I had the lab results in my other box, beta-HcG, positive, means pregnant. I called. She was surprised; she was supposed to have a quantitative - she'd been seen in ED for bleeding, likely miscarriage, follow-up HCG in two days to see if it's dropping. I had a new OB intake scheduled with her on Thursday. She was concerned, she's still got a little bleeding. This was an unexpected pregnancy that she was just starting to like the idea of, just starting to want. And she doesn't want to miscarry. Nobody does.
I called the lab. They had a stored tube. They reran the test. They said they would page me results, but when I got back from seeing a well-child check the results were in my mailbox, faxed. Numbers going down. I'd expected that; I'd seen the ED reports - 1 week 1 day-sized baby at 9 weeks on ultrasound, but a heart beat. I had hoped. She was going out. "Have the clinic page me when you get back," I said. "I should have them by then."
I'm on ER this month. After getting 5 hours of sleep at the Chicago hotel, coming in at 9:45 AM, showering and running to the hospital, getting my TB test placed then noon conference then looking for someone to take my clinic then patient calls, I worked until midnight (I will tell you some of those stories later), got to bed around 1, and woke up again around six. And I've got post-travel fatigue. I went home after morning clinic today and slept. My pager woke me up.
How do you call someone and tell them that their fears are true? She wanted to know, she'd had some preparation in the ED, but still I was handing her confirmation. I called. I got her on her cell phone, the number she'd left me. "It's Dr. B. I talked to the lab." Pause. Okay? "The numbers are going down." Going down...what does that mean? I could hear in her voice that edge that means 'tell me that word doesn't mean what I think it means' and I didn't drag it out. "It means you likely are having a miscarriage. I'm so sorry." Pause. It's never a great connection when there's bad news. The silence holds pops and clicks of static; interruptions in my thought. I gave it a moment or two, but silence is a double-edged sword, when you are not face to face. "You have an appointment on Thursday. I know it was supposed to be a new OB appointment, but I still want to see you. I want to talk about how you're doing, what to expect, next steps. I know this is hard." This woman does not know me; she has never met me. The first time I talk to her I tell her she is losing her baby. What is she supposed to say? Yeah, she says. It is. Thursday. I'll be there. "I'm sorry. Hang in there, I'll see you Thursday?" Okay. Beat. Long beat. And goodbyes. I hung up trembling.
I forgot things about phones. I forgot to make sure she was at a good point to talk, not driving, things like that. I am always a little awkward on the telephone, and I am afraid of how that came across. I am consumed with me now, that strange introversion that comes with a new and uncomfortable experience, putting it on, testing the fit. I have decided already that I do not like being the deliverer of bad news; I like it even less over the telephone. I doubt I will ever be comfortable with it, and I don't think I should be. But at the least I can do it well, I can maybe ease the sting as much as possible, and I do not think that today I did it as well as I could have.
What say you?