The morning started out terribly. One of our favorite patients had a miscarriage confirmed. There had been a heartbeat seen on their last ultrasound, but there was none today. As the patient herself admitted, it didn’t come as that much of a surprise, because she had been bleeding, her hCG levels had not been rising briskly and there was an observed slowdown in fetal growth seen on the last ultrasound. Being over 40, she was already at increased risk of miscarriage. Still, we had been hoping for one of those amazing recoveries that I’ve seen happen before. It was very sad for her and her husband and it was sad for our whole office, too. We had a 30-minute discussion regarding where to go from here.

I then rushed to the consultation room to meet with still another patient who had recently miscarried. We were able to spend a long time talking things over, discussing what happened, discussing what options to pursue next and discussing life in general. She reads this blog and out of respect for her privacy, I won’t share any clinical details. Suffice it to say, it added greatly to the sad morning.

I then got a short break doing some routine follicle-check ultrasounds and an IUI before going to the consultation room again.

This time, I got some devastating news from a patient. Again, without going into too many clinical details, we had not seen her for several months. She had abruptly cancelled treatment before we could finish her first cycle. She and her husband had just disappeared and today, I learned why. Apparently, her previously healthy husband had gone that day to the Emergency Room with a cold that wasn’t going away. He was admitted for pneumonia. The doctors were shocked as his condition worsened daily until he passed away in the ICU thirty days later. I listened as the patient shared with me the story of their amazing twenty-year marriage. As I listened to her recount what she had to endure in the past few months getting her life in order since his passing, I marveled at how brave she was. She shared how she wished that they had gotten to the point in their infertility treatment where they would have frozen his sperm, because then she would have the option of having his child still. She gave me a program booklet from his memorial service and invited me to read his life story and the testimonials from his friends.

I felt drained. I didn’t suffer any of those tragedies myself, so my sadness pales in comparison to the patients’ own misery. However, it was still emotionally painful to share a continuous two hours of back-to-back-to-back discussion with those going through such suffering.

The next patient was another prenatal ultrasound for which we saw heartbeat the time before. I’m by no means superstitious, but I was starting to get a bad feeling that this was the morning of doom. This was a patient for whom I had transferred a single embryo that had been confirmed by PGD to be a normal 46,XY. When I did the ultrasound we were all in shock. There were two babies! We now had identical twins who had split off from a single embryo. My assistant was jumping with joy and amazement. The patient and her husband were beaming! They had wanted twins, but there had only been one genetically-normal embryo to transfer. I called the embryologists to let them know and I’m sure it made their day too. This wasn’t anything worth writing up in a journal ever since someone recently reported a single embryo transfer that had split into triplets, making our news very drab in comparison. Of note, the twins were in the same chorionic sac, but in different amniotic sacs, which made it much safer. As the patient came out and proudly showed her ultrasound pictures to the rest of the staff, the energy was contagious!

After that much needed pick-up, another former patient visited unexpectedly. I was now done seeing patients for the morning and had time to let her show us her baby. As I held the eight-month boy, my staff talked with him and called his name, each time eliciting a huge smile and gurgle of laughter from him. It seemed rare for such a young baby to be so alert, so interactive, but his mom said that he was always like that. As I gently bounced him in my arms, I had a fun conversation with his mom, all the while with my staff surrounding us and cooing at him. It felt really good. After being in a dank pitch-black cave a few hours earlier, it was like walking out into the scorching midday sun at Laguna Beach.

I don’t really know what it feels like to be manic-depressive, but I can imagine.

This entry was posted on Tuesday, May 6th, 2008 at 12:16 pm and is filed under Inside view. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.