Test Anxiety

My second (and presumably last) pregnancy has been fairly easy. Or at least less worrisome than my first. I got pregnant without a thought and under the influence. I've experienced far fewer pregnancy symptoms and, probably because I've done this all before, I've truly worried about very little. So at my last check up when the nurse told me I needed to go down to the lab for "routine blood work" I thought nothing of it. I didn't question even what it was. I just naively rolled up my sleeve and stuck out my arm like a seasoned mother who has earned her stripes and no longer felt the need to worry about, or question, every little thing.

A week later, in the middle of an ice storm and while my husband was on a business trip in Belgium, I got a call from my doctor.

"Meg. We have the results from your blood work and things aren't good." She said flatly.

"What? Wait, what blood work? What did you test for?"

"We screened for Down Syndrome. Your results came back abnormal."

"Meaning...?"

"Meaning your baby is at high risk for Downs. I'm referring you to a perinatologist."

"What is that?" I stammered through tears.

"A doctor who specializes in high risk pregnancies."

"Why would you screen me for Downs?"

"I screen everyone. You'll need to do more labs. I'm having a test run which will tell us definitively if your child has Downs."

In a two minute phone call my pregnancy had gone from easy, healthy and uneventful, to "high risk." I stumbled to the couch to sit down. And there I sat for a solid hour, frozen in fear. I was eventually able to dial Jim, 5,000 miles away. He was silent on the other end of the phone after I told him the news. This was information neither of us could comprehend together, let alone that far apart.

I did the only thing I could think to do: I Googled. I read until each result on every page was purple. I tapped into academic and medical journals from databases I have access to through the university. I scoured dozens of peer-reviewed articles, validated studies and editorials in health magazines to answer the hundreds of questions I had swirling around.

I discovered that what my doctor had submitted me to was something called a Quad Screen. This measures four hormones within the body between 16-20 weeks of gestation. These levels, coupled with the mother's age, weight and due date all help to calculate a "risk factor" for chromosomal abnormalities such as Spina Bifida and Down Syndrome. My risk was 1/97 for Down Syndrome. Yes, a 1% chance was considered "high risk." The perinatologist would be giving me a Level 2 ultrasound to look for "soft markers" of Down Syndrome. And though only 60% of children with Down Syndrome even have any of the soft markers, I read up on each and every marker. I also discovered that the single greatest reason that this test is unreliable is because of miscalculations of the projected due date. Some studies even showed that being off by as little as 4 days could skew a woman's ratio into "high risk" when she otherwise wasn't.

The next day I went to the lab to give blood for the further testing my doctor wanted. While waiting there for an hour, the fear throbbing a little less and my logic taking over a little more, I wondered why I was being sent for this. I hadn't yet met with the perinatologist. No ultrasound up until this point had given my doctor any concern. I wasn't even in the age bracket that truly put me at a higher risk.

But that's what fear does to you. It makes you blindly do as you are told.

After the blood was drawn, there was nothing else left to do. I had read everything I could. I had made the appointment with the perinatologist for the minute Jim returned home, and I had blood drawn for further testing. There was nothing to do but wait. Well, wait and utterly ruin my husband's trip overseas with emotional texts and weepy voicemails.

The week had to go on. Even though my mind was fraught with worry, it was finals week. I had to administer and grade exams and post final grades into the university system. I tried to focus heavily on those tasks so that my mind wouldn't wander.

When my husband returned from his week in Europe, jet lagged and with severe bronchitis, we made our way to the high risk doctor's office in the early hours of the morning. The nurse took us back to a room with an ultrasound machine and said the sonographer would be in momentarily. When she left the room, we noticed the enormous high definition screen on the back wall, on which we would soon watch our in depth ultrasound. On the screen was my name, age, and my due date.

The due date was wrong.

I jumped up, flung open the door and called for the nurse. I explained the situation to her, and she called for the sonographer. The sonographer quickly laid me back and began taking measurements. She left the room for what seemed like ages. She finally came back with the perinatologist, who had my chart and looked apologetic.

"Well," she started. "I just got off the phone with your doctor, who admitted she entered the wrong due date in your records that were sent to both the lab and to me."

"And?" I asked, remembering what I'd read.

"Well, the single most common reason for getting an abnormal result on this test is an incorrect due date. We will need to have all your blood work recalculated with your actual due date. Your due date was off by more than two weeks."

I appreciated that the vein in my husband's neck popped out as he raged, pacing around the room recounting the week we'd spent in extreme worry. How this mistake, this very horrible mistake the doctor had made, had caused a lot of unnecessary concern and a battery of testing I didn't truly need.

The perinatologist agreed but said she wanted to continue on with the ultrasound just for good measure. We watched her study the screen, and click away hundreds of measurements, as our second child was swimming around, waving, kicking and spinning about. When the doctor moved the wand over our daughter's face, I said, "Can we get a clearer image of her nasal bone?" She smiled and complied. Later, when she was down around her neck I commented on how healthy her nuchal translucency looked. She said "It sure does. And someone has really been reading up." I nodded while asking her to zoom in closer on my child's palms.

She concluded, after nearly an hour, by saying the baby looked perfectly healthy in every way and that the recalculation of my original screen, and the definitive results of my most recent test, should corroborate. She apologized for what we had been through and asked what our plans were moving forward.

"Well we're getting a new damn doctor!" My husband yelled between biting his nails.

I left the ultrasound feeling an emotion that resembled relief. But I went to work preoccupied by the thought of my doctor so carelessly entering my information, causing me a level of worry I rarely reach. I'd gone days without sleep. Had eaten very little. And threw up for the first time in this pregnancy, not because of morning sickness, but because of nerves. As I turned on my computer, I stewed over her mistake and wondered if she was aware of the agony she had caused me. I shook my head as I tried to fathom how such an error could have been made. Her mistake was careless, reckless and absolutely inexcusable. While I pulled up my email, I vowed that I would find a new doctor immediately. As I pondered which doctor I should consider, I noticed an email from a student.

Dr. Morgan,

I made a good grade on every assignment and made As on both the midterm and the final exam. Can you please explain why you gave me an F as my final grade?

Thanks so much,

K

I froze. Which student was this? I had more than 90 students this semester, and while I take time to learn all their names, they still are hard to differentiate when looking at them as lines on a spreadsheet. I opened my grade book. As clear as can be, she had made a 94% in the class. And yet, for some reason, most likely just sheer distraction that week, I had failed a top performing student.

I immediately called the Registrar, the Director of Enrollment, my department chair and the student's academic advisor. I explained that I had made an error and needed to change the student's grade immediately. In less than an hour all the numerous necessary forms were filled out and her grade was officially changed in the system. I emailed the student back to alert her of the change and to give her a heart-felt, no-excuse apology for my mistake and for any worry I caused her. She responded back almost immediately.

Don't worry, Dr. M. I knew it was a mistake. Happy Holidays!

The student never lost her cool. She didn't go above my head. And she immediately forgave me.

That afternoon, while agonizing over the worry I must have caused my scholarship-riding student, I got a call from the perinatologist. She told me the recalculation proved there was never a heightened risk and the definitive blood work showed the baby did not have Down Syndrome. I exhaled a deep sigh of relief and said into the phone:

"Don't worry, Doctor. I knew it was a mistake. Happy holidays."