Anomalies.

As I take my patient back from the waiting room, I can see she is struggling to choke back tears. Her husband hovers behind her with anxiety-brimmed eyes.

I speak quietly and move quickly. I tend to walk too fast.

Once we're in the quiet of the exam room, the tears begin to flow. I know why she's here, so I'm not surprised, but I never quite know what to do in these situations at first. Do I offer a hug? A hand on the shoulder? Nothing at all?

"I'm sorry. I just... I'm sorry," she says.

I get down to her level and offer a kleenex. "No, no don't worry."

My heart is breaking. For her and her husband, who is as vulnerable and anxious as I've ever seen any man, standing in the corner like an injured animal.

I take her vital signs and ask a few questions. I hate a few of the questions I have to ask. She keeps apologizing for crying. I keep trying to reassure her. The husband adds on to many of her answers and asks more questions than she does; he's so concerned about his wife that I'm simultaneously heart-warmed and heart-broken.

The absolute joy of their first pregnancy was shattered by an ultrasound a week ago. At 10 weeks gestation, her OB GYN diagnosed their baby with anencephaly. It's a cruel death sentence: the neural tube of the fetus fails to close, leaving them without major portions of the cerebrum and head. Those who make it to term are often stillborn, and those who survive birth die within days. When it's diagnosed early in pregnancy, therapeutic abortion is often recommended. And that's what brought my patient in.

The D&E is awful and unreal. The room is heavy with pain and silence save the patient's whimpers. When it's all over, the doctor leaves the room with the tissues to go make sure she's got everything and I return to tend to my patient. I check her vitals, fetch her water, and let her recover.

Once she's dressed I do her discharge, and she hugs me. I feel relieved, and we just stand there holding each other for a while. She sounds better. She's not crying anymore, and I catch a sad smile. I'd like to think that although devastated, she left the office in recovery. There's the crisis, and then there's the recovery.