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Academic Medicine:
doi: 10.1097/ACM.0b013e3181ea5a54
Other Features: Teaching and Learning Moments

The Flickering of a Heartbeat

Johnson, Elizabeth Ann Massopust

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Ms. Johnson is a fourth-year student, University of Minnesota School of Medicine, Minneapolis, Minnesota.

Author's Note: All patient names and identifiers have been removed or changed to preserve patient anonymity.

A splash of cool blue gel, a wave of the transducer, and another hidden world comes alive on the screen—precious little movements, the flickering of a heartbeat, and, if all goes well, a face in profile. As a third-year medical student on my obstetrics rotation, 33 weeks pregnant with my second child, retrieving the ultrasound machine became one of my favorite responsibilities. I knew these as joyful moments even before my rotation, having marveled at fuzzy ultrasound images of my own babies. Now I took great pleasure in revealing these hidden treasures to expectant mothers. My translation of the grainy images drew admiration and appreciation, filling my heart with tenderness and, dare I admit it, fueling my pride.

On this particular day in labor triage, I once again retrieved the ultrasound machine. A patient was waiting, 31 + 6, a recent transfer of care from a nearby midwife clinic. “No doptones audible by the nurse midwives” was the nurse's report to me, but no one was worried. After all, the patient had felt the baby move yesterday; her records documented excellent prenatal care, and she recounted a healthy pregnancy without complications. A faulty doptone machine or an inexperienced practitioner was the likely diagnosis. I had witnessed more than one resident struggle for minutes to find heart tones in clinic. The bedside ultrasound would reveal the reassuring flicker of cardiac motion that the doptone had missed, and all concern would be assuaged.

I wheeled the machine through the triage curtain, smiling reassuringly at our patient. Her beautifully rounded belly, perfect size for dates, was soon covered with blue jelly. With the transducer in the experienced hand of my attending physician, the hidden womb emerged on the screen. I felt a familiar sense of pleasure and excitement. My own baby kicked as if on cue. We scanned slowly back and forth. The soothing hum of the computer was the only sound.

Scanning the screen, I was suddenly disorientated. I searched for familiar landmarks—a waving hand, the crescentric spine—but each effort was frustrated. The fluid pockets were too small, the picture too grainy, and the fetal anatomy too ill defined. Had the patient discovered my inner panic? I focused on the unfamiliar calm on the screen, the flicker of the heartbeat conspicuously absent.

“Ms. Harris,” my attending's voice pierced the endless silence, “the baby's heart is not beating. I'm afraid your baby has passed away.”

No, no! The patient's eyes were filling with tears. What had we done? Reassurance had vanished, replaced by the patient's quiet sobs and the wail of her companion. My own eyes welled up with tears. An instrument through which I had known only joy and tenderness suddenly became a messenger of death and devastation. I looked again with longing at the lifeless little one on the screen. My tears spilled over onto my cheeks.

My patient delivered courageously that night. The next morning during my rounds, I feared my protruding belly would draw her resentment, but instead, she welcomed me, speaking lovingly of her brief time with her child. She wished me well in my pregnancy, and, as I stepped onto the ward, I wondered if I could face another day with the ultrasound. My moment of decision came quickly. A new patient had arrived, and the sonogram was required. I blinked back tears and brushed past the curtain into triage, praying for the same courage I had seen that morning in my patient. It was my own small, heroic moment. The machine hummed, gel splashed, and I held my breath. There it was—a flickering heartbeat.

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Acknowledgments:

The author would like to thank Dr. Therese Zink, who assisted with the editing of this piece.

Elizabeth Ann Massopust Johnson

Ms. Johnson is a fourth-year student, University of Minnesota School of Medicine, Minneapolis, Minnesota.

© 2010 Association of American Medical Colleges

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