Gravida Plus One

Abstract

Gravida Plus One Anita Kumar Chang The moment I found out I was pregnant was also the moment I realized I was likely having a miscarriage. A week after that first pregnancy test, I found myself lying on an exam table at the obstetrician's office, undergoing an ultrasound to try to confirm the pregnancy or lack thereof. I lay quietly as the doctor pushed the probe around, searching and searching. I watched my husband's face as he watched the ultrasound screen, knowing that he, an emergency medicine physician, would understand what was happening before the OB told me. I could see concern, but I couldn't decipher more than that. I waited. After what seemed like an hour, the doctor told me, matter-of-factly, "yeah, there are no products of conception in the uterus," then turned and walked out of the room. I was stunned into silence. How could this be the way I found out? It was shocking and anti-climactic at the same time. As a physician myself, I was acutely aware of the lack of bedside manner and the lack of humanity he showed me. This may be a routine result for him, and he was certainly acting like it, but for me, a person who'd been trying to conceive for years, it was shattering. I don't think I started to cry until we reached the car. My husband and I sat there in silence as I wept. He was in his usual mode for dealing with bad news, denial. From the moment I took the pregnancy test until now, he hadn't had much hope, so he had prepared himself against being disappointed. I had known from the first spotting that my chances were 50/50 of miscarrying. But I like to read into things. I had calculated from my last menstrual when I must have conceived and realized it was on our wedding anniversary. It felt like a sign that this was meant to be and it was going to work out in the end. I had just moved to a new town to start my first job since finishing training. With all the "new," a new life coming into the world seemed to make sense. Yet, it wasn't happening. The stress didn't end there. The day before I flew to Savannah for my girlfriend's bachelorette party weekend, I had to have my blood drawn to track the pregnancy hormone to make sure it was trending downward appropriately. As I was waiting for my luggage in baggage claim, I got a call from the OB's office. My lab results had come back and it wasn't looking good. They wanted me to go directly to the nearest emergency department to make sure I wasn't having an ectopic pregnancy, a potentially life-threatening condition. Now in crisis-mode, my friends at my side, I went to the nearest ED and checked in. Part of the workup was another ultrasound, this time done by a technician [End Page E7] in the radiology department. While transport had wheeled me to the ultrasound room, no one was there to pick me up after the test. I waited in a wheelchair in the hallway for a while. Then the ultrasound tech, noticing that I was still waiting, gave me a pat on my back and with kindness, wheeled me back to the ED. It's strange how, at times like this, the smallest show of compassion makes its way deep into one's memory. The results came back, it wasn't ectopic, and I passed the products of conception. Back in my new hometown, the next week, I went to see the midwife I was originally scheduled to see for my first pregnancy appointment. I felt my face flush as I filled out the forms in the waiting room. What surprised, disturbed, and upset me, was the realization that I would forever be marked in OB notation as having had a miscarriage. In medical school, we learn about how to introduce a patient's obstetric history. The most basic part is the 'gravida para' numbers; gravida for the number of...