A friend asked me this week why I am happy in my job. It must be terrible, he said, to see patients who are carrying babies with abnormalities, when many times I have no treatment to offer them. I didn’t know how to answer at the time, and I have pondered the question since. I could have said that for every baby with an untreatable condition, there are many more that I can help, and this would have been true. I could have said that there are new tests and procedures being developed every day, and this is also true. But it’s not why I come to work every morning. Here’s why.
I came to medical school wanting to be a surgeon or an emergency room doctor. They were the heroes who stepped into a crisis and fixed everything. But after two years in the classroom and lab, my first clinical rotation was in obstetrics. I spent a month in Labor and Delivery, and I was hooked. Even though I was warned that the hours were unpredictable, the workload was tremendous, and malpractice insurance was expensive, nothing excited me like caring for pregnant women and being present at a delivery. I did my Ob/Gyn residency at a small community hospital. When women had pregnancy complications like preterm labor, preeclampsia, or fetal abnormalities, they were transferred away to the downtown hospitals. I found this very frustrating – I wanted to be the go-to person for these patients. And I wanted to be able to face down the most terrifying emergency and know how to take care of it. For these reasons and a few others (I found gynecology kind of tedious), I decided to become a Maternal-Fetal Medicine specialist. My MFM fellowship was everything I hoped it would be. I learned to diagnose fetal anomalies, treat emergencies, and perform procedures. We received patient transfers from all over the area. Finally, I was at the last stop for OB care. But it didn’t take long for me to realize that even at the last stop, outcomes were not always good. Not every problem was fixable. So what could I do for women who had babies who would not survive? When you come to me for help, and I have no treatment, no surgery, no chance of making this pregnancy end happily, what can I do? How can I best care for you?
I can let you know that it matters. Your baby, your grief, this time in your life – it all matters. I can’t tell you why you have been singled out for this burden. Events like this are random and cruel. They don’t make sense. There is no justice in them. How it matters, how this little one affects the pattern of the universe, I don’t know. But I know that you and your child are important. When the darkness is so heavy that you feel crushed under the weight of it, I will tell you that you won’t be crushed. There is a power here, a loving presence. It has you by the hand and it will not let you sink. Walking through this process is painful, but enduring it will make you stronger and better. I would give anything to be able to make your baby well. Sometimes I just can’t. I am simply here to cry with you and be angry on your behalf, and to remind you that all you have to do today is breathe. One breath, then another. One decision, then the next. Telling you this may not feel helpful to you today. But it’s all I have, and that matters, too. Some days, it is enough.