Monday, August 11, 2008

"Hi, this is the lab calling..."

"...and unfortunately I have some bad news for you."

This is how the conversation started. It ended with me making a patient cry.

In the IVF business we sometimes have to give bad news. The nurses and doctors have to give it all the time, in the form of "Your pregnancy test was negative" or "I'm sorry but the baby has no heartbeat." or something shattering like that. Usually the lab just has to give the facts, like "You had 8 out of 10 eggs fertilize." or "Your embryo quality is not perfect, and based on that and your age you might want to consider getting 3 embryos transferred instead of 2."

Occasionally, however, we have to give bad news. Like today. I had to thaw an embryo for a patient. It was her only embryo that was frozen from her IVF cycle late last year, where she became pregnant but lost the pregnancy in the early weeks. When I thawed the embryo it looked dicey. Most of the time I can tell right after thawing if an embryo is going to make it or not. This one didn't look great, but still looked like it had some hope. So I waited until the afternoon to look at it again. In those few hours it had taken a turn for the worst and had degenerated. So her embryo was dead.

This happens sometimes, but usually the patient has more embryos to thaw. If this patient had more embryos than just one I would have called her, told her that the one we thawed didn't look good so we should thaw another. But, with none left to thaw, there wasn't much I could do.

I showed by boss the pictures of the embryo, and she agreed that it did not survive the thaw. She said I should call the patient and tell her that she would not be having an embryo transfer today. It is rare that we cancel a transfer. Like maybe 3 or 4 a year.

I hate making those phone calls. I told her, as gently as I could, that unfortunately her embryo didn't survive the thaw, and since it was her only embryo that we weren't able to thaw more. I told her that I was very, very sorry, and that sometimes this just happens. She didn't say anything, and then started to cry. I told her, again, how sorry I was, and then she said "Okay, bye.", and hung up.

So now I feel terrible, and have been moping around all afternoon. We had originally had two transfers scheduled for today, and the doc who did the first one gave me some advice. She said that I have to not let this get to me, and that I have to put it in a little compartment and, without getting callous, try and have it not effect me so much. She said that it's terrible for the patient, but it's one event to her and she will deal with it and get over it. But I'll continue to have bad events in this business, and I've got to not let them pile up or I will be incapacitated by the grief.

It's good advice. I'll try to follow it. But right now I'm sad and I think I need chocolate.


Jen Travers said...

Understandably your upset--it's called empathy. If calling that woman and hearing her cry had no affect on you--then that's when you need to worry. Compartmentalizing will help, but so will chocolate and a nuzzle from your horse. Feel better.

Grey Horse Matters said...

That was a terribly hard thing to do, go have a box of chocolate and a good ride.

Katee said...

That's awful. I can't imagine having to make that phone OR receive that phone call. I think what you do every day at work is amazing. Hopefully this woman that you called has a good support system around her and a strong faith that there is a plan for her and it is GOOD. Hug your girls...they are precious wonders!

Anonymous said...

What a hard thing to do. I hope you feel better. I second the chocolates and a ride :).

Stacey Kimmel-Smith said...

The ability to deliver bad news with empathy and clarity is an important gift that unfortunately is seldom recognized. Have you ever learned bad news from someone who was unprepared to give it? I was in the hospital room when a friend found out inadverdently from a nurse that her liver transplant was considered a failure. My friend knew at some level this was true, but no one had told her. I imagined the nurse must have spent a sleepless night, or nights, over the error. I hope that you can take some comfort in knowing that you have mitigated the impact of the news by relating it knowledgeably, with skill and tact.

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