Suffering

I saw a patient last week who had had her pregnancy terminated four days prior, at twenty-one weeks gestation. The fetus had been diagnosed with cardiac abnormalities on ultrasound, and would have required several major surgeries in infancy and childhood. The patient had originally opted to continue the pregnancy, although her husband wanted to terminate; she eventually agreed.

She had been induced and delivered a male fetus, 476 grams.

The patient was new to Canada, and to me, and I learned all this as I flipped through the chart while we waited for the interpreter. The woman and her husband sat in silence. Her chin was pressed against her chest, buried in her black wool coat. He wore a pink dress shirt, slacks, and nice shoes.

"I'm sorry about all that's happened in the last few days," I said when the interpreter arrived. He translated matter-of-factly. It didn't feel right, watching condolences being relayed so efficiently.

We reviewed the cramping and bleeding. "That's normal," I told the woman. "Your uterus was like this." I made a full, round shape with my hands. "Now it's squeezing down, like this." I clenched my fist. The gestures felt terrible.

"Can you make my breasts stop hurting?" she asked. "They're leaking milk." She seemed surprised. I explained binding, cold compresses, and analgesia.

We sat in silence. They had waited for over three hours. I wasn't sure what they wanted.

"How are you feeling?" I asked. She started to cry, hands burrowed in her pockets, refusing Kleenex.

"Bad. Very bad," said the interpreter.

The husband spoke. "We didn't want him to suffer. We didn't think it would be right for him to be born, to suffer." No one said anything.

I thought of my patient in labour, a nightmarish ending to her first pregnancy. I imagined the fetus emerging into the world, and leaving it. I wondered if the mother had seen him, and whether the father had been present.

We arranged a follow-up appointment for two weeks. As she left, her sagging shoulders small and black, the woman shook my hand and thanked me. She thanked me for the things I said.

Her sorrow and misery followed me for the rest of the week. But only a week.