"Why are you crying?"

The following is a letter to the hospital where I was treated for my first two miscarriages. I felt compelled to write this to them for some time now:


Dear ___

I am writing this letter to advise you of my experience after recent treatments at this hospital. In June of 2011, I went to the emergency room early in the morning with the uncertainty that I was miscarrying at 11 weeks pregnant. Dr. K provided exceptional care, and the same when Dr. A arrived to discuss my options. It was surprising that both physicians were incredibly compassionate. One usually thinks it is the nurses who are the kind ones whereas the doctors are more clinical and time pressed. Upon the advice of our fertility clinic, we decided to have a D&C so they could later perform a cytogenetics pathology test. It was difficult to grieve in a public area after a number of ultrasounds confirmed our baby's heartbeat was gone. Finally, I was admitted and brought upstairs. When I broke down crying in my bed, my nurse (female) simply asked "why are you crying, are you in pain?" My husband reminded her I had a miscarriage as per my chart so I was emotional right now. She said "oh, is this your first? that's why". I felt completely dismissed with no level of compassion for what we were going through regardless of the number of women the hospital treats daily for miscarriages. There was also no thought of what my individual circumstances could possibly be, as we had been trying to conceive for a long time before this first pregnancy.

In the middle of the night I finally had the D&C. Dr. A told me he would hold my hand in the OR because my husband was not allowed there, and he did. I was slow to wake up so it was decided that I should stay overnight. Shortly after my husband left, I felt increasingly unwell. I was in a cold sweat and ready to pass out, however not in a nauseated way but I knew something drastic was happening to me. I kept pressing the nurse button and no one came, just hearing them outside chatting. I could hardly whisper to alert the other patients in the room to get help. Further, I could not even cognitively remember how to function my blackberry so I managed to dial my husband's phone number by heart. He was outside now and all I could whisper was "come back now". By the time he got up to the 10th floor using the really slow elevators, still no one had come. He took one look at my pale face and got help. Then a code was called and suddenly many people came. After a ECG, portable x-ray, and bloodwork, it was determined that I got aspiration pneumonia from the D&C which is incredibly rare and my blood pressure suddenly dropped from 110/70 to 60/40. I was told I was lucky I did not have a stroke. Yes, but actually I was lucky I was able to call my husband. When Dr. A left, I was scolded by the night nurse (male) that he asked me after the surgery if I was in pain, and I had said no (I had surgery before and the intubation had bothered my lower throat then too). It seemed he was embarrassed for not watching me closer.

I was in the hospital for three days. It seemed this nurse (male) did not remember why I was there in the first place. In private moments, I would sometimes break down as I couldn't fully deal with my grief in a shared room with others. The nurse would just ask my husband "why is she crying?" and again he would need to provide the reminder after being in his care. There was no awareness of the grief that couples go through.

On top of this, one particular younger patient in the bed next to me had an army of visitors who played music and boardgames. My husband had to repeatedly ask them to keep it down so I could sleep. The nurse only advised them once and we had to resort to carting my IV to the lounge so I could sleep on the couch there. In the middle of the night, I would just hear the nurses keep chatting some more.

I miscarried again in December of 2011, three days before Christmas. This time I was braced for what could arise but the D&C went well. When I woke up in the recovery room, the nurse (male) said to me that his sister had a couple miscarriages and they have a beautiful daughter now. He said "the next time I see you it'll be for your c-section". That is the type of compassion by a caregiver that means so much to a patient and something I remember to this day.

I have since had a total of four miscarriages and it is becoming increasingly apparent how there is a lack of  pregnancy and infant loss awareness in society as the grief we endure is hardly spoken of. That awareness though is incredibly important for all caregivers to understand - that a loss of a baby though miscarriage should be treated as a loss, and not an outcome that is shrugged off due to statistics and a perception that it will be okay after a little while. Each patient's story is different and caregivers need to be mindful of that.

I write this now as I have realized that patient advocacy is fundamental to ensuring that hospitals are aware of the quality of care it provides and how specifically that care impacts patients in the long term. My hope is that some training and education can be done on this important topic.


Sincerely,
R.