The young doctor and perinatal death

by Claudia Ravaldi
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This is the letter from a student of ours, now a brilliant medical graduate. His words are very important and precious: for those who care, and for those who receive them.

M. tells us about her experience as a young student, tells us about her reflections on care in perinatal death, and the difficulties encountered when there is no training and emotional support for the operators.

“My journey begins as a third year medical student who stumbles upon a” special “pathological anatomy department by chance, and then stays there until the thesis.

Today I am a young doctor who is keen to continue seeing autopsies, going to conferences / reading literature on stillbirths and above all reading testimonies or even meeting mothers. I will try to explain why, and to answer a question that is often asked of me: “Who makes me do this?”

Normally, according to the study plan, the medical student is not even expected to see an autopsy: it is up to the initiative / curiosity of the individual. I had no such curiosity, but I was passionate about the pathological anatomy lessons, so I asked to take a look at the ward and there I literally ended up by chance to see the fetus-placental autopsy as well.

The first autopsies were a storm of emotions, a great load to manage, with the fear of being crushed …

I remember that I had set out to always look at the name and remember it (this also for adults): it seemed to me a necessary gesture, the minimum .

Then there was Lia: a beautiful little girl with myelomeningocele and clubfoot. It was one of my first, I asked and had a moment to touch it before the autopsy: I ran her little fingers between mine, I caressed her eyes, I was kidnapped, she looked beautiful … why was she there? Just for that little thing in the lower back ?! And the feet, oh well who looks at them: it’s so beautiful! Obviously, in the third year I didn’t even remotely know what a myelomenigocele was: they explained it to me and unfortunately Lia really wasn’t there by mistake.

When the autopsy started I felt terrible, I had to force myself to stay anyway trying to absorb only the medical-scientific side of what I had in front of me.

So, thinking it might help, I tried to say enough : you no longer read the names of the children, you only think about the pathology and … thank goodness I’m there “safe” near the hood and away from the parents, why not I would know how to deal with them.

I even thought and said aloud ” but gynecologists should explain to mothers that they are not babies in miniature, that it is better not to see the malformations, macerations, etc … and then after the autopsy, how do you return it like this for the funeral ! “. How silly (to say the least): I’m ashamed to admit it, but I started from that too. I really thought this.

Yet not even I was interested in Lia’s malformation, she was beautiful for me, let alone for her mother !!!

Now I understand the beauty and importance of seeing, touching, hugging, kissing and photographing the child for the parent … but it is one of those awarenesses that have come to me over time.

In short, ” depersonalizingdidn’t work in the end. I could go home and tell myself “today I saw a unique atriaventricular canal” (one of those horrible things we doctors do all the time, right? Like “bed 3 asks for a painkiller!”) … but I don’t see the time to fall asleep again. a CAV, I see Giovanni or Giorgia.

I gave myself time and patience, and so I saw that instead I began to search, to need the story of the children and their mothers. The same story that scared me so much before.

I did not find these stories in pathological anatomy: I found them on CiaoLapo, at first looking at the site for short forays, always frightened but curious, then, always without forcing myself (so much was one thing only mine : a simple student-observer like me did not have to answer to any doctor / professor or patient) with more confidence, less fear, and a great desire to give a voice, a name, a space.

Then I met Dr.L. I didn’t even know that she took care of special mothers, the thesis path began in my eyes with a researcher who also worked with ProfB. Stop. How many things that cannot be imprisoned on paper did that thesis mean for me !!! She started telling me something about her work and for me it was a huge gift, full of trust! Finally close and tangible words, I can finally give voice to all my questions, even the most stupid : how is your job? What does a mother say, what does she ask of you? It’s beautiful but it’s hard right? What do you do if she cries? What do you do if he is NOT crying? How did you get there? Can you go home and “take” your mind off work? How do you do when you suffer …? Etc.

My growth / survival / coping has gone through a lot from exchanging and meeting others.

I have been and still am very lucky for the people I met.

So what to tell you about the graduate’s point of view on stillbirth?

That we are few, very few. Already there are few pathologists and gynecologists, let alone the students. In perfect Italian style, it is up to the individual to create (or not to create) an armamentarium of practical and theoretical knowledge on fetal-placental pathology as well as on the clinical and especially human management of 1 out of 6 pregnancies.

Obviously my weapons are few and blunt, I am only at the beginning, I do not walk alone even remotely … it is also true, however, that my tortuous path has enriched me a lot, it has really helped to shape the novice doctor who I’m. The stillbirths touched me, leaving their mark, and I needed not only as a student / doctor, but just as a person to “take home” the child and not the myelomeningocele, to talk about it, to remember, to compare myself and ask questions.

Even if I am just the one who attends the autopsy or goes through the archive of the reports for a study, a small piece of me remains with the cases encountered and a small piece of their history goes home with me: I have to take care of them a bit like the little prince with his rose.

And this taking care almost always passes through the encounter-confrontation with the other. An infinite wealth!

For this reason I first wrote “it is you who come to meet me”.

However it is a very personal point of view and cannot be separated from how I am and how I re-act … Together with me, for example, another boy did his thesis with Dr.L and ProfB, he too attended many perinatal autopsies, but his point of view is very different from mine: not because I am better or more sensitive (absolutely! It has nothing to do with it!), but why in the anarchy to which all (doctors, parents, midwives, psychologists, students, etc.) are left the death in utero event leaves the individual with the burden of finding his own way of ” cope with ” … and each individual responds as he can, addressing his needs and experiences . “

We have already written in Italian and international magazines on the need to rethink training for our young colleagues and for all maternal and child workers.

The effects of lack of support for operators in critical situations have been addressed several times: in particular, burnout and post- traumatic effects related to assistance have been the subject of numerous national and international publications.

M in his letter asks us to allow young doctors to reflect on pain, death and communication with family members during their studies.

We will talk extensively in other posts on the emotional, but also economic, cost of learning on your own to relate to the family members of a seriously ill or deceased patient.

Thanks to Dr.M, thanks to Dr.L and ProfB. For everything they do every day. Doctors, from whom we all have a lot to learn.

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