Archive for October 16th, 2006

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I hadn't been able to keep any food down at all last week, and by Friday I couldn't keep fluids down either. Couple that with some pretty serious cramping (getting progressively worse) and I landed myself back in the emergency room Friday night. Many of you probably know that I'm an Orthodox Jew, so this was somewhat complicated, as it was the Sabbath for me starting at Sundown, and there are all manner of Sabbath restrictions, including no driving, so I had to make arrangements for someone to drive me home once all was said and done and it was just more complicated than I would have liked. Also, I sat in the waiting room for 3 1/2 hours before they remembered I was there (they admitted to having forgotten about me, so I'm not just being bitter when I say that). Anyway, the cramping doesn't appear to have any important cause… they did an ultrasound and everything looked okay. I wasn't so much worried about the cramping as I was the dehydration, but they gave me IV fluids and antinausea medication on top of the lovely pain medicine they'd already given me. I was pretty happy then.

Now I feel like I've been doing situps all weekend, which is ridiculous, but unpleasant. The pain hasn't subsided in the least, but I'm happy that there's no good cause for it. I have an appointment with my OB on Tuesday, but I expect I'll be fine by then (but I still have to see him regardless to follow up re: the D&C so that he can make this month's car payment).

Have I mentioned lately how much I love my OB? I just can't get over how wonderful he was to me on Monday night. So I wrote him a letter. I have no doubt that he gets a lot of letters and baby pictures when everything goes right. But I doubt he gets a lot of positive acknowledgement for his role when things don't go right. So here's what I wrote:

Dear Dr. B;

I am writing to thank you for the exemplary care you provided me on Monday, October 9, 2006 when I had a miscarriage and subsequent D&C at HC Hospital 12+ weeks into my pregnancy. I would like to take a few minutes to explain to you why this means so much to me.

After four years of trying to conceive, five rounds of Clomid, and four IUI (with injectible gonadatropins) attempts, I was caught by surprise to find out I was pregnant. When my doctor at Shady Hell Fertility Shmertility Center, Dr. L. T., told me that what had originally appeared to be a miscarriage looked like a viable pregnancy, I didn'’t experience the same joy that I imagine most newly-pregnant women experience. Rather, I was afraid. I was afraid to leave the safety net of the fertility clinic and the rapport I had established with the doctors and staff there. I was afraid I wouldn'’t find an obstetrician I could trust. Most importantly, I was afraid I would miscarry before I even made it to my first pre-natal appointment. I had never given much thought to finding an obstetrician I could trust, under the assumption that it would never become relevant.

On the recommendation of Dr. T., and the recommendations of other friends, I made an appointment in your office for September 20th, 2006, when I was 9 ½ weeks pregnant. I knew at my first appointment with you that I had made the right choice. You took my concerns seriously, but were not overly anxious (your words were, "“It’s really hard to mess this up; women have been doing this for a long time”"). I had been experiencing bleeding throughout my pregnancy, and you carefully reviewed my medical history, the records provided from Dr. T.'’s office, and did a physical exam to ensure that there was no cause for alarm. I appreciated your calm, but thorough, nature immediately.

At my next appointment on October 4th, everything seemed fine and we heard a heartbeat and all was well. I asked if I needed to have any concern, as the bleeding I'’d been experiencing had increased dramatically the previous weekend. Though we had not planned to do an ultrasound at that appointment, you immediately offered to have an ultrasound done to make sure nothing was wrong, even though it was likely nothing to be concerned about. Sure enough, the baby was fine, measuring exactly 11 ½ weeks, with fingers, toes, and a heartbeat. You told me I had a subchorionic bleed, something I should not be concerned about, which does not cause miscarriages, and would resolve itself on its own over time. It was a relief to know that it wasn’t all in my head. In retrospect, I am very grateful that the ultrasound was performed that day, because it gave me a glimpse of a healthy baby, something I never thought I would see on an ultrasound of my uterus.

Despite two promising appointments, and a total of four promising ultrasounds, on Monday, October 9th, I began to have severe contraction-like pain, with significant bleeding. I paged you, but within a few minutes of paging you, the contractions had become so frequent and severe that my husband put me in the car and drove me to the hospital. (Upon my return home, I discovered that you had called back a few minutes later, and followed up with another call to make sure everything was okay) An hour later, I miscarried in the emergency room and the ER physician, Dr. G., called you. I expected that I would either be told to go home or a doctor I didn'’t know would perform a D&C if necessary. Instead, I received a phone call from you directly, something which I genuinely appreciate, though it was neither expected nor required. In our short conversation, you expressed sincere regrets and assured me that there was nothing I could have done differently to change the outcome.
You made immediate arrangements to come to the hospital and perform a D&C as I was still in tremendous pain and experiencing heavy bleeding. Your swift response was extremely comforting.

I learned later that you had spent the entire day at the hospital, and I know that my call pulled you away from your wife and your family after what must have been an exhausting day. Yes, it’s “all part of the job”, but I know that it takes a special kind of dedication to enter a profession with those kinds of demands on your time. I experienced tremendous relief when you arrived in the OR area where I was filling out forms and waiting for the D&C. You quickly reviewed the pregnancy history with my husband and me, and again expressed your sincere regrets for the loss we had experienced, and suggested some options for finding answers to the questions we have regarding why I experienced such a late miscarriage, saying that you would be as aggressive as we wanted you to be in finding out the answers. I know that a first miscarriage in a first pregnancy is not normally cause to aggressively seek such answers, but given my history of infertility, I am extremely grateful for whatever answers (if any) you are able to uncover. Once again your calm, but thorough, nature was comforting for both my husband and me.

Your gentle care, your thorough manner, and your swift response made a real difference in how I will look back on this otherwise rather unpleasant experience. I never felt anything but complete confidence in the care you were providing, or the choices we were making. And I have never been so certain that I chose exactly the right provider for my obstetrical care, no matter how short that care period turned out to be. I cannot thank you enough and I hope to someday soon enter your office with news that I am pregnant again.



It wasn't an easy letter to write, but I'm glad I did. It was rather cathartic, but more importantly, I'm glad I had an opportunity to communicate my appreciation to my doctor. He was extraordinary.

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