So much sadness.

She stared up at the ceiling, eyes welled with tears, while I stared at the screen, searching, looking for anything that would give me better news. Moments before we were in another exam room chatting cheerfully about the latest developments in her pregnancy. She had just started feeling movement and her fundus was a few fingerbreadths below her bellybutton, just where it should be for 17 weeks. I searched with the doptone for the classic “thud-thud-thud” of her baby’s heartbeat but all I hear was static and artifact.

“Baby’s being stubborn,” I said, a sinking feeling already settling in my gut. “Let’s go take a look instead.”

I looked and looked, feeling helpless- the machine was old; I’m not a trained sonographer- but I couldn’t see the telltale flicker that told me everything was alright. Everything was not alright.

“I’m having trouble finding a heartbeat. “ I put down the probe as tears filled my eyes. I didn’t hide them- they were no match for hers as she let out a panicked and woeful “No, no, no!”

I sat her up and hugged her hard. I told her I couldn’t tell for sure- old machine, needing a formal ultrasound- but I was worried. I had to send her to the hospital. She called her husband, forty minutes away and I repeated my uncertainty- it seemed what she wanted to hear, what would get her through that endless wait for her husband and then the drive to the hospital. I sat with her for a bit and then had to go see more patients. Between each one I checked back in with her, not having any words to say to would ease the pain, because there are none.

Husband arrived, off to the hospital they hurried and everything was confirmed. Her baby had died.

Here I am, a babyloss mom myself and I was still at a loss. I thought of all the awful experiences people have had with their providers (and remembered the good ones too). But I had a sudden empathy for the bumbling providers. Some behavior is inexcusable, but there are many other clumsy caregivers who just wish they could take away the pain, but know they can’t. Stupid words fall from their mouths, medical processes are focused on- all because they were helpless. Their pain is nothing compared to the patients, but I had a little more insight. It had been a long time since I had to say the words and it was my first time since my own loss. It sucked. It was terribly heart wrenching for me and even more so for my patient.

So much sadness.

What was your experience hearing bad news? What was done well? What do you wish could have been done differently?

20 thoughts on “So much sadness.

  1. Oh no. I’m so sorry. I’m sure the situation is awful for both sides – it was clear that all my providers were so sorry and sad to break the news when my cervix was short, my water broke way too early, when A&C were born.
    Did she know about your loss?

    • I dont know if she knows. I have a sign up in my office but I have no idea if she read it and I didnt mention it at the time- there was too much shock in the moment. but I might share with her when I followup- if it feels right.

      THough of course I’m not glad that your cervix shortened and your water broke and you lost your babies, I am glad that if it had to happen, your providers could show a little empathy at such a hard time.

  2. Meghan, I read your blog every day, but rarely comment, as I do not have personal experience with baby loss. However, a very close friend lost her “baby” (which was later determined to be twin babies) right around 17 weeks, and I remember the terrible experiences that she had with her provider. I commend you (such a fancy word, but seriously – I am impressed and amazed by you) for considering your patient’s feelings, for checking on her, and for really considering any little thing that you could do to lessen her pain. Your efforts are certainly appreciated.

  3. How terribly sad for her 😦

    It meant a lot to me when my doctor cried when she couldn’t find kidneys in my baby. She couldn’t fix anything, and I didn’t even understand the gravity of the situation at the time (she was only holding onto the fact that she knew for sure: my fluid was low, and I didn’t understand that at the time). As much as I sometimes think she was a little clueless, that sticks with me.

  4. My bad news experience so far has been finding another baby funeral taking place at my daughter’s cemetery. It broke my heart to see her, the one still wearing her maternity dress, with the IV plaster on her hand.. I couldn’t go over to speak with her, didn’t want to intrude, but I hope one day she reads my baby’s headstone and looks me up (both my names are written there – with my phone number!- I initially had them put on there in case she had an emergency- like a grave crack – yes am wacko) but I also hope someone walking in these shoes behind me reaches out to me through that.

    • oh wow. I can only imagine how sad that seen must have been. It’s lovely that you have you info on your baby’s stone- just in case someone else might need to reach out.

  5. I am so sorry for both you and your patient. I am sure that you did everything that you could. I think the only reason you are worried you didn’t is that you hold yourself to a very high standard. I remember one of the sweetest things my R/E did. It was right after I told him I’d seen enough to know how my poorly progressing pregnancy was going to end. He reached over and patted me on the knee (I was still in stirrups), and said, “I know. I’m sorry.” That simple touch meant so much to me. Also he sometimes gives my foot a little squeeze. It sounds odd, but it’s comforting. I’m sure your patient was comforted by your small gestures as well, even if she doesn’t know it until the shock has worn off.

  6. With my first pregnancy, I went to for an ultrasound at a small imaging place (my OB did not have the machines onsite) at 12 weeks. There was no heartbeat and the staff had not been trained to manage the situation compassionately at all. I was alone for the appointment (assuming it would be quick and happy), and after saying bluntly, “there is no heartbeat,” the tech left me in the room, on the table, with the image still on the screen. I just remember staring at it and sobbing.
    Someone then came in and told me they would call my doctor to see what I should do, and they moved me to a small closet-sized room with a phone. They said the my doctor’s office would call that phone and they would tell me what to do. I was left in there for a while, no one came to check on me, and from there I called my husband and my dad.
    Finally the phone rang and I was told to head to my OB, so I just walked out, back through the waiting room full of pregnant women waiting for their turn. I never want to go back to that place again.

    • i had a patient who had a similar experience. SHe came to my office after an outside ultrasound place (one that we didnt use often) and she came to my office describing the lack of sympathy from the radiologist- she said he gave her the news with a smile. How awful! Really, i think radiology needs some better training!

  7. I discovered my baby had died on an ultrasound at 10 weeks. There are no words for how excited we were to see the baby, and how shattered we were that she was silent and still. I cried and cried. Two months later, pregnant again, they wanted to do a viability ultrasound early. I was terrified to be in that room again. My husband was deployed and I had to go alone, with him in harm’s way.

    Baby was alive. Heartbeat perfect. Nurse looks at me and says, “See, your husband was just bad luck, is all.”

    She is a good person, was good to me throughout, but I’ve never forgotten those awful words. Thanks for this post which helps me see it from her side. My pain and sadness had to be heartbreaking to witness, and she didn’t know what to say.

    • Oh my!!! Yes, it is hard to find the right words to fill the space (i’ve learned that from being on the receiving end) and sometimes we all use humor when we are at a loss of what to say. but ouch- still hurts a bit hearing that! (its very kind of you to be so forgiving)

  8. After one of my missed miscarriages was discovered, the tech hugged me and got teary-eyed for me. I remember saying through tears, “This is the third time!” and she said, “I know, I know. It’s horrible and I’m so sorry.” It meant so much to me that she would hug me, even though I didn’t have the strength to hug back. That gesture–along with her tears and her words that acknowledged my pain without platitudes–meant so much.

  9. Oh. That could have been me — I was only about a week farther along than your patient. I wish you had been the midwife giving me the news. Even when it was blindingly obvious, my midwife never told me what was going on. After unsuccessfully searching with both the Doppler and the ultrasound she just cheerfully chirped “Oh, I’m not good at ultrasounds, so I’ll go get the doctor — she’s at the hospital so it’ll be about 20 minutes,” and then left me and my husband (thankfully my husband was there) alone in the room for the 45 minutes it took for the doctor to arrive. Needless to say, we had already figured out what had happened, and quickly started sobbing, but we were also confused and in shock because nobody had actually told us that our baby had died even though it was obvious. When the doctor came in and saw us crying, she still didn’t tell us what had happened, she just said she needed to make some measurements, and had me lie back down and put more goo on my belly. And she never gave me options for how to handle it — when she started talking about inducing labor and in a moment of clearheadedness I asked “What are my options?” she essentially told me I didn’t have any, which I now know is not true. There were other things that happened later that made it clear that this practice was sloppy and not good at dealing with late loss, so I have since found another doctor that I’m more comfortable with. I’m so glad you were so empathetic with your patient, and that she had you to support her while she was going through this terrible, shocking experience that is probably going to change her life. She’ll remember your kindness and your straightforward answers — nobody forgets that moment.

    • ouch. to be left alone with no information! as if your mind isnt enough to work up the worst case scenarios. I had to leave this patient for a bit on her own as she waited for her husband (the sad truth of having a full day of patients), but after each one I popped by in the room to see how she was. And i had my assistant interrupt me the moment her husband got there, so there would be no delay. I think of the day when I was told Mabel had no fluid. I asked the sonographer what she was looking at- she told me fluid. I asked how it was- she said low, 1.7cm. And then she left to immediately get the doctor. As a midwife, I knew how bad low fluid was at 27 weeks, but I do really appreciate her telling me and not trying to avoid. I cried as she left, thinking of what it meant (turns out it was even worse that I thought). That experience and from reading others experience I thought being direct, but kind ,seemed the best way. though I always wonder how I could do better. I;m so sorry you had such an awful experience on many levels. there is no easy way to give the news, to receive the news, but I think honesty and kindness seems the best way. you are right. nobody forgets that moment.

      I’ve had the privilege of following up with her a few times- asking about her delivery, names, plans for services and later giving resources. my loss has given me the tools and knowledge to know that the followup is just as important too.

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