Looking at the appointment book for July 12, 1978, I notice that Barb Daily will be in today for her first prenatal examination. "Wonderful," I think, remembering my joy as I helped her deliver her first child two years ago. Barb and her husband Russ are friends, and our relationship became much closer with the shared experience of that birth. With so much exposure to disease every day in my rural family practice, I look forward to today's appointment with Barb and to the continuing relationship over the next months.
Barb seems to be in good health with all the symptoms and signs of pregnancy, but her urine pregnancy test is negative. I reassure Barb and myself that she is fine and that the test just hasn't turned positive yet. Rescheduling another test for the following week, I congratulate her on her condition and promise to get all her test results to her promptly.
But the next urine test is negative, too, which leaves me troubled. Isn't Barb pregnant? Has she had a missed abortion? I could make sure right now, of course, by ordering an ultrasound, but the new examination is available only in Duluth, 110 miles away from our northern Minnesota village, and it is expensive. I am aware of the Dailys' modest income. Besides, by waiting a few weeks, I'll find out for sure without the ultrasound. I call Barb on the phone and tell her about the negative test, about the possible abortion, and about the necessity of a repeat appointment in a few weeks if her next menstrual period does not occur on schedule.
It is, as usual, a hectic summer, and I almost forget about Barb's situation until a month later when she returns. Still no menstrual period, no abortion. She is confused and upset, since, she says, "I feel so pregnant." I am bothered, too, especially because her uterus continues to be enlarged. Her urine test remains definitely negative.