:
I forgot to add that I passed my ARDMS OB/GYN registry yesterday. Hooray!!! 😀
