I’ve watched over five hundred fetal sonograms. I have a pretty good idea of what’s occurring on the ultrasound machine’s screen. And while watching the scan that the resident did, I could make out our daughter’s head and her chest, her abdomen and her limbs, but I could not see her heart beating. After a few minutes of searching, the resident picked up the ultrasound machine’s transducer, turned off the power, and said she’d be back in a few minutes.
“I didn’t see the fetal heartbeat,” I said.
“I didn’t either,” she said quietly, startled at my statement. “I’m going to call your attending.”
Beth and I sat in the room crying; no one came to explain what was going on or what would happen next. Finally, after about a half hour, Beth’s doctor appeared at the door. He told us that it seemed as if the baby had died. He talked with us, answered our questions, and told us what the most appropriate management plan was. Since the labor pains that had begun this whole episode a few hours before had completely ceased, Beth agreed to wait until natural labor resumed, an occurrence her doctor assured her would take place within the next week or so. And so, devastated, we prepared to go home.
After leaving the labor room, we approached the nurses’ station. The nurses and the resident who had done the ultrasound were having an animated conversation, laughing and apparently enjoying themselves, but as we approached, they became silent. I was used to this; I had been part of this kind of behavior, especially during my time in the neonatal ICU. But now I was experiencing it in a different way; Beth and I were the opposition now, and this behavior made our grief just a little bit worse.
I’ve learned something from this experience, and accordingly I’ve altered the method I use when talking with the families of children who have died. This isn’t an experience I would recommend, but it did help me understand a little more about what goes through the mind of a parent whose child has died.
Andy
MAY 1986
Wednesday, May 7, 1986, 7:00 P.M.
I finally finished Infants’. It was a horrible, depressing month. About a week after the baby with heart disease died, I had another patient who got very sick and had to go up to ICU. I intubated him myself. He deteriorated so fast, he almost died on the ward before we could get him up to the unit.
Now I’m in the OPD, and all the details are starting to blur. I suppose if I spoke into this thing religiously every day, I could tell you endless story after story about all the kids and their various problems. But what does it matter? It’s all just a horrible blur, one after the next, made up of all these poor, sick kids.
Thursday, May 8, 1986, 10:00 P.M.
It’s become really hard to continue keeping this diary. Over the past few months I’ve lost touch with my inner self; I’m not sure completely why that’s happening, but I think it’s because I’m defending myself against all the bad feelings I’ve had about being an intern. It relates to a lot of different issues having to do with the general feeling of being abused and mistreated, and the fatigue and the sleep deprivation, and the death and the morbidity of my patients. So certainly that’s one reason I haven’t been talking. I’m out of touch with myself, and it’s hard to know what exactly to talk about. The other thing is, the thrill and excitement and novelty are gone, and they’ve been replaced by a more realistic perception of what I think medicine is. And for some reason, there’s something in me that doesn’t want to relate all those stories about all the various patients. Talking about it makes me feel like I’m back at work, and I hate even to think about being at work.
Saturday, May 10, 1986, 4:10 A.M.
I just spent the last six hours in the Jonas Bronck ER working on a fucking child-abuse case. I really hate them; I hate them more than anything else in this job. I think I’ve seen enough child abuse for an entire lifetime. I don’t want to see any more, thank you. They never go well, they’re always difficult.
This one, I just pulled the chart from the box, I didn’t even read the triage note, and I called the kid in. She had a bandage on her forehead. Oh, great, I thought. A laceration. I asked what happened and the mother gave me this story that the girl was lying on the floor and playing and she bumped her head and cut herself on the hinge of her glasses or something weird like that and cut her forehead. I asked her to go over that again and the mother gave me basically the same story. So I took the glasses off the kid’s face and I tried to find a way to make the hinge hit up against the forehead. I couldn’t do it. The frames were plastic and they were totally intact. I thought, No way! No way the kid could have done this!