Dana Holland, 24, early in her pregnancy, came in to Temple University Hospital’s emergency room on Thursday morning with cramps. She was terrified she was going to lose her baby. She lay in the little bed, under a sheet, fearing the worst. Her pink sneakers on the floor beside her.
11 months ago, in August, Holland miscarried. It had been her first pregnancy. She got cramps then, too, but ignored them, and a few days later lost the baby at 12 weeks. It devastated her.
This time, the moment she felt cramps, she rushed to the ER.
Dr. Stephanie Barbetta, in charge of the Green Zone, the area for sprains, stitches, and less critical emergencies, walked into Room 40 to see Dana Holland.
Barbetta was kind, calm and reassuring. She asked lots of questions, did a physical exam.
Then she went to get a portable ultrasound machine.
The patient had never seen an ultrasound machine. She did not have an obstetrician and never had a pre-natal visit.
Barbetta rubbed jelly on Holland’s belly, then put the ultrasound probe there moving it around to get a good look. Using sound waves, the probe is able to get a picture of the baby inside the uterus, and that image is displayed on a computer screen.
“I see a heartbeat,” Barbetta said. “That’s a good sign.”
Holland, lying in bed, couldn’t see the screen. She was still so anxious, and fearful, she took no apparent comfort from the news. She still seemed lost in her fog of fear.
“Want to take a look?” Barbetta asked, turning the ultrasound screen toward the bed.
“That’s the heart, Ok?” the doctor said, pointing at the screen.
Dana Holland sat up in bed. She brought both hands to her mouth, astonished.
“Oh my god! Oh my god!”
The doctor continued moving the probe, pointing at the screen. “And the head. See?”
“Oh my god!”
“Anything really dark white is bone,” Barbetta explained, “so that’s the backbone. It’s laying on its back now….”
“Oh my god! Look at that… Looks so big!”
“Oh, you wait,” Barbetta said, smiling.
In 14 years working in the ER, seeing countless pregnant young women, Dr. Barbetta had never seen one so excited, so filled with wonder.
“See it kicking?” Barbetta said. “Kick, kick, kick.”
Tears welled in the young woman’s eyes.
“I was so scared there was something wrong.”
Barbetta was gentle and reassuring but clear. “Things look pretty good today, but I have to tell you that if you have some cramping and you’re pregnant, a miscarriage is always a possibility. I’m not trying to scare you but I need to make you aware of that. Ok?”
Holland couldn’t take her eyes of the screen.
“I don’t think I was ready for this,” she said.
Well, you’ve got about 23 weeks to get ready!” the doctor said, smiling.
Holland laughed. She touched her belly.
“There’s really something in here.”
She turned her gaze back to the screen. “Like a little bird. It’s so fast.”
“It’s 162 right now,” Barbetta said, referring to heartbeats per minute. “Which is perfectly normal for a developing baby. That’s exactly what we wanted today.”
“Thank you,” Holland said.
“You’re very welcome,” replied the doctor.
“You don’t know how relieved I am. I was so — you don’t understand. I was so scared, this being my first baby.”
Holland still had a question.
“So the cramping,” she asked, “what is that from?”
“Your uterus, where the baby is growing, has to stretch,” Barbetta said. “Your uterus is like a big muscle. As that starts to stretch, some people feel a little soreness here and there. Cramping can be normal early in pregnancy. Could that be a miscarriage five days from now? I can’t predict it. But from what I see today, a good heartbeat, you’re measuring appropriately. It looks good.”
Barbetta made sure Holland understood how important it was to drink plenty of water, and eat healthy food, take prenatal vitamins, and lay off all the wrong things.
“It’s really important you get an OB appointment,” the doctor said. “We can help you with that.”
Holland graduated from Simon Gratz high school, went to Mansfield University briefly. She’s been working as a home health aide, and wants to take a class to become a certified nursing assistant, and get a job in a nursing home, like her mother.
“With a little one I have to do it,” she said. “I have to be on my Ps and Qs now. I have to get it together.”
The portable ultrasound machine did not have a printer. “If you want,” Barbetta offered, “I can let you take a picture of the screen.”
“On my phone? Yeah. That’s good to me.”
The doctor went to take care of some paperwork, arrange for an OB appointment.
Holland texted the image to her mother, brother and boyfriend, and almost immediately the phone started to ring.
Michael Vitez, winner of the 1997 Pulitzer Prize for Explanatory Journalism at The Philadelphia Inquirer, is the director of narrative medicine at the Lewis Katz School of Medicine at Temple University. Michael.firstname.lastname@example.org