In Shock Page 18

  We left the social worker’s office believing we would adopt. We prepared a binder of sunny, enticing pictures of our lives together. Photos of us engaged in activities children would enjoy, like eating ice cream and making art. We got on the waiting lists and waited, unsure if we were being overly cautious or overly optimistic. We didn’t know if my body, after what it had survived, could even become pregnant. We didn’t know if a birth mother would choose us. We debated and wondered and then decided we would trust in something bigger than ourselves to determine our path. We would stand in the presence of our lives and embrace whatever approached us. I stood in church and promised silently, Whatever baby you decide to bring to me, I will know is it is meant to be mine. And we became pregnant before we could adopt.

  And so it came to be that we were sitting in an obstetrician’s office rather than a social worker’s. The obstetrician entered and sighed as he sat, smiling at us and our chart in series. He looked exactly the way you hoped an obstetrician would look, late-middle-aged with grayed temples and sharp glasses. He had clear blue eyes that conveyed an intent to get things right. His shoulders were slightly hunched and his brow furrowed despite the smile.

  “I know, we’re here really early in the pregnancy,” I explained, thinking his sigh was a message meant to convey that we were too excited, too early. “And I know that there isn’t anything much to do so early, but … well, you know what happened last time, and, well, we’re probably crazy now. Which is why we are here, I guess. For reassurance.”

  “Yeah. That’s OK. You’re at about six weeks, right? That’s fine,” he reassured us.

  Smiling at me sadly, he then said, “I might not be seeing pregnant patients for much longer. I’ve been trying to cut back on my hours. If I could get down to eighty hours a week, that would be really great. I talked to my chairman; I told him I just couldn’t keep up with the pace anymore. I love the work; I am just trying to find some semblance of balance.”

  He described the toll his job had taken on his family. His difficulty in his first marriage, the kind of husband he wanted to be but wasn’t. The way they blamed each other for their failures. The stigma and the blame of the cases that ended poorly. The variety of unhealthy coping mechanisms he’d sometimes employed to get through. How he was exercising more and it was helping. He cited chewing gum as his only vice.

  “It is hard work being a parent,” he admitted. “And a spouse. And it is hard work being a doctor. We carry around a lot of fear and anxiety and shame, don’t we?”

  I nodded. Randy’s head ping-ponged between us, unsure as to whether he was understanding what he was seeing.

  “Yeah, I know. So, you’re six weeks pregnant, and that’s wonderful. We’ll check some blood work and you’ll have an ultrasound in two more weeks. Maybe we’ll get lucky and see a heartbeat. That would be nice.” He smiled. “It’s just that I want you to know, it never gets any easier, you know? But it will be fine. One way or another, it will be fine.”

  I felt suddenly certain I would cry. His suffering was palpable, and I knew by extension he more than understood our special kind of crazy. And I trusted him that no matter what, it would be fine. Either way, we’d be OK.

  Anxious patients can be frustrating. Their endless lists of questions are easy to view as some passive-aggressive indictment of our capabilities. Physicians often become defensive, or worse, patronizing. Hearing “don’t worry” or “just rest” is, more often than not, frankly insulting. And I had heard that repeatedly. But then there were physicians like him, physicians who had had their hearts broken. He understood implicitly where I was and how I had gotten there. He had been humbled by his own suffering.

  He spent the next six months in partnership with us, accessible and present. He validated our occasional fears and meticulously followed through on his promises. And just as he had assured us, it was mostly fine. It wasn’t until the twenty-seventh week that we realized there was a serious problem.

  As was true of every other stitch placed that first night, the ones placed in my uterine wall were intended only to vaguely approximate tissue, not to facilitate healing or entertain the possibility of future pregnancies. As the baby grew, and the wall stretched, it became perilously thin.

  He called me an hour after my routine ultrasound was completed.

  “Hi, where are you?” he asked.

  Oh, how I hated that question. “I’m here, in the hospital, I just had my ultrasound, but you probably already knew that. I was just headed back to the ICU.” I realized I was rambling, possibly as a means of stalling the news.

  “Good.” He was not deterred. “I want you to go to OB triage, and tell them I said to put you in a bed on the prenatal ward, and give you a steroid shot to help the baby’s lungs mature. Do that right now, OK?”

  “Why? What’s wrong?” I asked, struggling to catch my mind up with the apparent urgency of the situation.

  “The wall of your uterus, in the area of the scar, it’s just that there’s no muscle there. It’s about two millimeters thick and it should be two centimeters at least. You are at risk of uterine rupture and you need to be on bed rest immediately, that’s all.”

  My initial reaction was pure self-pity. I wondered silently and aloud why it was so difficult for me to get past this stupid seventh month of pregnancy. The disappointed voice didn’t last long. It was quietly and tenderly replaced by a comforting line from “Birthday Girl”: “No matter what happens to a person, he or she will always be who they were meant to be.”

  “It’s going to be OK,” he assured me. “I’ll ask the neonatologist to come by. We’ll handle everything. They’re used to early babies.”

  “I know you will, but it’s too early,” I told him, remembering the awful translucence of the first baby’s miniature body from the black-and-white photo.

  “Maybe we can get a few more weeks out of you, we’ll see. But either way, it will be OK. I want you to remember that.” And with that he hung up.

  I sat, phone in hand, wondering who to call first.

  * * *

  I was checked in and handed a gown. A papery ID band that recalled entry to childhood carnivals was secured tightly around my wrist. As I looked down at the gown and neon socks with built-in traction stripes, I recognized myself as a patient. Then a long needle was plunged into my backside as if to accentuate the conversion. Randy arrived, shaking his head, incredulous we were here again so soon.

  The neonatologist laid out the possibilities for us. “At twenty-seven weeks, it’s certain the baby would need breathing support. By thirty-two weeks this decreases significantly. The risk of bleeding into the brain, or intraventricular hemorrhage, is decreased by the steroid, but still a very real complication, and the incidence similarly decreases with age,” he said. “Usually by twenty-seven weeks, it’s rare to lose the baby. We can do what we need to and keep them alive, it is more a question of disability.”

  I smiled at his confidence, knowing we’d lost the last baby at exactly twenty-seven weeks.

  I listened to each risk estimate he put forth, each horrific possible scenario, with a certainty that it would be OK. It wasn’t that I didn’t value their carefully formulated risk estimates, it was just that in the same way my body had warned me of its own impending demise, it was now covertly reassuring me that it would be fine.

  Whatever the challenge or disability or setback, I would be who I was meant to be. And something told me I was meant to be this baby’s mother.

  I made myself at home on the antepartum ward. I was kept entertained with a steady supply of books, food and company. Randy came every morning on his way to work and every evening on his drive home, as if the hospital were a refueling station on his daily commute. He brought in bouquets of brightly colored tulips to cheer the room. They served as a visual reminder of rebirth allowed by each change of season. My mom would arrive laden down with bags of soft pastel reams of wool and warm food. She patiently taught me to knit, effortlessly crafting beautiful re
ceiving blankets by way of example. I knitted misshapen hats and booties from online patterns. The days passed peacefully, with a comforting rhythm that allowed for testing, but also space to not feel as if I were a patient every minute of the day.

  My friends and colleagues stopped by to check on me; as I was conveniently located within our shared workplace, it made a good break in the day. They seemed consistently surprised to find me perfectly well. Behind their cheery greetings, there was often a fine trail of sorrow trailing behind them. Bad outcomes, elusive diagnoses and mistakes that left them tinged with guilt followed them into the room. In that quiet space, where absolutely nothing new happened to me from day to day, there was space to fill. They were offered tea or homemade cookies by my mom and the disclosures would follow, liberated by the shared time, carbohydrates and caffeine. Though they arrived most often in pairs, in my memory we’re all in the room together, at the same time, sitting in a circle. Drinking strong tea or coffee out of small Styrofoam cups. There would be a period of silence and someone would start talking.

  I have a kid in my unit, he’s not quite brain-dead, but anything that would have defined him as himself is clearly never coming back. But he can breathe above the ventilator and blinks once in a while. But the family just can’t accept it. They keep saying they are hoping for a miracle, so now the poor kid will get placed in a nursing home for the rest of his life. And I just feel horrible about it. Like I somehow should have stopped this from happening. But I didn’t know how. How could I have done that differently?

  I came to recognize these admissions as a form of purging. These were the thoughts that haunted us. They nearly always came out rapidly, with almost pressured speech. Always en bloc, without even a pause. The questions posed within them were entirely rhetorical. Asked of themselves, of the room and of me, without any expectation of an answer. They were our collective memories, shared in traditional storytelling format. Uniting us as a group by reflecting our shared experiences back to us. As if we had hit our limit of individual understanding, and by sharing our experiences with our little community, we hoped to understand them through the combined wisdom of our group.

  We rarely responded to each other, opting instead to share another event or struggle. At times the disclosures were framed as irritations or annoyances, when really it was a deep remorse over a flawed system that we felt powerless in the face of.

  So, my team told the patient that Nephrology wouldn’t offer dialysis because of how sick he was and that the patient should really have comfort measures only. Then, Nephrology comes by and says they will dialyze the patient. So we look as if we aren’t communicating, which I guess we aren’t, and everyone is confused. And now the family doesn’t trust us, or our suggestion that the patient enroll in hospice.

  Rather than any awkwardness, the silence in between disclosures was a kind of tacit support. It said, Yes, I know how that feels, and it’s terrible. I have felt how you feel and I have no answers. I saw how, lacking other options, we internalized so much of the anger that was directed at us. We believed being conciliatory and acquiescing in the face of confrontation was the professional thing to do. Friends who were physicians at neighboring hospitals would visit, and I would be struck by the commonality of our experience, regardless of venue.

  The team wasn’t sure of the code status of the patient, so they did thirty minutes of CPR and intubated the poor ninety-six-year-old man, and his daughter comes in this morning just livid, not understanding how this could happen. What could I say but “I’m sorry”? Because honestly, I don’t understand how it happened either.

  There was a range of distress expressed that went from compassion fatigue to addiction to full-fledged burnout.

  I’m finding it hard, seeing so much sadness every day, to even feel it anymore. And I’ve been drinking so much more lately, and I know it’s not good, but honestly it’s the only way I can fall asleep.

  I am seriously considering switching training programs or getting an MBA. This just isn’t what I thought it would be like, clinically. I don’t feel as if I am making a difference for anyone in any meaningful way.

  And at times, we reflected on utterly heartbreaking moments that somehow were supposed to be just part of a day’s work.

  The patient wouldn’t accept a blood transfusion, so I told her, “That’s fine, we’ll deliver the baby and I’ll hand it to you and you’ll have maybe one or two hours with your baby, and then you’ll have to say good-bye.” And she looked at me and said, “You mean I’ll die?” And I had to tell her, “Yes, without blood, you will die, but I will honor your wishes that you do not accept a blood transfusion, even if I don’t agree.”

  We had no idea what to do with our own feelings over the losses we carried.

  Today I had to watch a seven-year-old say good-bye to his mom, because she won’t be getting a liver transplant. He looked at me and said, “Are you going to fix my mom so she can come home?” I mean, what am I supposed to do with that? I’m scared to go home because I know as soon as I see my kid who is about the same age I’m going to lose it.

  There was heartbreak and mountains of guilt and the desperate wish for some mechanism, any mechanism, to augment our resilience. As a physician, I understood how perilously close we always were to failing someone. Even when we intended to do no harm, it seemed we lacked the necessary tools to heal without layering in some added suffering.

  I didn’t realize during these visits what we were doing in sharing these stories. I didn’t know that we were exploring the relationship between memory and trauma. But because the site of the trauma was always in our workspace, and would necessitate being revisited rather than sanctified, we had to find a different way to venerate the loss. While the rooms our patients inhabited were the sites of shared trauma, they could not assume the connotation of a consecrated space; they had to be reused. It’s interesting: in turning over the rooms to the next patient or the next procedure, we were obliterating the memory of the sacred. In communities that experience a shared loss, obliteration is usually reserved for tragedies that are a source of shame. Did we realize we were obliterating our losses? Was it because we lacked a marker for the trauma that we absorbed it into our beings? Having no physical place to memorialize them, we collectively took them on as our own. We held them in our chests and in our stomachs and in our hands.

  I saw how much we all hurt in the same vulnerable places. The shame of doing your best and never having it be good enough left its mark on each of us. And though we’d grown accustomed to never discussing it, there was a grace and a mercy to be found in sharing our pain. It transcended the individual trauma, united us as a sacred group. By organizing and understanding the events within a social context, we organized and mapped our memories in the kind light of shared understanding. I knew then that the deficits I had witnessed as a patient and my struggles as a physician were not in any way unique to me. And I knew that while we had no solution between us, we were a community.

  “You have a really hard job,” my mom would say, looking up from her knitting needles, addressing those visiting in the same way, almost independent of what they had said. And we’d nod. She was acclimated to the sadness of our stories as well as the harshness of our own lens. There was no judgment and no attribution of blame, only acceptance. It was such a simple validation, and yet for us, in those moments of risk and exposure, it was what we needed. We had sanctified and found refuge in such an unlikely place—a room on the obstetrical floor, just meters from where I had first died. And perhaps what was the most surprising was how little it took to heal our spirit. A safe space, shared disclosure within a trusted community, and we could each breathe again. We could reenter our world.

  The bonds formed in that room outlasted my stay there. Even years later, when we encountered each other in elevators and hallways, we would skip the superficial and say exactly what we were thinking.

  “Did you hear about the suicide over at the medical school?” my colleague asked a
s we walked in to a meeting. I had.

  “I’ve been thinking about running a seminar for medical students on shame. Would you be interested in helping?” he asked, his eyes cloudy with sadness. I would.

  We found each other when we had a case that unhinged us. We didn’t hide. We texted each other after a code: I need to debrief, and we would come together and we would listen.

  Our circles gradually expanded, bringing more people into the protective fold. We brainstormed and collaborated, finding agency in our shared grief. We developed seminars and communication workshops, armed ourselves and other physicians with the tools necessary to navigate difficult conversations. We gave lectures on empathy, we shared poetry by e-mail and tried reflective writing. We admitted we needed each other. We became a community.

  * * *

  Before we managed to put any of that in place, I was offered a reminder of why it was so necessary. Four weeks into my stay on the antenatal ward, things deteriorated, and my uterus threatened to rupture. It began subtly contracting, challenging the thin wall, leading the obstetrician on call to come in to introduce himself, just in case. His insistence upon addressing me from just inside the doorframe immediately irritated me. He appeared tired and vaguely bored. He asked me no questions but instead began by saying, “I know the plan is to take you to the OR in the morning, but if things get worse, I just wanted to have met you.” I considered his statement and was confused by it. He wanted to have met me, as if that were the only prerequisite necessary to operate on someone.

  “OK, so you’ve seen my scans?” I asked.

  “No, I haven’t, but it’s fine. There’s nothing to worry about,” he said, attempting to reassure me.