Relating to my patients

I had a shadow with me in the office again this week. A doctor, new to our practice followed me around for a day last week to get familiar with our electronic medical records and the ins and outs of our office. This week our newly acquired midwife did the same. I’m apparently the go-to provider to show people the ropes. It’s interesting being shadowed, especially by people with more experience than me (as were both the doctor and midwife.) I felt the need to represent the practice well and to represent myself well. Last week I felt empowered at day’s end because I didn’t feel self- conscious being watched as I cared for my patients. This week, I felt pretty much the same, but I had a few moments of unexpected pain throughout the day too.

“Are you having a boy or a girl?” the new midwife asked the pregnant woman, in an effort to fill the void in conversation as I flipped though the patients chart.

We midwives become masters of small talk, chatting during potentially awkward times. I usually use the time I spend doing a breast exam to talk about the new pap smear guidelines with my patients. At the beginning of each visit I get a good social history from my patients (relationship status, job, what’s new…) and often use that to create conversation during a pelvic exam. “So what are your wedding colors?” or “How long have you been at your job?” are good time fillers. I often ask couples to tell me how they met while I’m in the labor room pushing with a woman.

Prenatal visits are quicker, having gotten the big chunk of the social history in the initial visit and so asking more “fun” questions about the pregnancy has been my fall back for conversation fodder. “What are you having?” or “Are you having a baby shower?” or “Does your younger child understand what’s happening?” are all non-essential questions but help support the bond between patient and provider.

I don’t ask those questions anymore.

They are too painful, too intimate. They make the pregnant belly in front of me more real and thus more of a reminder of what I have lost. If the conversation picks up from there, it’s hard not to try and relate to my patient. When someone tells me they are getting married in September, of course I’m going to say “Oh, how lovely! I got married in September, too. We had great weather, I hope you do too!” It’s human. Patients like it and it makes my job more enjoyable too.

If a patient replies, “We’re not finding out,” to the what-are-you-having question, I want to say “I didn’t either!” I did it while I was pregnant, so my natural inclination is to do it now too. But I hold my tongue, because then they might ask, “So how old is your child?” And then I have to disappoint them with the news that my baby died. Since I can’t seem to hold back my attempts to try to relate, I simply just don’t ask. I think my relationship with my patients suffer because of this.

Being observed, I wanted to tell my new colleagues, I’m better than this. I usually am much more chatty and ask those kinds of questions. I actually had the chance to exactly that last week, at the end of the day after a conversation about Mabel, and that made me feel better. But this week with my new shadow, I heard her have conversations with my patients that I should be having… if my baby lived.

“What do you have at home, a boy or a girl?” The new midwife asked my patient who was having back pain.

“A boy.”

“Oh, I have two boys! I know how they can be, running around…” she said laughing. “Make sure you bend with your knees and not at your waist, when you pick him up.”

My chest ached witnessing this conversation. Oh, how I wish I could relate to my patients this way! I don’t have living kids to bond with them over and I hesitate to bring even my pregnancy experiences into the conversation, for fear that they will lead to the words “my baby died,” bringing sadness and attention to me in the exam room, when the focus should be on them.

It’s the same kinship I feel with patients who have had babyloss. I’m sure many of you have felt it too- when you’ve met someone who either shares their story with you or when you’ve heard of someone else and you reach out to them. It’s natural to want to say “me too!”

This is just one of the many secondary losses we experience after our babies die. I have lost the joy I had in relating to my patients. What are some of your secondary losses?

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10 thoughts on “Relating to my patients

  1. I now despise the ‘how many children do you have’ question. It torments me to be asked and even more to answer. I find myself staying out of situations where I will meet new people to avoid being asked.

  2. Mine all have to do with not being part of the mommy community in my neighborhood that I wanted so desperately to join, and not having our son grow up with K’s two best friends, who both had babies this year. Nothing new there…. and for what it’s worth, is it weird that I wish I were in CT so I could have you as my provider? I think there’s something very special when your midwife or doctor truly understands what it means to have lost your first child.

  3. For much of my husband’s life, he was defined by athletic and physical abilities. There were other aspects of excellence and talent that were overshadowed by descriptors such as, “state champion swimmer,” “Special Forces,” “sub-5 70.3,” “qualified for Boston (Marathon) on a training run,” etc.

    Then his accident happened. Grief struck. He was no longer able to compete, to be who he knew he was, and he had immense energy that needed and demanded an unknown outlet.

    In time, he turned to another source of excellence and talent. It’s left him fulfilled and he views it with the same determination and mental focus that netted him a sub-3 hour marathon.

    It took time, a lot of patience, and a believing-supportive wife (humbly said) for him to accept, but he has.

    Still, the losses are there. He went to an adventure park yesterday, high ropes. His balance was way off. His left side (once fully paralyzed) was unable to reach ropes. This man, who delights in his chest built from push ups, was humbled and reminded once more of his losses.

    Yet, as a twist, he met a guide who was 82nd Airborne (hub was 19th SF). They talked, took inspiration, and encouraged each other.

  4. For me, in addition to answer “how many children do you have?”, it is the friends’ kids pictures shared online. They never stop. It hurts to look and to be reminded of my loss.

    • ugh, yes! even the more simple question “do you have kids” puts me at a loss. yes/no/i dont know! But the sharing of photos online, I totally understand too. Having no new photos. and even when I share something new (like a photo of a carrot), seeing less and less likes, when my friends kids are commented on like crazy! it is a sad loss…

  5. I’m blowing up your comments today, sorry! I’ve had a busy couple weeks and haven’t been on-line much. Secondary losses, oh boy. Connection to my ex-husband’s family, since we split when I got pregnant (and would not have split otherwise – largely because I wasn’t ready to say goodbye to his family, especially his older son from a previous relationship). My identity as the daughter/sibling/co-worker that has everything sorted out and can handle whatever’s thrown at her… and my role as the person who will always be there as a rock for everyone else to rely on (ultimately, these identity/role changes are positive experiences, but they’re still huge and scary changes). The possibility of being a surrogate for friends who can’t have kids (with my good health, huge hips and comfort with needles, I was a shoe-in and looking forward to it… but after my big c-section, that’s no longer a possibility). My trust in medicine, science, myself, other healthcare providers. My ability to see late pregnancy and infancy as happy, beautiful times instead of absolutely terrifying times, my love for obstetrics, my interest in doing c-sections and possibly becoming an abortion provider. My desire to pursue another relationship and consider having more kids. My plan of working and raising Sacha at a jungle clinic before he reached school-age. The opportunity to see my grandfather holding my child.

    Oh man, I could keep going but I’ll stop it there 🙂 So many secondary losses to work through!

    • Blow it up! I love it!

      You totally mention one that I struggle with, that I havent talked too much about- trust in medicine. In all the amazing things I see happen in my hospital, the one I consider the best in the state, how can they not figure out how to save my “big” preterm baby! HOw could there be nothing to do prenatally for her? I know there was nothing they could do- medicine and obstetrics hasnt come that far. I guess it less mistrust for me, and more the awe has been stripped away. Yes, they can intubate and save 22 week babies. WOmen can break their water at 18 weeks and go on to have babies that live and thrive. (side note: these are rare successes, most of these babies don’t make it, but there are successes), but my 36 week, 5lb baby, who had fluid at least until 22 weeks, wouldnt respond to ventilation. I think I”ve lost my blind faith.

      also, I”m picturing you raise Sacha in a jungle clinic! Oh the idea makes my heart ache- in a loving and sad way!

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