The Magic In Transparency

This phrase struck me as the perfect way to describe an experience I had my intern year. My first continuity ob patient had a fetal demise at 34 weeks.  She was the first patient I had followed from the beginning of her pregnancy.  I performed her dating ultrasound at 9 weeks.  Unlike many of my patients, she and her husband faithfully came to every prenatal visit.  She did not smoke, use drugs and followed the dietary guidelines.  Her husband was the chatter one of the duo, while she would calmly take everything in at our visits.  They both teared up when I told them they were having a girl at the 20 week ultrasound.  They told me her name was Emma.

Then, I received a phone call from my colleague who had seen them for a prenatal check.  She could not find heart tones and did not see movement or cardiac activity on ultrasound.  They were sent over to the hospital where the demise was confirmed.

I drove to the hospital and sat in the residency conference room.  I was terrified to go up and see them on L&D because I kept thinking how they trusted me and I had missed something.  They wouldn’t want to look at me, let alone talk to me. I cried.  Then I poured over my records to find what I had missed.  I am grateful to have had an attending that I was able to sort through the case with, and who gave me the confidence to go face them.  I was armed with explanations but when I saw their faces, I had no words but I’m sorry.  I sat while he spoke and she cried.  Neither one could make eye contact with me.  Then he said, “I just wish we had known something.” I said, “I wish I had known something, too.” The change was immediate.  They both looked at me and we all cried.  They asked me to deliver Emma, which I did.  I was the one they wanted to hear from regarding the autopsy.  They said the words, “we trust you to get us all the information.”  I gave them my cell.  She brought me an angel pin to wear on my white coat at her 6 week post-partum visit.

I wanted to give in to the fear.  To not face my patients in the midst of tragedy.  To listen to my internal excuses that they would not want to see me. But a supportive faculty member pushed me to face my fears.  This set up a moment.  One moment of vulnerability, one moment of unveiled honesty.  Eye contact.  The magic of that transparent moment forged a therapeutic bond that I will never forget.  I am happy to now have words for it.

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