It was a gray winter day, and I was running behind schedule. I still had Christmas shopping to do and was hoping to get out of the clinic before 6 p.m. The prospect of cold and dark skies on the way home wasn't appealing, and I just wanted the rest of the day to go smoothly.
My next patient's case appeared to be straightforward. She had been referred to me because of an abnormal alpha-feto protein test (a blood test used to screen for certain birth defects such as spina bifida or Down syndrome). The encounter would involve counseling, a detailed ultrasound to look for fetal or placental abnormalities, and possibly an amniocentesis. The latter test requires the insertion of a needle into the amniotic sac. As a maternal fetal medicine specialist, I knew that patients worried about the possibility of a fetal abnormality, such as Down syndrome, but also about the amniocentesis procedure. They worried about the potential pain and complications, as well as the subsequent decisions they would face if the amnio or ultrasound were abnormal. Would they continue the pregnancy? Would they terminate it?
The time of year, when many patients were trying to focus on the holidays, seemed to heighten the anxiety.
--
Cold response
I walked into the room briskly and with a smile: "Hello, I'm Dr. Castro. I'm the perinatologist, and I will be doing the ultrasound and the amniocentesis if you decide to have it." Immediately, the room seemed to grow cold. The patient and her husband stared at me. I proceeded to explain the potential reasons for an "abnormal AFP test," the sequence of evaluation and the benefits and risks of an amniocentesis. I spoke fairly rapidly with quite a bit of detail, and the room seemed to grow colder. "Is there anything I have said you don't understand?" I asked. The couple looked angry now. I sighed. Something had gone wrong and it wasn't getting better. Were they angry because they waited too long? Did I explain too much too quickly? Did I offend their religious beliefs? I thought for a moment. I wished I could just start the whole encounter over again. Then it occurred to me -- why not?
I looked at the patient and her husband. "I'm sorry, I feel as if you are both upset by something I did or said, but to do the best I can for you and your baby, we need to trust each other. So, if you don't mind, can we start over?" A glimmer of a smile appeared on the patient's face. "Yes," she said.
I briefly left the room.
