Breaking Bad News

A few months ago I participated in a small group session about breaking bad news.  It was a requirement during my Ambulatory Rotation in December.  During the session people took turns role playing a physician breaking bad news to a patient.  In each activity the patient would react differently, perhaps getting angry or expressing denial, and the doctor would have to respond appropriately.  I attended a similar session last year as an intern.  However, I had no idea that only a month later I would find myself in just such a situation.  Unfortunately, this time I would find myself in the role as the patient.

I suppose that this is as good a time as any to announce that I am pregnant.  My husband and I learned at the beginning of November that we were expecting our second child.  In fact I found out after my second long-call shift in the ICU.  My month of working 28-hour shifts every three days was especially tiring in early pregnancy.  I had lots of nausea, but no vomiting.  And unfortunately, it meant I had to limit my caffeine intake, so some nights felt especially long without some caffeine to sustain me.

In December I crammed for and took Step 3 of the boards, my second board experience while being pregnant.  I felt complete unprepared and left feeling like I had surely failed, but learned later that I passed with flying colors, one more test to put behind me.  I had planned my first OB visit the day before my exam, but mixed up my dates and ended up rescheduling my appointment.

Two days after Christmas I went to see my OB for my first visit at 11 weeks.  Things went well until we couldn’t heart a heartbeat with the Doppler.  No big deal, this happens sometimes this early in pregnancy, so she sent me across the hall for an ultrasound to make sure there was a heartbeat.

As soon as I saw my baby on the ultrasound, I felt such a relief.  I could see one (yes, only ONE!) tiny little baby, wiggling and wriggling around.  And I could see a tiny little beating heart.  Now I could relax, knowing I wasn’t having twins and that the baby had a heartbeat.  But I could also tell something was wrong.  I had multiple ultrasounds when I had Anika.  And this time I noticed the technician was unusually quiet.  Maybe it was nothing.  Not everyone is talkative.  But something felt off.

My suspicions were confirmed a few minutes later when the technician left to go get someone.  I knew who she was getting.  She left the machine on, she didn’t wipe off the gel.  She saw something.  And she was going to get the doctor.  And I knew.  He was going to be breaking bad news.

In walked to the doctor – the maternal fetal medicine specialist.  He introduced himself and sat down.  And I knew exactly what he was doing.  I recognized every step, every technique.  He fired a warning shot.  My ultrasound was abnormal.  He spoke slowly and clearly, trying to let his words sink in.  There was fluid.  Fluid where it shouldn’t be.  Fluid around the brain.  Fluid around the spinal cord.  My baby had Hydrops.  He showed me on the ultrasound.  He asked if I understood what he was saying.

My mind flashed back to medical school.  I remember learning about it.  I couldn’t remember all the details.  But I knew it wasn’t good.  I also knew that, based off my training, I was probably going to forget most of what was said for the remainder of the visit.  I tried to focus.  I held back the tears.  I asked him what exactly that meant for my baby.  Probably a chromosome abnormality, such as Trisomy 13 or 18, possibly down syndrome.  Or it could be a cardiac defect.  Again, I remembered learning about trisomies in medical school.  I had vivid images of deformed babies with cleft lips or one eye.  I asked what the next step was.  A blood test, he said.  This would tell me my risks of chromosome problems.

And then I asked what I dared not ask.  With this ultrasound, what were the chances my baby would be born without any problems?  He said, “Well, that would be very rare.”  He asked if he could call anyone for me, as I had come to the visit alone.  My husband was somewhere in-flight to Cancun for his 30th birthday.  I had no one to call.  I was alone.  He was very kind.  He said I could call tomorrow if I forgot anything he said or thought of anymore questions.  And I knew at that moment that he did a very good job of breaking bad news.  He had done this before.  But it didn’t make it any easier.

I sat sobbing in the waiting room to get my labs drawn.  I looked around and hoped that no one would recognize me.  This was my hospital after all.  They called patient after patient while I saw with tears streaming down my face.  Couldn’t they see which lab they were drawing?  Wouldn’t my lab take precedence over everyone else’s CBCs and BMPs?  I just wanted to go home and cry.

I cancelled my afternoon clinic.  I felt guilty knowing my patients would need to be rescheduled, but I knew I couldn’t go.  I tried to call my husband, but I couldn’t reach him.  I texted my family and close friends.  I asked for prayers.  And I knew I shouldn’t, but I started to research Hydrops.  The prognosis was poor – 50-90% chance of fetal demise, and only around 40% of babies who were born survived to 1 year.  I researched every possible etiology of Hydrops – Edward syndrome, Patau Syndrome, Downs Syndrome, Noonan Syndrome…you name it.  I didn’t even know what to hope for.  What was the best case scenario in this situation?  A heart problem?  Miscarriage?  I felt so confused.  I couldn’t imagine burying my baby.  But I couldn’t imagine a baby with special needs either.  No matter which scenario I imagined, I knew that I couldn’t handle it.

I was finally able to reach Nick later that night.  I felt horrible breaking the bad news over the phone on his birthday.  And he felt horrible that he was so far away, and I was alone with such news.  He was able to fly home several days later.  We cried together while we waited for my test results.  It took a week.  The longest week of my life.  But we had good news, the labs showed that we had low risk of chromosome abnormality.  And it also showed that we were expecting a girl.

We met with the MFM specialist a week later.  He scheduled another ultrasound.  In the meantime I asked for prayers from everyone I could think of.  We had hundreds of people – friends, family, complete strangers – praying for our baby girl.  We needed a miracle.  And if God wouldn’t grant us a miracle, I just asked for strength for whatever lay in store.

Nick was able to go with me to my next ultrasound.  I held my breath as the technician looked at our baby.  Her little heart was still beating.  She was kicking and sucking her thumb.  It was a relief just to know she was still alive.  I felt a sense of hope.  This time the technician was very talkative.  That’s a good sign, I thought.  But again, she left to go talk to the doctor.  Again, I became worried.  That was never good.  She returned a few minutes later, without the doctor.  She sat down and said she had discussed the ultrasound with the doctor.  They had compared it to our previous ultrasound, and he said that the baby looked completely normal.  Whatever had been seen on the first ultrasound, was completely gone.  She said that the doctor couldn’t believe it and told her, “They must be saying a lot of prayers.”  In all her years as an ultrasound technician, she said, she had seen a number of miracles, and she was glad that they were still happening.

As I sit typing this I can feel some tiny baby kicks.  Something I thought I may never get to experience.  I feel so blessed, so lucky.  So many people out there don’t get the miracle that we did.  I know that anything can happen, and I still have five months to go before I can hold my baby girl, but so far things are looking promising.  I have more ultrasounds and a fetal echo ahead, just to be sure.  I am grateful for the physician who had to break the bad news to me.  Having been in his shoes, I know it’s not an easy job, but someone must do it.  Now that I know how it feels to be on the other side, I hope that it will help me be more understanding and more empathetic the next time I’m called upon to break bad news.

Baby girl Howard - Due July 16

 

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About emilyehoward

My name is Emily, and I am a second year Internal Medicine Resident in Phoenix, Arizona. I live with my husband Nicholas and my daughter Anika. And I hope you enjoy my blog!
This entry was posted in Doctor, Health Care, Medicine, Osteopathy, Physician, Residency and tagged , , , . Bookmark the permalink.

5 Responses to Breaking Bad News

  1. Gena Reich says:

    Wow! I will still be praying everything continues to go well.

  2. Shelly Chloupek says:

    Touching post, Em. I have read it several times and each time just can’t wait to get to the “good news” part of the story. I continue to pray for you and Nick and Anika.

  3. CONGRATULATIONS!!!

    I’m so sorry you went through that. From one momma doc to another, you are doing a fantastic job, and will be a great momma to this new little one. I am so glad that you got good news on the follow up! I will be praying that everything continues going well for you.

  4. Maria says:

    Congratulations and prayers that your baby girl continues to be healthy! I can’t imagine going through such a roller coaster, and that alone. A doctor friend had recounted at her father-in-law’s funeral that all the medicine seems to escape your head when things are going downhill. Glad your doctor was good at delivering the news, though. Looking forward to reading more about your baby! ❤

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