Preparation

I seldom get medical consults from the OB/GYN floor, but one weekend I was asked to see a 33-year-old woman for evaluation of chest pain. Thirty-two weeks pregnant with twins, she had been hospitalized with preterm labor. I ordered an immediate electrocardiogram, which had normal results, but before I had a chance to see the patient, she was taken to the operating room for an emergency cesarean section. I reviewed her chart while awaiting her return from surgery. No ongoing medical problems. No significant family history. Nonsmoker. Married, 4 children at home. Unlikely to be cardiac, possibly a pulmonary embolism; now that she's delivered, a ventilation–perfusion scan would be much lower risk, I mused. After some time, a nurse interrupted my reverie to alert me of the patient's return and cautioned, “Baby B is doing well in the NICU, but Baby A was born with lethal anomalies, anencephaly, and a severe bilateral cleft palate. She's still alive, though, and we just bathed and dressed her. She's in the room with the parents. Just so you'e prepared.”

I paused. Prepared? As a mother of 3, I get physical symptoms over any situation where a child is harmed or hurting. This very tendency weighed heavily in my decision in medical school to avoid any pediatric-related field and focus on the relative safety of adolescent-and-up internal medicine. I tried to prepare myself for seeing the malformed …