She had not come to the ER that night looking for much, just a sign of life and a small one at that. She was 12 weeks pregnant and bleeding from the uterus, an ominous combination for any woman, and a terrible d?j? vu for her. She had been pregnant twice before, and both of those pregnancies had ended in miscarriage. She had every reason to fear that her hopes for a child would be dashed again.

Her desperation had a power he could feel when he walked into the exam room. She looked quickly from his face to the electronic fetal stethoscope he held in his hand, because she had come to the ER that night looking for that stethoscope, not for a doctor. It had a speaker attached to it so expectant mothers could hear the fetal heartbeat, if it was there to be heard. She knew the stethoscope would soon tell her future and that of her baby, and nothing so mechanical would ever speak more simply and profoundly. If it found a heartbeat there would be joy, and hope, and a world of possibilities. If it found none the silence would mean no there would be no baby again, that she would not be a mother in six months, and that life would have handed her one more reason to stop hoping for anything better. She had heard such a silence twice before.

Her hands and face looked older than her years, and suggested to the doctor perhaps a hard life of many dashed hopes. He wondered where a woman found the optimism to live a life of unmet dreams and still try a third time to have a baby after two miscarriages. He had come from a childhood of comfort and lived the privileged life of a physician, had every reason to think good fortune was his due, and yet doubted he would ever have her strength and optimism against the odds.

She looked from his stethoscope to his eyes and he knew that if looks could will, her will for a life within at that moment could make anything possible. He was her last hope; two experienced ER nurses had already tried to find the fetal heartbeat with the same stethoscope that night, and failed. He knew that each time the stethoscope had been placed on her abdomen her hopes had gone out on a limb and then been pushed off. He also knew that for a woman who wanted so much to be pregnant a miscarriage was a long way down to hard ground. And yet, when he walked in the room, her hope was right back out on that limb a last time, waiting…

He looked carefully for just the right place to put the stethoscope, because he wanted to find the fetal heartbeat quickly. Every moment of listening for it without hearing it would be agony for her, and he wanted to find the heartbeat and end that agony, or not find it and let her begin her grieving. He chose the spot, placed the stethoscope, and turned it on.

Her abdomen was motionless, for she was holding her breath in anticipation, and her eyes closed as she listened and waited. The room was quiet; neither of them spoke, for words are an intrusion at such moments.

He searched, they listened, and then suddenly they heard the whoosh of a heartbeat on the speaker. But this heartbeat was disappointingly slow, because it was the sound of the mother’s blood rushing through the arteries of the abdomen on its way to her legs, her uterus, her … baby? He slowly redirected the stethoscope, listening carefully, aiming for a heart he could not see, a heart no bigger than a thimble. He had looked for such hearts in a thousand women, but found himself caught up in this woman’s moment, waiting and hoping with her.

Whoosh, whoosh, whoosh – there it was! Nothing else in the body of a woman makes that unmistakable sound of a tiny heart in the womb going 160 beats per minute. He felt the jolt of his own excitement and turned to her just in time to see her eyes fly open and a glorious smile break across her face. Neither of them said a word; he simply held the stethoscope in just the right place, letting the heartbeat’s whoosh fill the room, letting her savor the sound and its meaning.

When they were done she thanked him simply and quietly. He gave her instructions for followup care, and while wishing her the best he also cautioned her that she should not get her hopes too high; this pregnancy still might not survive. He did not think she heard that, hearing only the echo of the heartbeat as she walked out into the night.

As Christmas approached this year the doctor reflected on the gifts he and she had exchanged that night. He had given the gift of reignited hope and possibility that she could carry with her another day. She had given him a heartwarming memory he would carry for the rest of his life. He thought again of her smile the moment she heard the heartbeat of hope, and reflected on the fact that the world does not often turn on a dime, but it does turn on the hopes bestowed on the beating of a tiny heart.

Merry Christmas.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.