After six years of nursing, Birgit Umaigba knew what an ER in crisis mode looked like.
The 35-year-old Nigerian-born nurse had gained a large social media following during the pandemic while tweeting from its front lines in Toronto. She appeared on TV to advocate for paid sick days and wrote op-eds for newspapers to explain why nurses were leaving the field.
But seeing the impact of the health care system’s shortcomings as a patient was something else.
Serious, painful and life-threatening complications from a miscarriage in August sent her to the ER four times. “It was like torture for 25 days,” she said.
During one trip to a Toronto-area hospital, she noticed an overwhelmed triage nurse trying to balance assessing people with tending to a large load of patients. Ms. Umaigba tried to lighten her load by disconnecting her own IV.
“When I was in pain and at home, I was in that position where I was a patient. And then when I stepped into the health care facility and saw the quality of care I was receiving, I felt like I needed to be a nurse for myself.”
Ms. Umaigba learned she had miscarried when she went for her first pregnancy ultrasound in late August. Her doctor estimated she was six weeks pregnant and outlined her options: She could take misoprostol, a drug that would induce contractions and cause her body to expel the tissue at home, or she could have a dilation and curettage procedure (better known as a D&C) where the tissue would be surgically removed.
The doctor encouraged her to take the misoprostol, explaining that there was a surgical backlog and she’d likely have to carry the dead fetus inside her for several weeks until she could be scheduled for a D&C. (Driven by the pandemic, the provincial backlog for health care services ballooned to 22 million according to a May report from the Ontario Medical Association.)
Ms. Umaigba felt like she was being talked out of getting a D&C in every possible way because the system was beyond capacity. Two days later, she began the three-day course of misoprostol.
The pain set in almost immediately after the first dose. It was far worse than any of the contractions she’d experienced when in labour with her daughter. It was raw and intense, as though she was being sliced in half with a machete. In the first six days, she bled so much that she couldn’t always make it to the toilet in time; her bathroom floor looked like it had been dyed scarlet. She would layer four maxi pads in her underwear and they would soak through immediately. Was this part of the miscarriage? Was this normal? Like six million other Canadians, Ms. Umaigba does not have a family doctor, so she had no one to follow up with.
She wound up in the ER, where she was given pain medication, more misoprostol and sent home. Days later she woke up at 2 a.m., her abdomen gripped by such intense pain she couldn’t even roll over.
“I literally thought I was going to die,” she said. Ms. Umaigba called her husband, who was working a night shift, and asked him to come home. Then she called 911.
She didn’t want to rouse her sleeping 11-year-old daughter and cause panic, so she summoned all the strength she had and crawled to the front door so paramedics could carry her out quickly and quietly.
For a second time, Ms. Umaigba was given pain medication, antibiotics and sent home as the extreme discomfort and bleeding persisted. She returned to the ER again a few days later with the same issues.
On her fourth ER visit, in mid-September, she wasn’t assigned a nurse because staff had forgotten her in a procedure room that patients weren’t usually put in. She was bleeding heavily but it was hours before her vital signs were checked. She was offered misoprostol once more.
“No, I’m not doing this again,” she told the doctor. “This is my fourth trip. You guys want me to bleed to death or go septic and end up in an ICU?”
It wasn’t until that visit – after weeks of pleading for surgery – that Ms. Umaigba was finally able to consult with a gynecologist and told she could get a D&C.
It was only after the procedure that she felt she could finally return to work and begin to mentally process the miscarriage. Before that, it was only in the moments when she was laying in a hospital bed, getting painkillers through an IV, that she had the luxury of crying.
“I felt like I didn’t have the space to grieve the emotional loss just because I was always in pain,” she said.
Always the advocate and educator, she tweeted about her experience, opening up a channel to hear other devastating stories of pregnancy loss and the frustrations of navigating the Canadian health care system afterward. One woman told her she had two D&Cs because the surgeon failed to remove all the tissue the first time. Another said she was told to wait two weeks at first for her body to naturally expel the fetus. When it didn’t, she took pills and then finally got a D&C. She said she cried from the moment when no heartbeat was detected during her ultrasound to the point three weeks after her D&C.
Having worked on the other side, Ms. Umaigba has empathy for the staff who didn’t care for her properly. Many nurses have left staff jobs at hospitals for private agencies because they can make their own schedule; others have quit the industry altogether, prompting a critical dearth of nurses across the country. The departures have placed an added burden on those who remain in hospitals.
“We need to improve working conditions for nurses and health care workers in general,” Ms. Umaigba said, “so they are not so burnt out and off-loading their burnout on patients who are already so sick.”