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?

Good Parenting

I watched the mother parent her child. She was great. She answered my questions through the visit while still keeping her one year old quiet and engaged at the same time.

I brought that baby into the world one year ago. In the before, I would coo and oooh and ahh at the child. “Remember me?” I’d ask the kid, smiling at my own joke. “Or maybe you remember these?” I’d stick out my hands in my baby-catching position towards the child. That would usually get her mother laughing.

But now, in the after, I gave the quickest, faintest of smiles toward the baby and focused my attention on her mother. The baby became restless, strapped into her stroller and her mother was bound to the exam table. So I worked my magic, blowing up a blue exam glove into a balloon, as I continued to listen to my patient. I handed the glove balloon to the child without ever losing eye contact with the mom. I bought us another few minutes.

During the exam, the mother took over and effortlessly kept her child occupied. They counted the fingers on the exam glove.

“One, five!” the little girl shouted.

“Almost…” her mother said laughing quietly. “Can you say ‘two?’”

“Blpppth!”

It was a beautiful interaction watching the mom, such a natural teacher. She didn’t use a baby voice or play it up for my benefit. I was impressed that such a young baby even knew that five was a number. I watched and listened surreptitiously as I did the pap smear.

After the exam was over, the patient looked at her little girl and said to the baby, “she delivered you.“ She said it kind of sadly, in a way that made me realize I was in some way disappointing her. She wanted the before Meghan- the one who coos and cracks jokes about being at the baby’s very first birthday party.

Oh, how I wanted to tell her that I know I delivered her daughter! And she had grown up into such a beautiful toddler, the kind that should be in a diaper commercial. She seemed smart and I think that’s because her mother was teaching her so well. She was a good mom.

I wanted to tell her that watching her parent so well caused my chest to ache. That it impressed me, but also brought me sadness. I saw in her mother-child duo, what I had lost: The chance to parent well. Or the chance to even parent poorly. The chance to parent my baby at all! Many of us in the babyloss community have our gripes when we see people who are parenting poorly in our eyes- those who yell harshly at their kids, those doing drugs in pregnancy, those who show no appreciation for what they have. The injustice that they get to parent live children stings us all.

But seeing good parenting has its own sting for me. I want to be that parent! Sadly, all mothering is some sort of trigger for me. All kids are reminders. Newborns remind me of the Mabel that I knew. Six month olds remind me of the Mabel that should be now. Older children remind me of the Mabel that will never be. Mothers remind me of the mother I don’t get to be.

 

Some people were raised well

She was a young woman. Some people do well at the gyn and for other’s it’s a struggle everytime to make it through the door. I had one patient tell me she’d rather come to me for a pap smear than go to the dentist (so true! Me too! Pelvics take 2 minutes, the dentists takes an hour!). Another patient tells me each time that she cant understand how I can do what I do. It all grosses her out.

This nervous young woman said in the middle of her visit- the visit that was focused on her and her issue and her nervousness around the exam- “I just want you to know I’m so sorry about your baby.”

In all her nerves and angst, she could take a minute a look outside herself and say something kind. That’s amazing.

I smiled. Thanked her. Thanked her for saying something.

It’s young women like these that make me want to hunt down their mothers and just say “Good job. You raised her well.”