A broken doctor, a broken womb

"I laid in the hospital bed alone, waiting for the emergency operating theatre to call. They had admitted me to the labour ward. There were no available single rooms. I was flanked by couples with their newborn babies.  Behind the curtain, their cooing voices carried over as I curled crying in bed in a fetal position."

I still recall the second time I miscarried. It was during my morning ward rounds. An impending signal - the sudden gush of fluid. I was at my third patient talking to my MO. My face did not betray the bodily insult. It was 9 am and there were 15 more patients to go. It would be at least another 2 hours before I would be done. 

I think most women would go to the toilet to immediately check.

I knew myself - if I stopped to check and confirmed the beginning of the inevitable, I would lose all focus. But I was a doctor with patients waiting to be seen and junior doctors directly under my supervision. How could I then make rational clinical decisions? If I dropped everything and ask for urgent cover, I would have to explain why - and that would crumble any remaining composure I had left.

With the force of steel, I blocked all emotions, and pressed on methodically. Examine, check results, click click,  listen to my MO and direct the clinical plans. Next patient. Ok, ok, mmm. Yes do this. Ok next patient. One could not tell that my womb was shattering.

After what seemed like an eternity, I finished. I walked slowly to my office, subconsciously clutching my abdomen, each step closer to the privacy of my office where I could finally let go. I was sure I was miscarrying. I called the hospital and they told me to come in. 

I was admitted for D&C that day due to my previous history of heavy bleeding. I phoned my husband to tell him. He couldn't come till later. I laid in the hospital bed alone, waiting for the emergency operating theatre to call. They had admitted me to the labour ward. There were no available single rooms. I was flanked by couples with their newborn babies.  Behind the curtain, their cooing voices carried over as I curled crying in bed in a fetal position. 

I finally understood how hospitals can seem indifferent to the human tragedy of illness. 'Bed situations' is something I am all too familiar with as a doctor. One couldn't afford to wait for their choice of bed when waiting to go into emergency surgery.  It wasn't the fault of the nurses or the doctors or the hospital. But in that very bed and abject moment, the care felt insensitive and I was hurt more than I needed to be. 

It would have been a boy.

The very first time I had miscarried, it was a missed miscarriage. One week the heartbeat was there, strong and rapid. Two weeks later it was gone. I didn't have any pain or bleeding then. I remember my doctor's words as she said tonelessly, 'there is no more heartbeat'. The fetus had stopped growing. I was alone then as well. Even then, I was more a doctor than a patient. I didn't demand answers or cry. I understood the finality of the scan. This was news she had probably delivered many times before.  Being the good patient, I nodded and said 'ok I understand' in a small voice. I looked at the medical student in the room, her innocent, round eyes revealing her thoughts.  I walked out and the tears started to roll, crying on the phone to my husband. 'The baby is gone', I sobbed. There is no more heartbeat. It was a first for my husband too and he didn't know what to say.  

I had elected to miscarry naturally rather than remove it surgically.  Four weeks later I had a gush of blood at home and I started to bleed profusely.  Seven night pads soaked within the hour. A small, pale yellow fetus came out, the size of a large olive. It had the beginnings of a baby; small dotted eyes, little arm with five fingers and a small tail. We buried it. 

We rushed to the emergency department and I had an emergency D&C that day.  The products of conception were stuck behind my cervix and my uterus was not able to contract effectively to tamp the bleeding. The contractions rolled into another, trying to expel out everything. I lost 3 grams of blood that night. 

The third miscarriage came very early and that was like a normal period but the loss was all too familiar, if not worse. I was also at work when it happened. 

Looking back,  I don't know why I was so stoic when I miscarried at work. Why did I continue with my rounds? Why didn't I stop? After all, when someone dies, we as colleagues automatically understand, we take over, no questions asked and we tell them 'please go and we will sort everything out'.

Was the short life in the womb still considered a life? It once had a spontaneous heartbeat.

Is the loss any less if it wasn't born?

Was it the pragmatism of female physicians? We know the science of it, we know it happens. So we deal with it.

Why are we so hard on ourselves?

We rarely talk about miscarriages despite how common it is. It seems like a shameful secret and something not to be shared in the open. The grief is often hidden, as if we do not have a right to grieve openly. 

Sure, we get two weeks of leave. The physical contractions may abate, but the psychological trauma takes far longer. It took me months to be able to control my tears every time someone would ask how I was. An innocent 'how are you' would unleash the flood. 

After the third miscarriage in a year, I resolved not to put myself through the stress of work and another miscarriage. I had tried to work while staying pregnant. But I failed, three times. I was burnt out after  three years of becoming a consultant. But I had been working continuously as a doctor for thirteen years by then. Work had always been a priority - my patients came first. I stayed back late to make sure plans were documented well, called families after work, checked in on patients on the weekends and monitored my work phone religiously. 

But it had reached the tipping point. That same year I had also received a letter from a family member who filed a complaint. I looked after their parent two years ago who eventually passed away in a different hospital.  I poured over the notes. Was there something I could have done better? Did I miss something? 

It was a challenging family with different members at odds with each other, often blaming the other for the physical deterioration of their parent. They were coloured by a previous negative experience with the hospital and this made my job of gaining their trust harder .I spent a lot of time speaking to different family members and sought input from various specialties. It was not a simple case. They could not reach a consensus on the next step of treatment, and in the end they transferred the patient to a different hospital. The patient passed away later. The letter made me feel incompetent. I felt truly bad that the son was not able to find closure after two years. He believed that the clinical team had not done enough for the patient.

I had given everything that I could then. But it was not enough for him. My confidence broke and I began to question my clinical decisions and this made a traumatic year more stressful. Sleep would elude me as I stayed up at night re-thinking my decisions for the day.

I had become a broken doctor with a broken womb. 

I started my preparations to leave. I told my boss six months, maybe a year. The anticipation of leaving work was what kept me going. There was an end to this madness. It was coming soon and the thought filled me with mixed feelings of delight and apprehension. The future was uncertain. But I couldn't care less if I could not return or didn't have a job later or if my clinical projects failed without me.  It was pure emotion driving my decisions. After all, who had cared when I was repeatedly miscarrying? 

It was time to care for myself. 

Never mind the many working female physicians that have gone through repeated IVF cycles and still continue to work and achieve amazing feats. 

Never mind my superwomen colleagues - their breast pumps chugging monotonously whilst they type their clinical notes in the privacy of their offices and checking on their babies at home via their phone apps. 

Never mind the unasked questions in my colleagues' eyes - why is she taking leave? Is she unwell? Did she have a breakdown? Is everything ok? 

Did they deserve an explanation and all its miserable details? After all, I would be imposing on them to look after my patients while I was away. But I didn't want their judgement nor needed their approval to look after myself.

Perhaps I am one of the few that choose to stop amongst the many that choose to carry on. Leaving work wasn't going to guarantee me fertility success, but I had become so preoccupied with wanting to be a mother that I had to take all possible efforts to succeed. My 37th birthday was just around the corner. If not now, then when?

I was in a spiritual turmoil, at war with myself and ordained Decree. Why was it so important that I become a mother? What is the true purpose of motherhood? What if I totally stopped working? Who am I if I was no longer a doctor? For so long my sense of identity had been tied to this two-lettered title. What human shell would it leave if the core was no longer there?   

I knew if I continued, I would break. I resented my job, the unwanted administrative duties and projects and the hospital politics that had become toxic. The glory of doctoring paled in comparison to my struggle to become a mother. I wanted to do my best for my patients but my best had lost its shine. It had become an old, bitter woman.

So I had to leave.