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.
“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?