Mention Their Names

“She currently…does not want providers to mention the name of her fetus to her.” I openly wept reading those words in her chart, seated in a Houston coffee shop. This couldn't be the 24-year-old patient I cared for several months earlier—scared but excited for her first pregnancy. That late night, she already had a mountain stacked against her: a young, Black woman in America, financially supporting her disabled parents, with an ex-partner no longer involved in the pregnancy. She confided in me her goal to return to school to be a nurse, only recently applying for classes before this unintended pregnancy. Acknowledging her uncertainty, she whispered her “decision” to keep the 8-week fetus despite a lack of support. I enthusiastically recommended group pregnancy classes, feeling paternalistic as I recalled data associated with improved fetal and maternal outcomes in Black women. Completing the encounter, her medical record number was saved to my follow-up list; in my head, I would deliver her firstborn son after she gracefully floated to her 40-week gestation. “Limb body wall complex.” My vision blurred as I searched this horrific phrase, tearfully learning of the malformations her fetus would have and the impending impossibility of sustained life. At 19 weeks, halfway through a tenuous pregnancy, her world shattered, shards spraying and cutting through my own heart. Documentation from her counseling, riddled with unintelligibly long medical terminology, also documented her anguish. She had begun to buy baby clothes and had deferred nursing classes to provide for her growing family, but that dream was over. Grasping an unimaginable situation, she no longer desired to hear her baby's heartbeat or hold her newborn. The child that would surely die, whether inside or outside of her uterus, had become a growing nightmare. I sobbed harder recalling her decision to carry the fetus, now legally strong-armed by her state government and cornered by her socioeconomic situation. When he finally arrived, 15 weeks early and without a beating heart, his malformations dwarfed the delivery room. Knocking softly on the door, I walked in to see her baby swaddled, a friend at her side, and an indescribable expression on her face. Words and a hug were laughably insufficient, but that's all we had. Her postpartum depression, and inevitably the years of grief and confusion to follow, sat with us in that room. After a few minutes, she shared his name with me. When she could bear it no longer, she asked for him to be taken away. I wish this encounter left us both, but some stories brand us in different ways. Even today, her image weighs down my bones as she and others face insurmountable barriers. Sometimes, for all our medical prowess, even we can feel helpless to fix the hurt. But don't excise these emotions out of your practice. Feel the hot tears, taste the salt. Embrace the empathy, fight for equity, and hug your patients. And when you can, mention their names.