Rather than further her healing, the obstetrician’s words alienated her and added yet another layer of wounding.
Letter continued
That hospital was my personal place in hell from the moment I entered until the day I was discharged. You and your office staff seemed totally oblivious to this fact. Now a year has passed—a year of pure devastation—and I still have pain and sadness that cannot be understood by anyone who has not experienced the death of a child. And I have anger at the incompetent ER staff and at myself for being “a good patient” and ignoring my intuition.
I deserved a physician who can remember who I am and my relevant history—one who would come to see me immediately and reassure me that everything possible would be done for my baby and me. I deserved a physician who can acknowledge the awfulness of such a loss and offer sympathy and support. And to make matters worse, you immediately retreated behind the fear of a lawsuit.
Grief, interrupted: When the business-as-usual world interferes
An outpouring of grief in the face of loss is normal; it mobilizes energy and is an integral part of the healing process. Emotional healing may seem protracted when it is viewed in the context of chronological time, and pressing demands frequently interfere with the process. In this case, demands included the need to attend an ethics meeting, arrange a funeral, care for a 2-year-old son, host parents-in-law who had arrived from out of town, and, the following week, throw a birthday party for her son.
Disenfranchised grief: How wrong words, or none, can slow healing
This patient found little validation or support for her grief from those who were around her:
- Medical personnel acted defensively and insensitively.
- Her in-laws kept busy, making idle chitchat while they fussed over the party and memorial arrangements.
- Her friends plied her with platitudes: “God needs an angel in heaven,” “God needed your son more than you do,” “We can’t know why God makes these decisions.”
- The priest performed the memorial service in ritualistic fashion. “He couldn’t even get Eric’s name right,” she lamented.
- Her return to work was marked by awkward cheeriness, “as if I had been on vacation.” Her boss’s comment? “Best hop right back in the saddle.”
Three symptom clusters signal PTSD
Dr. Foster’s description of her postdelivery experience suggests to me that she sustained an acute stress disorder—a condition that involves feelings of intense fear, horror, disorientation, and helplessness in response to an unusually traumatic experience that threatens death or serious physical injury to self or others. In Dr. Foster’s case, the stress disorder progressed to PTSD—a pervasive chronic anxiety disorder characterized by three clusters of symptoms:
- Recurrent, intrusive recollections of events; recurrent flashbacks and dreams. “At night, after going to bed, I would see the fetal monitor showing my child’s heart rate running like a video stream in front of my eyes. This went on for months. It would take me 1 to 2 hours to force myself to fall asleep.”
- Persistent avoidance of stimuli associated with the event; numbness and detachment. “I had feelings of numbness and unreality but couldn’t really understand or process them. Eating became difficult, and I was unable to experience any pleasure. Survivor’s guilt plagued me. Why am I alive? I asked myself. I had some 30 years, but my son didn’t even have a chance.”
- Persistent symptoms of increased arousal; insomnia, hypervigilance, irritability, difficulty with concentration. “I returned to work after a month but could not focus or concentrate, so I took 2 additional months off. Whenever I heard the obstetrician paged at the hospital, I had a physical reaction. My muscles clenched, my skin flushed, and my heart raced. Eventually, I stopped working at that hospital because I couldn’t stand being there.”
In Dr. Foster’s case, PTSD went unrecognized and untreated.
How to avert, and alleviate, PTSD
As with any disaster, careful planning can mitigate consequences even though it cannot necessarily prevent PTSD. Prenatal visits offer a unique opportunity to build a trusting partnership with your patient and her partner. Skilled professional communication is essential. Anticipate common themes: