Story No. 506: Dr. Bill from California

Mary (a pseudonym) was a 23-year-old who was newly pregnant for the first time. The pregnancy was unexpected, but welcomed. I initially met her on a Monday, when she was seven weeks along and had started spotting over the preceding weekend. So, she had spent two days worrying about what was happening and what she had done to cause it.

My ultrasound confirmed that she was having a miscarriage. I gave her several minutes to get dressed and to be alone with her husband. When I returned, I briefly explained the medical criteria used to make this heartbreaking diagnosis, and then immediately described all the possible things that do NOT cause miscarriages: too much or too little exercise, eating, sleep; having had a recent argument; having had an uncomplicated STI or abortion; being on the pill; thinking unkind thoughts about someone; being punished for past behavior; etc.

As I went through this list, she abruptly starting crying—it was clear that she had felt enormous guilt that she had done something to hurt her baby, and she was relieved it wasn’t her fault.

This emblematic patient encounter always reminds me that our patients are whole people with varied life experiences, and that, while I couldn’t do any anything to heal her pregnancy, Mary still needed my care. Giving a patient medically accurate information about her medical condition (in this a case, a miscarriage) in the context of her personal circumstances is essential for her recovery and life-long well-being.