Saturday, September 1, 2012

Unexpected!

“I’ve never seen something like this before. Come. See!” My urgent waving of an arm alerted my assisting nurse to look at the black and white images on the ultrasound monitor.

“Look,” I pointed with my finger smudging the screen a bit. “See.” I adjusted the ultrasound probe so that we could see the hollow dark circular structure within the lighter colored uterus.

My nurse leaned in closer and stared intently. “Uh huh.” She said hesitantly.

“Notice, here is the uterus.” I traced the outline with my finger. “Here’s the bladder.” I indicated the black structure that lay above the uterus.

“OK.” She nodded.

“Now, here’s the inside of the uterus and you can see that this dark area inside is fluid in the uterus.”

“Yes, Doctor.”

“That fluid is the embryonic sac. Can you see it?”

“Yes, Doctor.”

“OK.” Now I slid the probe upward on the young lady’s abdomen. She lay quietly listening to our little teaching moment.

“Here’s the fetus inside the womb. See how it is inside the embryonic sac. Remember how the baby grows inside the amniotic sac?”

“Yes, Doctor.” She replied.

(Have you noticed a certain theme to my nurse’s answers yet?). Most people, including my nurses, automatically reply, ‘yes doctor’ to any leading question, such as those I was asking. However, I have come to notice the subtly in the ‘yes’ portion. There’s the ‘yes’ that really means ‘no, I don’t understand,’ and then there’s the ‘yes, I really do understand’.

Although Vivian lacks experience, she has a sharp intellect and can quickly put two and two together. She’d already seen several other obstetric ultrasounds so I felt confident that so far, she understood the images on the screen.

“OK. Now let’s measure the fetus. Write down the figures, please.”

“Ok, doc.” She picked up the obstetric ultrasound report form and held her pen poised and ready to write down numbers.

I quickly found the white oval ring that represented the skull of the fetus, froze the image, and ‘calibrated’ the head circumference and diameter. Unfreezing the screen, I continued my scanning until I had found and measured the abdominal perimeter and the length of the femur. From these three readings one can estimate the age of the fetus.

“Fourteen weeks and one day,” I concluded looking at the numbers the computer had calculated with its internal algorithms.

“Ok, so now let me show you this,” I continued with more excitement and anticipation in my voice. I wanted to confirm my initial gut reaction to something I’d seen earlier. I’d never seen anything quite like it, so I wanted to double-check myself.

I shifted the probe down toward the pubic bone of our long-suffering patient. Despite a full bladder, she was not complaining.

“See this white, wavy line in the amniotic sac?” I pointed to a ribbon-like image dividing the sac into two compartments. “See how the line creates two sacs? One with a baby inside and one empty?”

“Yes, Doctor.” She leaned in closer and traced the line with her own finger.

“I’ve only seen something like this on twin pregnancies. I think that’s what we’re seeing here,” I hesitated a moment but decided to go ahead with my assessment. I would be explaining things in simpler form to our pregnant friend in just a few moments. “I think this represents a twin pregnancy but one fetus is gone; only the second one is there. And, the baby is perfectly healthy!” I added for the benefit of our patient’s peace of mind.

“Wow! Doctor. I can’t believe it!” She was enthused now.

We both were surprised and amazed at our findings that morning. And, why? Well, there’s more to the story!





Earlier in the morning, JD came to consult the doctor for ‘irregular menses’. This is a complaint that covers a host of issues. In a young woman of childbearing age, it often infers a missed menses such as in ‘I’m late for my period,’ kind of deal.

JD was 17 years old. She was a student at the nearby University of Buea. Like most students, she dressed in modern, European styles. She had an exceptional grace and beauty about her well-proportioned figure and smooth silky skin. Her sequined sparkling pink scarf wrapped around her neck accented her pink striped fitted blouse and tight black skirt.

She spoke shyly in a soft voice that gave her an aura of naivety. Her heavy make-up and eyeliner couldn’t disguise the fear and anxiety in her large, brown eyes. She kept her purse slung over her shoulder with her fingers entwining and untwining in the straps during the entire interview. Though quiet, her speech was well articulated. Her English was quite advanced revealing a bright, intelligent mind to go along with her attractive looks.

Her story began three months ago when JD discovered that she was pregnant. Her boyfriend was not ready to support a baby. She couldn’t fathom raising a child while studying at the University. Her boyfriend took her to a private hospital where she had an abortion.

She experienced bleeding after the procedure but, as expected, the bleeding tapered off and ceased. However, her normal menstruation did not come the next month. In fact, she still felt fatigued, a bit nauseated at times, and bloated. She waited for a few more weeks but no reassuring period ever came. Now she was sat in our office awaiting the doctor’s diagnosis.

I recommended an ultrasound. She agreed.

Now you can see why my nurse and I were amazed. Despite a dilation and curettage, there was still a living, moving baby inside that was about three months old! The baby and the pregnancy appeared normal. The only odd finding was a floating membrane forming an empty adjoining sac.

I took one last scan of the uterus and its contents. Then I printed out a picture. Finally switching off the machine, I rubbed off the excess gel with a towel. As she sat up and adjusted her belt I instructed her. “Get dressed. Go Pee. When you come back we’ll talk more.”

She nodded and left the room to empty her very full bladder! I finished writing up my report while she went to the restroom.

“Have a seat over here,” I indicated a wooden chair in my office sitting in the shadow of my looming ultrasound machine when JD came back.

I sat down opposite her with the ultrasound pictures. “The reason you have not seen your period is because you are pregnant,” I stated this fact rather bluntly while searching her face for any reaction.

She looked stricken but not completely surprised.

I continued. “The baby is about three months old. He, or she, we can’t tell the gender yet, is very healthy. A completely normal baby.” I showed her the ultrasound picture of her baby. Despite the early stages of the pregnancy a face, legs, arms, hands, and feet, were clearly visible. He or she looked like a fully formed newborn just on a smaller scale.

JD was obviously experiencing a huge onslaught of emotion as she viewed the picture. Here eyes welled with tears threatening to spill over and down her cheeks. She didn’t say anything at first. Just clutched the picture and stared at it.

“You know,” I reached to give her a reassuring squeeze of the hands, “This baby is a miracle. I have never seen this before.”

She nodded silently.

“It’s really amazing! This baby is a miracle from God.”

Again she nodded her head yes as she started to gather up her things.

“What are you going to do now?” I inquired.

“I’ll keep it.” She said softly.

“What about your boyfriend?”

“No. It’s ok. I will tell him.”

“Will your parents help you?”

“Yes, I think so,” she replied sniffling a little. I gave her a tissue.

“Can I pray for you?” I asked before she exited my office.

“Yes, please.”

The three of us bowed our heads. I offered up a very simple, short prayer on her behalf. A prayer for courage.  A prayer of thanksgiving for the miracle of life. A prayer for wisdom as the days unfolded. And finally a prayer for her peace of mind.

She thanked me as she slung her purse over her shoulder and picked up her medical book and ultrasound report.

I hope I see her soon at her first prenatal visit.

“Before I formed you in the womb I knew you, and before you were born I consecrated you;”
Jeremiah 1:5