She was in the twilight of her child bearing years, and on the verge of tears. Her husband sat next to her bed cradling their two year old son who was only slightly distracted from his mother’s discomfort. The bleeding had just started that morning, but it was the pain and cramping that brought her to my emergency department.

From a clinical point of view, it was an easy workup. Blood type, pelvic exam, ultrasound. Mostly likely she’d go home, unless there was an obvious ectopic pregnancy. Except at six weeks, it was unlikely that we’d see an ectopic. I would also guess that invitro fertilization greatly reduces, if not eliminates the possibility of an implantation outside of the uterus.

Step one, the pelvic exam, started out routinely enough, I donned a mask as has become my custom for pelvic exams…you just never know what’s in there. Just then, her mother arrived. I let her come into the room to say hello. What happened next was somewhat unreal. The patient burst into tears, mom gave her a big hug.

“It’s just so unfair,” the daughter cried.

“God has everything under control,” reassured the mother.

“But I wanted Jonathan to have a little brother,” she sobbed.

“Just be glad you have one healthy child. That’s more than a lot of people have.”

“I’m so afraid that this is my last chance,” she said through her tears.

“Everything happens for a reason,” mom reassured.

I was touched not only by the mother’s wisdom, but also by the intensity of the daugher’s attachment to the outcome of this pregnancy. A planned implantation to provide their healthy, happy two year old with a brother, a second child for the family. As a physician, I know that most miscarriages do happen for a reason…a genetic defect, a bad implantation, something gone awry in the intial stages of the pregnancy. Spontaneous abortions are a protective defense against the birth of unhealthy children who wouldn’t likely survive outside the womb.

The pelvic exam was unremarkable, but the ultrasound told the story. Her uterus was empty. Her hormone levels extremely low for six weeks of gestation. I had to tell her that this was mostly likely an inevitable, if not a completed spontaneous abortion.

She and her husband were crushed, and left the department holding thier son who had been shielded from most of the visit. I truly felt bad for her, but not only because she had lost the pregnancy. I felt badly that she and her husband had placed such an incredibly strong emotional attachment to the outcome of a modern day scientific miracle of fertility, even in light of having one healthy child.