Tonight, I blasted on the radio, declared that the next song was going to be the summary of my day, and it was good ole' Travis Tritt crooning "It's a Great Day to be Alive." Thus leading to my blog entry.
I am currently on my OB/GYN rotation and I spent the day at a high risk obstetrics outreach clinic. The only staff members were the maternal fetal medicine doc, the ultrasound tech, and myself. We had 10 patients and were basically just doing the standard growth and anatomy ultrasound checks. I got to see a few sets of twins, some benign anomalies, and become more comfortable with reading ultrasounds. With 9/10 patients down, I went to review my notes on the last patient. I remembered being confused about her earlier in the day because the only note I could find in the chart read "Fetal heart tone." I asked the doc for some more info, and the doc told me that the patient's first trimester ultrasound revealed marked nuchal translucency and cystic hygroma. Cystic hygroma is usually an indicator of Turner Syndrome, a chromosomal abnormality where the patient only has one sex chromosome, having a karyotype of 45, XO, instead of the normal 46, XX (female) or 46, XY (male). Unfortunately, 99% of conceptions with 45, XO result in spontaneous abortion or stillbirth. The surviving 1% of patients with Turner Syndrome are actually able to lead pretty normal lives, with the exception of some cardiac defects (commonly a coarctation of the aorta) and fertility problems.
Anyway, back to clinic. This lady was scheduled as the last patient of the day, so that we could take the time to break bad news to her. If her baby had Turner Syndrome, there was an extremely high chance that it would be dead when we looked at the ultrasound. This would be the first patient encounter for me in which we had to break this kind of bad news, and I was nervous. The doc gave a quick practice speech to me, so I knew what to expect and how we would counsel the patient, what the next steps would be, etc. I went out into the hallway and was immediately relieved that she had brought a support team with her -- her husband, mother, and other children. I brought her back into the room and we all tried to maintain a positive atmosphere, like we weren't about to drop some of the most devastating news of her lifetime. I flipped down the lights, and the ultrasound tech placed the probe, and said a phrase that I will never get tired of hearing:
"Look! Here is your baby's heartbeat."
Yes, Travis Tritt, it is indeed a great day to be alive!
