The human heart is a complex and fascinating organ. By just 5 weeks gestation, it develops from a bundle of cells into the intricately designed muscle we depend on to pump blood throughout our body. To confirm a pregnancy on ultrasound, I search for the rhythmic motion of its ventricles as the patient waits anxiously for confirmation of life. When the heartbeat begins to echo from the machine, I can feel the stress dissipate, most often replaced by pure joy and excitement.
Fast forward to labor, and the fetal heart remains our focus. I walk into each patient room and instinctively listen for the heartbeat projecting from the monitor as my internal metronome interprets the speed. The core of a busy labor floor is not complete without screens of squiggly horizontal lines on time-marked grids, each representing a baby and the uterus it currently occupies. We watch the undulations for hours on end, ready to intervene at any moment.
So far in residency, I have had what some people call a “white cloud” while I watched my co-residents deal with tragic and sometimes traumatizing outcomes. Then one day, in the middle of what had been a normal shift, I looked up at the monitor and saw a steep downward slope in the tracing for one of the triage patients. I quickly made my way back to see what was going on, expecting to turn her onto her side and hear the baby’s heart rate recover, as they most often do. But this time was different. I had a gut feeling that something just wasn’t right.
I ran to get the ultrasound, placed the probe on mom’s belly and immediately looked for the baby’s heart. Now a more complete version of the same fetal heart whose motion signified the beginning of this woman’s first pregnancy journey.
I visualized the atria and ventricles. I watched the valves open and close in what felt like slow motion. Within seconds, my fight or flight response kicked in as I realized this patient and the life of her child were in my hands. Decisions were made and before I knew it, we were in the operating room. I looked for the heart on ultrasound again, but this time there was no movement. There was no time for emotion, only action. I knew that every second mattered.
I continue to see that ultrasound image in my head on repeat. So burned into my brain that I could draw it from memory. I picture the heart valves moving like the wings of a coasting bird. Imagining the gradual slowing of her heart to a complete stop. Realizing what I had witnessed was the moment of this unborn child’s demise.
I have diagnosed early first trimester losses before, but their cause is often inevitable with me as the unfortunate messenger. This was far different and my heart aches for all the providers who have had similar experiences. I feel selfish to be somewhat traumatized by this when there is a family experiencing so much worse. But feelings are meant to be felt, not ignored. There will undoubtedly be more death and trauma in my career, but I refuse to become numb.
❤️❤️❤️