Second Trimester Tragedy

The patient had come in for something minor—slight vaginal spotting or minor cramps—at 19 weeks gestation but over the course of the morning had become more uncomfortable. “The cervix is open, it’s an inevitable abortion,” my colleague said, using the vaguely poetic medical term for a pregnancy that is all but lost. The pregnancy was pre-viable, before 24 or so weeks, so there was no way to sustain the fetus outside the patient’s body. My colleague made the plan with the emergency room to bring the patient upstairs to our OB-GYN floor. “We can watch her here,” she said. “If we have to, we can deliver her here.”

Twenty minutes later, I am still at the nursing station trying to finish up my notes when I hear a lot of noise coming down the hall. A woman, in a stretcher, is arching her back in pain. The transport guy is working as fast as he can to get her into the vacant room. The patient’s mother is cursing at the transport guy, at the nurses who swarm the stretcher, at me.

I’m not supposed to be her doctor, but I’m there, so now I am. I talk to her. I move her into a more comfortable bed and explain what she has already heard. I offer her morphine; I warn her that it might make her forget, but she is grateful to accept it. Ten minutes later, she delivers a tiny waxy fetus with extensive bruises under its translucent proto-skin, followed by a small placenta. The fetus shows no spontaneous movements and has no heartbeat.

I wrap the fetus up in a blanket and put a hat on it, which is what we do. It makes it look larger, more like a full-term baby. The bundle still looks too small, the barely formed eyes still alien, but with the blanket the bundle now has a more familiar heft; it feels like something with substance.  I put the bundle in the patient’s arms. Her mom, no longer combative, is on the phone, hunched, small, her voice breaking. “She lost the baby,” she says. “The baby ... it’s gone.”

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In the land of grief, there is no currency. There’s no equality, and there never can be: My tragedy and yours are different. This is true even if they are the same event, because we are different people, with different contexts, and choices, and reactions. In the land of grief, there’s no bartering—not because it’s physically impossible to trade but because even if you could, the tragedies wouldn’t be the same. My tragedy is different from yours.