I know we all bemoan the chief complaint of vaginal bleeding when it pops up on the board. Your heart sinks even more when it is followed by HPT+, the dreaded home pregnancy test. No ED provider is going to love seeing patients with first trimester bleeding. More than anything, I loathe the drag it takes on my time and productivity. Labs, urine, moving them to the appropriate room for the GYN exam- all cumbersome tasks.
But almost invariably each time, I am grateful for the lesson it provides me. Because in the franticness of my second year in residency, it reminds me why it is I became a doctor. It is the moment when I walk in and see a woman holding her husband’s hands from her stretcher, red-eyed from crying, who says softly to me “I think I lost it.” You can’t but help pause and feel her pain.
When you start residency, emergency medicine seems an impossibly large world of guidelines and acronyms, new medications and dosages, overhead pages, interruptions from nurses, medical students, attendings, not to mention the ebb and flow of traumas rolling in. There is the anxiety of providing return precautions for the first time to your patient, while you wonder to yourself, is it really me that should be doing this? I barely know what I’m talking about. But then gradually, somehow without even noticing, knowledge has seeped in and you hear your voice becoming more assertive and confident.
Away from the chaos of the ED hallway and the Tetris-like cluster of beds, there is a moment of calm in a private room. My exam is complete. There was moderate blood in the vault, an open cervical os, and no fetal cardiac activity on my transvaginal ultrasound. For one woman she considers the implications, for me – I remember why I became a doctor. Because I want to comfort, I want to explain, I want to clarify, and ultimately I want to be of help. I give her time, and let her questions flow.
It was in this space that I realized it wasn’t the numbers or statistics that my patients needed. They needed empathy, support, and understanding. There are important points to cover and I always reinforce them as, and when, space allows. First and foremost, this is not her fault. The listening comes easily to me, especially on the subject of women’s health. Call me biased – and I rightfully am, as a gay married woman – but we are strong in moments like this, because in these patients we see ourselves, our friends, sisters and daughters.
For another mother, I explain that while I see the fetus, the heart rate is much too slow. In light of her heavy bleeding and age of 43, there are not only return precautions to discuss but also decisions to consider. “I just don’t know my thoughts on termination,” she said. “Neither do I myself,” I confessed. “I’ve already had two seizures this week,” she continued, alluding to her poorly controlled epilepsy. “My neurologist said I can’t afford to stop the AEDs. My husband just doesn’t get it,” she said. “He’s so excited that I’m pregnant again. I just don’t know what to do,” she said as tears welled in her eyes. “You must take care of yourself first,” I said.
As stressed or anxious as I am entering the room, I almost invariably leave it feeling re-grounded. Because whatever my troubles of being a resident, there is pain in the world I know I am adept at treating. It isn’t the type that responds to morphine or dilaudid. Yet it comes in waves of equal power. It’s the pain of loss, of fear, of motherhood. And to be a healer in that moment, saves one woman to help another – be it her child, husband, or lover.
After discussing management options, my patient appears now emotionally regrouped. Dressed as her usual professional self, I paused one more time to ask if she was okay. “Yes,” she said, eyes dry. “I’m going to go home now to my son,” she said as she turned her phone to show me the backdrop of her child’s grinning face. “I like the plan,” I said, “go home and give him a big hug.”