When the worst happens

It’s a seasonable May evening in the golden hour just before dusk. I’ve just finished a run along the water and through a patch of forest near my house. As I walk between massive, old-growth cedars towering above and listen to the birds rustling and chirping in the dense canopy, I breathe in the crisp fresh air and think to myself that, in this moment, I feel contented. If you were to peek into my life 18 months ago to ask me if I ever believed that I would find myself in such a moment, I would have crumpled to the floor in a heap of despair. This is because on a cold and snowy November night a year-and-a-half ago, while working a locum on labour and delivery, I experienced the worst outcome of my short career. The ward was busy, as it always is, and everything was going as well as one can expect. Until suddenly it wasn’t. I was called urgently to a room where a heartbeat was suddenly lost. For a second, I panicked. But then, I did exactly what I knew to do. Everything moved quickly and before I knew it, I was cutting faster than I’d ever done before. In less than 60 seconds a baby was in the world and in the capable hands of the pediatrics team. However, it wasn’t enough. We weren’t enough. I wasn’t enough. Read: Talking with patients about complementary alternative medicine A colleague came in to take over the rest of my shift, but the hours that followed in the early morning went by in a blur of mental anguish and torment. I will never, ever, forget the harrowing moment when I faced a woman, tears running down both our faces, while she held her still child, with nothing to offer but a deep and regretful apology. As I left the hospital that morning with absolutely nothing left inside of me, the only thing I could think was, “This is all my fault. I should have done better.” Shame and guilt In the days following, I went through all the necessary actions—the debriefing with the unit staff, talking with the family, all the mountains of paperwork and documentation, and finally a trip back home where I was expected to resume my normal clinical duties. Despite all the talking, all the debriefing, and all the reassurance that I had done everything I could, I could not erase the shame and guilt I felt over what had happened. Read: When self-care is self-preservation My nights were haunted with nightmares reliving the night over again in different permutations and combinations of scenarios. I couldn’t sleep for the incessant self-interrogations, sifting through the events with a fine-toothed comb, wondering where I made a mistake (did I even make a mistake?), or where I could have done something differently, or if any other course of action might have changed the outcome anyway. I found myself begging for the impossible chance to re-do that night over again. My days were filled with flashes of memories: the mother and her baby, the moment I pulled the baby out and handed her over, and even the flashbacks of somehow competently completing a surgery as tears clouded my vision, and likely dropped into the surgical field to become part of the woman with whose life I tragically collided. Barely a week went by when I realized that this outcome, this tragedy, this “mistake,” was consuming me, and I needed help if I was ever going to survive the torment I was experiencing. Even that thought—that I would survive this point in my life—felt like an impossibility. I started by talking to some trusted colleagues—my friends from residency— those I knew would understand the medical side of things and would understand the gravity of what I was experiencing. I shared my self-torment with a few close friends whom I felt could be trusted with the ugliest and scariest parts of myself. Finally, I reached out to the physician support program in my province to speak with a therapist about my grief and trauma. Despite making these connections, I still felt very alone, as if I was on the other side of grief itself. I felt as if I was standing on the wrong side of a two-way mirror: I felt that as a physician, with the need to move forward and to remain professional and respect confidentiality, I was an impermeable silver wall of compassionate stoicism. Yet behind my reflection was a vast expanse of emptiness, where I ultimately still sat alone with a grief that I had to bring myself through. Feeling less alone One physician friend recommended that I watch Dr. Brian Goldman’s 2010 TED talk about doctors making mistakes. The talk starts by comparing all-star baseball stats (batting 4/10 safe hits is legendary) with the expected “batting average” of the average doctor or surgeon being nothing less than 10/10—100%. And Dr. Goldman asks, where does that leave us physicians who are human beings, who err just as everyone else—and who then hold in ourselves the shame and guilt of never being good enough? Although I was weeks into my rather ineffective healing journey, this talk was the first time I began to feel like maybe I wasn’t completely alone in navigating the after math of a terrible outcome in medicine. The next most helpful step in my journey to recovery was understanding that the process to healing would take time—and likely more time than I wanted or felt that I was able to give. Once I accepted that reality, I let myself focus on the journey one step at a time. I was grateful to reconnect with a therapist with whom I’d had a previous therapeutic relationship. There was also space within the physician support program to lengthen the services to provide the support I required over the time I needed. Gradually, months passed. Although the rawness of the experience faded and I was able to allow the memories to blend into the background of my life, hardly a day passed when I didn’t think about the family inextricably weaved into my history. As the anniversary of that night approached, I relapsed into a new sense of grief. I longed for something I didn’t think would ever be possible—closure, a final acceptance. As the one-year mark approached, I found myself standing in a card store, attempting to choose the perfect card to send a family who, like me, were barreling towards the anniversary of an event that changed their lives forever. Once I settled on one, I constructed a simple thought to let a family know that I always think about them and the time I spent crossing their path has never been forgotten. I opened a long-ago folded scrap of paper in my wallet—the only piece of information I saved from that fateful night—an address. Sending a card was the most closure I could ever ask for. In that moment, I feared that I was selfish in sending this small token of my own healing journey; I worried that perhaps in doing something to help myself move forward, I was causing more pain for someone else. But I did it anyway, and I accepted this as the book end on this tragic event in my life. A letter from the family I believed my healing journey as complete as possible, and I never expected a response from the family. But a few months later, there it was, sitting on the counter in a thick envelope with their family name printed heavily across the top left corner. I stared at the envelope for a long time before opening it. Inside was a card, complete with pictures of their whole family, and a beautifully handwritten note. In it, they thanked me for my kindness in sending them a card, and for the role I played in their lives. They filled me in on little details of the past year, including findings from their baby’s autopsy, in case I didn’t know what was found (I never knew the outcome, so this was instrumental for me), and the admission that they think fondly of me when they remember their time in the hospital. I cried as I read the letter repeatedly. I didn’t realize how much I wanted to hear from this family again—how much I needed it to finally feel a sense of peace. In that moment, I was grateful that I took the risk in reaching out to this family—not only because it provided me with a feeling of contentment after so long, but because it demonstrated the true power of authentic human connection, even in the face of life’s worst moments. A few months more have now passed, and I have accepted that this fateful outcome will always be part of who I am. Since that morning 18 months ago, I have traversed a path from a place of darkness, unfathomable shame and devastation, to where I am now: a place of contentment in where my life has taken me. If we lived in a world where we could change the past, I would redo that night differently every time, and maybe it would have made a difference. However, in this world where we can only move forward, I am content with the knowledge that my life has forever been changed and I am a better person for that change. Dr. Ginevra Mills is a reproductive endocrinologist based in Victoria.

When the worst happens

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