Change of shift

I love my job ... just not as much today. I’ll be the first to admit that I’m usually very lucky. Most mornings, I wake up knowing I’m going to enjoy my day, whether I’m going to work or spending the day with my wife and daughter. Today, I’m just not lucky. Today, I wish I never even thought of medicine. I was on the overnight shift last night. Around 1 AM, a woman with previous miscarriages was complaining about some cramping and vaginal bleeding. She’d passed a little tissue that looked like a fetus. The medical student saw her and did the pelvic examination. There was a little bleeding from the cervix, but it was slowing down. I like to teach. It’s part of why I love going to work. The medical student is bright, thorough, and reliable ... the type of student we all like to work with. We talked about the emergency medicine workup of midtrimester abortions and the concerns regarding the patient’s care. She’s only a third-year, but, despite it being my first shift with her, I trust her. The only thing she hasn’t done is look at the specimen the woman brought in. I talk to the patient. We discuss her cervical incompetence. She tells me she had an ultrasound scan last week and she’s roughly 18 weeks along. Other than being understandably upset, everything’s like the medical student said. I almost forget to examine the tissue for completeness. The black garbage bag is sitting on the counter. It’s heavy. She must have scooped up water from the toilet or something. I don’t blame her. Who’d want to touch a miscarriage? I open the bag. Now I won’t sleep for days. Every time I try, I see my hands rummaging through the plastic. Going through layers of wrappings. There’s a lumpy mass that looks like it’s wrapped in one of those beige plastic supermarket bags, except now I can see the shape of the fetus underneath. It’s too big—30 weeks or so—and the plastic is the membrane of the en caul miscarriage. My hands tremble, and the fetus almost falls. I cover it back up and turn to the woman. She must have known. This isn’t “a little tissue.” I want to scream at her, to ask why she didn’t tell us (warn us!), but the way she’s looking at me, she knows. But she doesn’t want to know, or think about, or answer, or care that this makes my hands shake, my eyes water, my heart race, or my confidence break. She’s upset and scared and can’t even begin to make sense of what she just went through. It’s her third miscarriage. She just wants her babies: the one she’s had, the ones she’s lost, and the ones she will probably lose. In residency, we learn that the first thing to do in a code is check our own pulse. It’s good advice for most stressful situations. But right now, I’m not thinking that way. I leave the bag in the room and put my diaphoretic head on the counter of the nurse’s station. An inner voice is crying, “I didn’t want to see that. I didn’t want to see that.” I see images of my daughter’s birth: she was a little blue at first, and wasn’t much bigger. It’s the middle of the night, my shift doesn’t end for hours, but I need to check on my Sophie the way I did when she was days, weeks, and months old. I want to hug her, stroke her wild, curly hair, tell her it’s OK and she’s all right. I want to hug my wife and tell her about the inarticulate, nightmarish pictures that are flying past my eyes. Now it’s time to check my pulse. I have to examine the woman myself. The uterus and vagina are fine. I have to check the abortus. The medical student brings the bag to our utility room. (I don’t trust myself to carry it.) My anxiety rises toward the surface. “Just don’t let it be a girl. Be a boy. Be a mole or a Siamese twin. Be anything. Just not a normal girl.” But today, I’m not lucky. Today I hate my job. Today I have to open the mem0196-0644/$30.00