The Sacred Space of Care

This is a miscarriage story based on an account relayed to me from a patient.  The amazing thing is that it happened over 20 years ago but the memories are still strong.  Here is her story and my reflections.

The A&E Department was busy on this particular Saturday afternoon.  A woman in her mid-30s sat nervously waiting to be attended to.  It wasn’t her first miscarriage but this one was hard to take.  She and her partner had been hoping to bring a 2nd child into the family.  She wasn’t getting any younger and having a playmate for their 1st child was something that fuelled their dreams.

 The young doctor who appeared before her was keen to help her.  He only had a few questions to ask her, then the real treatment could start.  So let’s get the questions out of the way so we can get to the business of care.  The last question, “would you mind signing this consent form madam?”  This puzzled the woman.  What was she consenting to?  She pressed the doctor to tell her more.  The doctor was somewhat taken by surprise by the hesitancy of the woman.  Eventually he said that he needed her consent so that the consultant could “extract the products of your conception”.  What we call an EPC form.

 It didn’t seem too much of a shock at first.  And the doctor said it without blinking an eyelid. But for the woman, this was her baby, not a “product of conception”.  He didn’t mean to upset her, but she couldn’t help feel deflated and deeply saddened by this terminology of words.  Her heart sank, just like her dreams when she noticed that something was wrong when the bleeding appeared.

Enter the consultant.  Smiling but not overly.  An older man but with a presence.  He kneels down so he is at the same eye level, reaches out to hold her hands, looks her in the eyes and says in a calm but reassuring voice “I’m terribly sorry your baby has died.  You must be very upset   (Pause…).  If you wouldn’t mind, I’d like to ask you some questions to help you through this difficult time.  Would that be OK?”

Her eyes widen, her heart-beat slows, and she sighs a breath of relief.  Someone here understands me. That feels so reassuring.

On reflection, the woman said the younger doctor did nothing wrong…technically, but left her feeling upset and disheartened by the whole experience.  The consultant also did nothing wrong technically, but her experience of care in this encounter was 10-fold better.  She felt understood and engaged in the caring process.

She described the encounter with the young doctor as a “transaction”.  An action needed to be undertaken, the signing of a consent form.  Conversely with the consultant, it felt more like an “interaction”.  There was a recognition and acknowledgment of what she was feeling.  Miscarriages bring with them lots of emotions. 

Healthcare is different in its process from many other professions.  Because of the nature of healthcare and its inherent levels of trust, there is a sacred space that pervades these interactions.  At the heart of this sacred space are the communication skills of the health professional.