Despite the weighted concern and anticipation that enveloped Room 21, I was greeted with two genuine, hopeful smiles. Innocent smiles, actually. Smiles that unassumingly revealed a faith and confidence that life would be fair and good to them.
From the moment of our introductions, I liked this youthful couple, both just entering their twenties. She was the patient, sitting upright in her treatment cot, her legs fully-extended in front of her and nervously crossed at the ankles. She was thin but strongly built, her athleticism exposed by her muscular tone. Her angular jaw and full cheekbones were framed by the pixie-cut of her light brown hair. Her blue eyes sparkled.
He stood beside her, to the right of her cot, holding the hand she offered him. He was tall and pudgy, several times nervously swiping at the sheen of worry revealed by his forehead. His blondish hair was haphazard and messy. His face was average, muted, nothing quite as striking as his girlfriend's, and yet his brown eyes burned with a fierce intensity.
They had presented to our ER with a a significant concern. The patient was pregnant, barely nine weeks, and had started having abdominal cramping and vaginal spotting approximately thirty hours before they arrived. "Now I am bleeding so much, it almost seems like a period," she shared, looking from me to her boyfriend before looking back to me again. Her face was expectant, almost willing me to tell her that everything would be fine. That this bleeding and cramping was not out of the ordinary.
Unfortunately, I couldn't speak those words.
"How far along are you?" I asked them. "Nine weeks and two days," the boyfriend answered. Such exactness already answered my next question. "Is this your first pregnancy?" They both nodded yes. The excitement and magic that accompanies a first pregnancy is unbridled and elicits many memorable moments--including ticking off each day of the forty weeks. I could picture this couple's calendar hanging on the wall in a small, canary-yellow kitchen with old white appliances, an "x" drawn through each passed day.
"You really want this baby, don't you?" I asked, trying to learn about this couple, after I had finished with my pertinent medical questions.
The patient answered. "We do. We've faced a lot of opposition from our families and friends. And this pregnancy certainly wasn't planned." She paused here, looking up at her boyfriend, before continuing. "But, we are both certain we want this."
"And," the boyfriend added, "we just got engaged last week. We might just be throwing ourselves a wedding in the next few months, too." Without letting go of his fiance's hand, he continued to explain that they had dated since their sophomore year in high school. They were certain they had both found their soul mates.
I congratulated both of them on their happiness. Through work, I have seen every imaginable angle that accompanies an unplanned pregnancy and, although their story wasn't new to me, their can-do spirit and enthusiasm for one another and their situation made me think, just maybe, that, with or without this pregnancy, this was a couple that could endure and thrive on their life journey together.
Trust me, though, when I say that I don't get this warm and fuzzy feeling with every unplanned pregnancy. Their commitment was refreshing, plain and simple.
I called in their nurse, Carla, and we performed a pelvic exam. Unfortunately, the patient appeared to have some active bleeding that resembled a typical period. On her bi-manual exam, the opening to her cervix (the lower part of the uterus), which is usually tightly closed during this stage of pregnancy, was loosely open. Things did not look good.
"What do you think, doctor?" the boyfriend asked, unsure where to direct his nervous energy.
I needed to ask one more question before explaining the exam at length. I looked to the patient. "Have you passed any small clots or anything unusual with this bleeding?"
She hesitated somewhat before answering me. "Yes, this morning. That's not good, is it?"
Quite honestly, no--it wasn't good. Not only had her exam concerned me, but her quantitative hCG hormone level, through blood work, had come back barely traceable. Again, at this stage, the level should have returned significantly higher. Every indication was that this patient was not going to have a healthy, full-term pregnancy and was, in fact, actively miscarrying.
"No," I said softly, answering the patient's question, "it doesn't look good. I'm sorry."
It was important for this couple to start connecting the dots on their own terms. Inherently, I had to believe that they knew she was having a miscarriage, and just needed a little guidance and coaxing from my part to start accepting this reality. So I sat there on my stool a minute, silent, absorbing their response.
They both grew glassy-eyed right there in front of me. Remarkably, though, in that split moment where life can make you angry, or defeat you, or make you question everything about yourself after you've received unfair, upsetting news, this couple did an amazing thing.
They didn't get angry. Instead, they wiped one another's tears with caring thumbs. Tenderly. Sweetly. With a maturity and naturalness that belied their years. And, when they were done, they feebly smiled at one another before the boyfriend bent down to envelope his fiance' in a genuine, heartfelt embrace. He whispered in her ear and she nodded at his words.
I looked to Carla, who was watching the couple with the same wistfulness that I felt. One simply could not help but cheer for this young love. Nor could one be in that room and escape the emotional intensity of their love. Despite their youth, they were demonstrating the stuff of which people spend years trying to instill in their own relationships.
When they had collected themselves, I explained everything at length. The patient would need to get repeat blood work in two days. If the hormone level hadn't doubled in that time, or had stayed the same or even dropped, it would be confirmation of our suspicions. Suspicions that were extremely solid, already.
Sitting at my computer station after treating them, out of sight, I heard their familiar voices speak to our secretary on their way out of our department. "Please tell Dr. Jim and Nurse Carla that we appreciate all they did for us today." I rolled my chair through the doorway into their view. "Thank you," I said. "I hope you both have a fantastic future together. You deserve it."
And I meant it. They did deserve a bright future.
As always, big thanks for reading. I hope this finds you all enjoying the last days of summer...