sharing your stories and remembering your children
By: Brian Sinischo, M.D.
Experiencing loss is painful, both physically and mentally. As an expectant mother, partner, family member, friend, or health care provider, we all face this loss from our own perspective. I remember the first time I diagnosed a fetal demise by ultrasound. I was in my first year of residency. I was working on the OB floor in Saginaw, Michigan and one of the nurses came to me and asked me to find a baby’s heart tone as she couldn’t find it with the doppler. I didn’t have enough experience to even get anxious about this ultrasound. I took the machine into the room, gelled up the patient’s abdomen, and used the abdominal probe to assess the heartbeat. The baby was 34 weeks along, and it should take four seconds to find, but when I got in the right position there was no cardiac activity.
I didn’t realize I changed, but my expression must have shown my thoughts. The mother went into protection mode and started asking this young doctor some hard questions. "What’s wrong? Why is your face like that? Where is my doctor?" Very soon, tears started to come. I kept my composure and explained what I was seeing. I showed her the heart and showed her how there was no movement when there should have been.
Then my tears started… I remember wanting to make it all better, but I couldn’t. The program I trained in allowed us to follow patients through their time with us, giving us the chance to learn and watch all of the stages of birth. I will never forget this induction and helping deliver this baby that looked so perfect, and watching as the family grieved on what should have been a joyous day. I left that delivery and cried too. I spent a lot of time listening to this family and how they worked through their grief. It was educational and, honestly, some of the hardest medicine I have had to learn.
Much of medicine, I have learned, has nothing to do with drugs or procedures. I feel in many ways I live in two worlds. One, the medical world of terminology, definition, safe practice, protocol, medication, and sterility. The other world is heart-related, compassionate, and not linear. Traditionally, physicians are trained to separate the two worlds, probably so the practitioner can function, despite the tragedy unfolding in front of them. But I’m learning how to blend the two. Here are a few things I have learned to do:
1) Offer ultrasounds. (I drag the ultrasound machine all over my office and the hospital to show patients exactly what is going on inside before any procedure or induction or decision needs to be made.)
2) Attempt to keep medical jargon to a minimum and repeat myself. Often when trauma occurs it is hard for a person to remember what was said and comprehending new information is hard.
3) Allow time. Patients need time to process and make decisions. There are times when patients come to the office three or more times before they make a decision on how to move forward.
There is a fine line to be walked when informing patients of risks associated with loss. Watching and waiting is almost always an option but comes with risk of infection, hemorrhage, and sometimes worsened mental anguish. There is no one right answer when deciding how to treat the loss of a baby. It often feels like we are forced to make a decision in an impossible situation, as many families are in a devastated mental state.
I have also learned to never take it personally. I have been hit, screamed at, kicked, cried and vomited on, hugged, and prayed with. This process is tumultuous. When someone is going through their worst day, I strive to be calm, compassionate, consistent, and know that it’s okay to cry. Some may consider it unprofessional; I consider it human.
If you have gone through the loss of a baby, I’m deeply sorry. I hope compassion is what met you, and I apologize if it was not. We learn as we go and sometimes as medical professionals we learn from our current situation. Most physicians and medical professionals I have had the privilege to work with and desire to serve, understand, and help. During trauma, many emotions are involved and, unfortunately, like my facial expressions from the above episode, are mistakenly shared. In attempted grace, I hope to serve Hillsdale well and grow in the amazing teams with whom I get to serve.
Brian Sinischo is a OB/GYN at Hillsdale Hospital.