Surgeon Carmen Fong reflects on her experience of miscarriage while working in a demanding and male-dominated profession
Trigger warning: miscarriage, gore
Disclaimer: The author acknowledges all definitions of gender and sexuality, even though this is written from the POV of a cis-gendered, queer, able-bodied female.
Addendum, May 26, 2022
I wrote this a week before the Alito papers leaked and our world was thrown by the possibility of Roe v Wade being overturned. Decades of abortion rights simply signed away.
In the aftermath, complaining that I lost my pregnancy seemed trite, when others were fighting not to have one. But in the end, the right to an abortion and the right to be pregnant are two sides of the same reproductive rights coin— a woman should be able to choose what to do with her body, and her uterus. If she wants to carry a baby and not be subject to grueling manual labor, that is her choice. If she does not want to carry a child, for whatever reason at all, that is her choice.
But too often, we are still stuck in this white male dominated world where women, people of color, and the impoverished do not get to choose. In the land of the free, so few of us are.
***
I stood in the operating room miscarrying with a man’s cancerous colon in my hands. Two weeks ago today, though it seems like a lifetime ago now. Or this embryo’s lifetime, anyway. I had been sitting at the robot console when I felt the urge to pee— not unusual, sometimes this happens midway through a surgery. I went to the bathroom and when I stood up, I saw blood filling the toilet in chunks and clots. My heart fell out with it.
Not knowing what to do, I told myself it was nothing, I had a patient on the table, and I had to go back and finish the case. So I scrubbed back in and stood there, a man’s cancerous colon in my hands while blood poured down my legs. Don’t panic. Smile. Talk like you normally would. I made my movements swift and sure, wouldn’t let my mind wander or doubt.
The whole world continued to move as it normally would, even as I felt frozen in place. I cannot begin to describe the feeling of standing in a room having a miscarriage and feeling like all I can do is keep going, finish the job, there are things bigger than you right now. I had to save this man’s life or at least keep him alive.
At the end, as soon as he was extubated, I excused myself and rushed to the bathroom again, cross-legged running, tying a gown across my butt in case it was soaked in blood. It was, of course, and I crouched in the hallway between my bathroom and my office, knowing full well that I had one more surgery to do that day, one more patient to go. I knew if I called my wife I would start crying, so I didn’t call her. I called my doctor‘s office and spoke with her nurse.
“I’m bleeding,” I said, my voice and veneer finally breaking.
“Sometimes there’s a clot,” she said, “Sometimes this happens.”
I didn’t call the doctor’s office because I didn’t know what was happening. I knew. I called because I wanted her to tell me if there was anything I could do, clamp my legs together, lay down for the next three days, shake holy water over my uterus to stop it from happening. I would have done anything to stop it from happening. When she said, “No, there’s nothing to do but come in tomorrow for an ultrasound”, I stayed in a squat, my legs weak, considering my next move. Finally I got up, tucked paper towels in my underwear, went downstairs and finished another surgery.
It was a late day at work, and it was almost 7 PM before I got home and told my wife. I watched her face fall. Sharing it made it undeniable, what little hope there was that this wasn’t happening. She gently led me into the bathroom where she had prepared a bath, mood lighting with candles, and a side table of my requested foods—strange cravings over the last few days—pineapple juice, mango, strawberries. She had done this before she knew, when we thought I was six weeks pregnant, because I had been so stressed at work the past week, juggling early mornings heading downtown to the lab to have blood work drawn before going to work.
Even then I could not cry. We clung to each other on the couch, questioning the chances that this was just a little bit of bleeding and that somehow our baby was still holding on inside my uterus. This is what I imagined: little Purple hanging off the top, unwilling to let go. I patted my belly and told her: I’ll take care of you. Please stay in there. I promise I’ll take care of you.
By morning, I had been bleeding for 17 hours. This was no slight spotting. When I went into the doctor’s office, I asked if my wife could sit in there with me despite the COVID regulations. They must’ve seen the look on my face because they said yes.
It was a different doctor this morning and, after a few seconds of poking around with the ultrasound, she said, “There’s no evidence of a gestational sac. There’s no evidence of a pregnancy in here. I’m sorry, this seems like a miscarriage.”
The tears started rolling then, and I could barely get my words out to thank her for her time as she muttered some next steps and hurriedly left the room. Once I got into the waiting area, my wife took one look at me, set her jaw, and nodded.
“OK, let’s go,” she said.
Once we were outside, I announced, “Purple has left the building.” We both thought it was strangely grim, macabre, and funny. My wife went home and I went to work. Insane, I know, but I didn’t know what to do. All I could do was keep doing what I usually do, keep putting one foot in front of the other. What else was there to do?
That day, after the doctor confirmed my miscarriage, I went to the office and saw 12 patients, a light day for me. Later in the afternoon, I was in the middle of talking to a patient when the nurse called. I excused myself and answered the phone. The nurse said, “It’s a possible loss.” In my mind, I said, It’s not possible. It was a loss. I haven’t stopped bleeding. But no one is willing to say it. I lost her.
For the next few days, the blood kept coming. I’d peer into the toilet at this blobiness or that blobiness and ask, “Are you Purple? Or are you Purple?”, trying to recall the pictures in my medical school textbooks of what a spontaneous abortion looked like. A whole lot of nothing, a bean-shaped blood clot that was once going to be a child. There were things that looked more like the albumin part of an egg, and things that looked straight like chopped liver.
A 2018 study out of Brigham and Women’s showed that female surgeons had a 42% chance of pregnancy loss, double that of the general population. Female surgeons were already more likely to have fewer children, more likely to delay having children, and more likely to use assistive reproductive technology, according to the authors, compared to male surgeons. Compared to non-surgeon female counterparts, female surgeons are more likely to have obstetrical complications. *The study excluded female surgeons with female partners because it was unclear who carried the pregnancy.
In the days that followed, I went through all the stages of grief, finally landing on anger. Anger that I couldn’t make it better, anger that it was all so outside of my control, being a person who is used to very much being in control. On the subway, I would ask myself if I was still worthy of a seat— no longer pregnant, but I just had a miscarriage two days ago?
I blamed my work, of course— in the past 27 days, I had gotten 20 consults, operating at all hours of the day and night. Not honoring my body, not eating and drinking for 12 hours, as I had trained myself to do over the years. Not peeing. Lifting patients with BMIs over 50. But most of all, I blamed myself. The irony is, the first 12 weeks of the pregnancy are conceivably the most important, but this is also the time that you can’t tell anyone that you’re pregnant, because of some superstition or social convention, and I, insistent on maintaining the image of a strong, female surgeon, no less able than my male counterparts to run around all day, was unwilling to ask for any concessions for myself. I didn’t, and felt that I couldn’t, ask for help.
Two days after my miscarriage, I did eight minor surgeries in the ambulatory center. I ran into my senior partner, who said I looked tired. I told him what had happened. He said, “We can hire a man next.” To this day I have no idea what he meant by that, or perhaps I know exactly what he meant, but I was too tired to argue.
The following day, I helped him with an abdominoperineal resection, one of the most physically grueling operations in our profession. The day after that, a Saturday, the chief of our division, a woman, called to ask why some consult had been transferred uptown. I said I didn’t know about it but, incidentally, I was going through some medical issues, I’d just had a miscarriage. She said, “Well, that is a different topic we should discuss later, but colorectal surgeons should still take all consults.” We never did discuss later.
She is a respected member of our speciality and someone I looked up to, someone who seemed to be on the side of women physicians. As such, I was disappointed in her answer. The following day, a Sunday, I went in and did surgery. I worked eight out of the nine days after my miscarriage.
An earlier study out of Boston, from 2013, showed a 32% rate of infertility for women in surgical specialties. Of those, general surgery, orthopedics, and otolaryngology had the highest rates of infertility. Colorectal surgery, my chosen and beloved profession, is a subspecialty of general surgery.
As a perfectionist, a miscarriage feels like a failure. You never think it will be you until it is. We did everything right— I was obsessive about my medications, I didn’t drink, I didn’t change the cat litter. The hardest part is we will never know what went wrong. As a society, we don’t talk about this enough, of course. The dreaded ‘M’ word, as if speaking it will bring it into existence. The fact is, it happens more often than we think. I ended up telling exactly five people, five people on a need-to-know- basis. I couldn’t bring myself to tell my closest friends or family, even, afraid to burden them or curse them.
Three weeks after my miscarriage, I went to dinner with four close friends, all of whom are also surgeons. We had the distinction of being a rare chief class where 4 out of 5 of us were women. We trained together, and therefore, went through hell together. We’ve known each other for nine years. At this point, of the three other women, one of them has two babies, one of them has one, and one of them has twins on the way.
I had been looking forward to seeing them because we had all gone our separate ways after training, but in the hours before dinner, I started to dread it. I knew they would talk about babies. I knew they would talk about motherhood. And I would have to sit there, smiling, nodding. Would I bring up my miscarriage then? If we were all sharing, should I?
In the end, I didn’t. I didn’t want to ‘bring down the mood’ with my trauma. I didn’t want to start answering questions about IVF. So I drank a beer, the first one I’d had in months, and discussed the technical aspects of an ileorectal anastomosis with my male friend, while the three of them discussed baby carriages and feeding times.
It’s been two months and twenty-eight days since my miscarriage. Every time I pee, I hesitate upon standing up and wiping, worried to see more blood. Most people pee 6-8 times a day. 528 moments of dread.
I haven’t missed a day of work. I go into the office, see my patients and smile. I like what I do and taking care of my patients brings me joy, so I don’t mind. But in the wee hours of the night, I lay awake, thinking about what I’ve given up for this.
Women are supposedly ‘the same’ as men but we’re different. We want workplace equality but we give up more for it. We want the same jobs and the same pay but we have to work twice as hard and be better than a man in the same job to get it. We have to manage a family or try to start one at the same time. I gave up twelve years of my life for my profession. My job infringed on the time I spent with my wife. But until my career cost me my pregnancy, I didn’t know how much I had neglected myself. We don’t want to ask for special accommodations but maybe that is exactly what we need.
It may seem counterintuitive but we sometimes we have to honor our biological bodies before pursuing a political ideal.
We want to be feminists, but we have to be female, first.
Dr. Carmen Fong is a writer, artist, and colorectal surgeon who recently moved from New York City to Atlanta, Georgia, with her wife and two cats. She was a Stony Brook Children’s Literature Fellow and is currently a Doximity Op-Med Fellow. Her work has been published online in The Apothecary, The Bookends Review, and The GoatPol, amongst others. She writes about healthcare and surgery for BaselineMed.com. She can be found on social media, mostly on Instagram @drcarmenfong, on Substack @hongkongfong, and at www.carmenfong.com. When she is not writing, she enjoys cooking, drawing cartoons, and reading about the mysteries of the universe.
