Friday, August 06, 2004

biohazardous material

I was in the ER last night when EMS brought in a woman who had miscarried a second-trimester fetus. This might seem strange to you, as I'm working in the Pediatric Emergency room, but by the rules of the hospital, anyone under 21 goes straight to the Peds ER regardless (irregardless?) of the medical problem. The patient had delivered the fetus in the ambulance and EMS had saved the products of conception in a red biohazard bag and stuck it in the lab. One of my attendings took me to the back to see. He wanted me to guess how many weeks the fetus was.

He opened up the bag. Trying to sound for all the world like the calmest, been-around-the-block senior resident in the ER, I said (testing my voice for shakiness) somewhere between 16 and 18 weeks. He concurred. I nodded sagely. But inside, I was losing my shit.

I had seen one miscarried fetus in the past, a 20 weeker during my Ob/Gyn rotation in med school with multiple congenital anomalies and fetal hydrops. It was clearly a malformed fetus, like something you might see on those tasteless websites that display pictures of unusual medical conditions for gross-out value. You know, those baby-in-a-jar pictures. It was disturbing. But this fetus last night was worse.

The attending went into a little mini-embryology lecture, detailing the fully formed anatomy, proportions, growth. But I wasn't really listening. To tell you the truth, I felt more than a little bit scared. It was like watching a horror movie and forcing yourself to watch the climactic scene with your eyes wide open. I don't know why I felt so spooked. But the fetus looked just like my patients in the NICU. Sure, it was smaller, more translucent, and had a couple of weeks to go before even approaching viability, but otherwise looked for all the world like the fully-formed premature infants in the little plastic pods upstairs. Only instead of a pod, it was lying in a red biohazard bag in a plastic emesis basin in the back room of the Emergency Department.

It wasn't a matter of personal beliefs or reproductive rights. It was a matter of seeing something close up and in that harsh flourescent lighting that you feel you shouldn't be seeing, ever. That feeling of internal discord you get when you see something private and harsh and real, like the intractable pain of a cancer patient, or the grief of a parent given the diagnosis of their child's terminal medical condition. It's hard to look in the face, and you just don't want to be there.

The attending was holding the fetus in one hand, and when he moved his fingers distractedly, making a point, it looked like the fetus was flexing its legs. I almost jumped. It looked like such a natural movement, and the tissue still so pink and fresh, as though still being perfused. It looked like it was alive, though I knew it was not. And then it was over, we were walking out of the lab and going back to tending to our ER full of sick and hurt children. The teenager who got jumped on his way home from school. The little boy with allergic wheals all over his body. The baby with a fever to 104. Only the fetus was still there, in the back room. And I kept thinking about it for the rest of the night, those perfectly formed hands and feet, that tiny face.

Currently reading: "The New Yorker" article about Munchausen Syndrome By Proxy. I like it when they have medical articles sometimes.

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