When my doctor couldn’t save my pregnancy, he did the next best thing | Ranjana Srivastava
Near the end of his life, a patient says to me, “If you ever need it, I hope your doctor is as good to you as you have been to me.”
It is an unusual blessing.
In honor of our long collaboration, I stopped by after work when a crisis broke out and had difficult conversations with his wife, not to mention other doctors, to say that sometimes “the best interest” means someone has to die. Now I sit at the foot of his bed for the last time, but I can’t imagine any doctor thinking these are “favors” done to our patients; they are simply the bread and butter of good medicine.
He falls asleep before I can tell him that I have already experienced my share of a doctor’s life-changing generosity.
The beginning of my motherhood was marked by the sudden loss of a previously healthy, midterm twin pregnancy. Fate knew how to deliver a swift blow; I was pregnant on Monday and not pregnant on Wednesday. The following week, during my ward rounds, my pregnant belly continued to attract my elderly patients who were desperately missing their grandchildren. When was I due? Was this my first? Boy or girl?
I didn’t have the heart to pierce their joy, but instead saved my fear for the bathroom and prepared my body to shrink back down to size. In an act of defiance, I threw away my vitamins and cursed those translucent pills for their telltale “glow.”
Even though it was raining kindness, I felt stuck in my sadness. Betrayed by God and body, I was too young to realize the universality of suffering. I also had an existential question: If a mother was said to be only as happy as her unhappiest child, where did that leave me? Did the ruling apply to all pregnant women or only those who had successfully given birth?
More accustomed to giving care than receiving it, I turned against myself. When I thought back to the plight of my patients, I thought my grief was self-indulgent, much to the dismay of my social worker friend, who encouraged me to democratize my grief and let people in. But still in shock and surrounded by pregnant friends, I didn’t. knows how.
The smooth half of my pregnancy took place in the United States, where I had completed an ethics fellowship. In Australia I had just met the midwife who performed the fateful scan. He was thinking about his career until he pushed the probe so hard that I jumped. An exciting hour followed. Then came silent consultations just out of earshot, an urgent amniocentesis and the summoning of ‘fetal subspecialists’, a specialty I didn’t even know existed.
After wiping rivers of gel from my stomach, the midwife escorted me to his small office. As he explained the physiology of death in the womb, I marveled that in another world this would have been a great tutorial. When I looked up I saw his tears; I would save mine for the car.
Pregnancy and funeral over, I waited for better days and congratulated friend after friend on having babies.
One afternoon I received an elegant envelope. It wasn’t a bill or fine, not even a reminder to renew a medical journal at an ‘just for you’ price.
Dear Ranjana,
I trust you are doing well after the very sad events of the past few weeks.
My eyes darted to the end to find my midwife’s signature.
It must have been so hard.
I froze at the memory.
After all the initial good news, it must have been incredibly hard to walk into our scanning room and be hit with all my news.
This simple observation destroyed me, written by the only person who witnessed the precise moment my life changed. This from the doctor charged with diagnosing a fatal condition and delivering the bad news without preparation. Who had struggled to control his own emotions while trying to anticipate mine.
I read and reread the letter and absorbed the contents. All this time I had struggled to measure my own grief. Caught between the instinct to grieve and the urge to forget, I had dismissed strange dreams about dead people and tried to minimize my loss.
Not to mention that I’ve taught myself to be grateful that what happened to me happened in a big hospital in a rich country, because we all know how much messier the outcome could have been.
In the midst of these conflicting thoughts about the ârightâ response to my situation, my doctor’s letter landed as a permission slip. If, armed with a lifetime of experience, he had found my situation difficult, perhaps it really would have been. By naming his own grief, he had validated mine. I felt seen.
Hopefully we will see each other again under more positive circumstances.
As much as I wanted this.
I thought I had lost the letter, but last month it fell out of one of my old diaries while I was rearranging my collection.
More than 18 years later, his words still fail me. Even more moving, their timeless empathy touches my three healthy teenagers who are now old enough to understand why kindness matters.
Through a mutual friend, I contact the midwife to thank him, without expecting to be remembered among the thousands of high-risk patients. But I should have known that our âworstâ cases have a way of staying with us.
When we meet, he remembers the day and his sadness as clearly as I do. I finally have the chance to tell him that the decisions he made on the spot shaped my entire approach to patient care.
Healthcare workers are starting a new year with a lot to take stock of, as healthcare crises seem to be overlapping, creating a familiar fatigue. Many problems are systemic in nature and require better resources in the right places and more far-sighted decisions.
But I can’t help but think that at least some of the problems our patients face don’t require more money, technology, or bedsâthey simply require us to use our moral compass.
When my doctor couldn’t save my pregnancy, he did the next best thing: he chose to be kind and made a difference that still ripples through my life.
I could live by this belief.