Sign up for the Slatest to get the most insightful analysis, criticism, and advice out there, delivered to your inbox daily.
I spent the year after I turned 30 tracking my cycle, googling the best sex positions for conception, dipping ovulation test strips into a dedicated pee cup I kept in my bathroom, and experimenting with sobriety, acupuncture, and meditation. I was willing to do anything to become pregnant. After a year of trying on our own with no results, my partner and I were anxious for medical support—so we turned to a fertility specialist. After enrolling at a clinic, I logged into MyChart, my new doctor’s online patient portal, for the first time.
MyChart is a secure website and app that collects a patient’s health records. In the past, I had used a similar portal for doctor’s appointments but wasn’t familiar with MyChart’s tabs for things like lab results, ultrasound images, conditions, prescriptions, and messages. Initially, I was thrilled to finally have all this information in one place, after a year of yearning for answers. But I had no idea how much time I would soon spend on MyChart in pursuit of the goal of conceiving a child—and how its confusing messages and surprise diagnoses delivered through instant lab results would begin to chip away at me.
Alarm-bell emojis and lab-result meters that ranged from green (healthy) to red (bad news) added anxiety to an already anxiety-laden process. Soon, some of the harshest news and realities I’d ever received arrived in my inbox in the form of a familiar subject line: “You have a new message in MyChart.”
MyChart and other patient portals like it emerged in the late 1990s from early adopters hoping to bolster patient agency and became prevalent in 2006 after both Google and Microsoft launched their own electronic personal health records. In 2016 a U.S. policy, the Cures Act, mandated that patients immediately gain access to their medical reports, making the use of ePHRs the norm for all doctors’ offices. Today people want answers faster than they can think of questions. Patient portals help provide those answers. But when it comes to the business of making life, is digital efficiency morally conscientious?
Advertisement
Advertisement
Advertisement
“When you’re sitting on the brink of an unknown diagnosis and waiting for test results that can change your life or the life of your unborn child, the worst way to find out is a red exclamation point.”
One in five American women experiences infertility. As many as 52 percent of them suffer from depression because of it. Not only is infertility an incredibly lonely experience, but childbearing is also still a taboo topic. Portal messages, delivered without a voice or a face, make the silence of our suffering all the more pronounced. Yet I found myself practically addicted to MyChart—and I’m not alone.
Advertisement
A mom and health care provider shared with me her dilemma over the psychological damage these portals can wreak on patients. “When you’re sitting on the brink of an unknown diagnosis and waiting for test results that can change your life or the life of your unborn child, the worst way to find out is a red exclamation point,” she said. Another mom told me she learned about her placenta previa through the portal, which “led to WebMD and hysteria.”
The first message I received from the portal arrived after my gynecologist sent my information to the fertility clinic. Perhaps no one assumed I’d comb through the entirety of the 30-plus-page uploaded PDF—but since the doc was there, and filled with photos of my insides, I downloaded it and read it.
Advertisement
Among lab results and other health data were images of my first ultrasound. In one, the cystic mass that took over most of my right ovary, a growth my doctor had pointed out in our appointment, had been zoomed in on. She had circled it with her cursor’s yellow highlighter and labeled it “endo? (may affect egg quality).”
Bad-quality eggs? I added that to my list of shortcomings, failings that regularly paraded through my mind as I tried and failed to become pregnant. It’s difficult not to blame yourself when your body seems to be the problem. This was when the Conditions tab of MyChart itself started to feel like that list of shortcomings. I’d told my doctor about the first two conditions on the list: depression and anxiety—previous diagnoses I had successfully kept at bay the past couple of years. That’s also when I spotted a condition I hadn’t seen before: anemic. Who knew?
Advertisement
Advertisement
During our next session, my doctor asked lots of “Have you ever?” questions I had never considered, pertaining mostly to extreme menstrual pain. I answered the same to all: yes. When I logged into the portal again, I had a new diagnosis in my profile: endometriosis. I spent the rest of the night researching, gutted to find that 50 percent of women with endometriosis suffer from infertility, sometimes temporarily but often rendering them unable to conceive.
Advertisement
Advertisement
Nearly a year and countless blood tests, invasive X-rays, hormones, and failed cycles later, I found a new message in MyChart. At the time, I had just arrived in Italy for a wedding. The note was from a gastroenterologist I’d seen for chronic stomach pain I’d been experiencing. Cryptic, uncapitalized, and without a whisper of bedside manner, the messily typed diagnosis was grim: “You have e coli … i hope you didn’t go to italy … we need to txt with antibiotics.”
It was the middle of the night in the U.S. I clicked tabs, frantic for answers. Under Lab Results, two alarm bells glowed red. One confirmed an E. coli positive lab result. The other revealed a thyroid dial in the red zone. The new diagnosis in my profile read: hypothyroid.
Advertisement
My heart pounded. Hypothyroidism is known to affect fertility. I sent messages to the gastroenterologist and my doctor. One day went by, then two, then three. No one answered.
A friend told me she had encountered similar communication obstacles in MyChart after she gave birth. “The portals for our OB [and] pediatrician don’t allow replies when you send in a question to your doc,” she said. “I swear, the system is built to drive us insane.”
Advertisement
It’s inevitable that as we age, our diagnoses will grow. But when your diagnoses, which are the potential reason for your suffering, are followed by silence from your doctor and are accompanied by an alarm-bell emoji, it’s, well, alarming.
Advertisement
Two and a half years into our fertility journey, after my second artificial insemination procedure, I got a positive pregnancy test. I was thrilled to finally be growing a life—and to soon graduate from the clinic, along with MyChart. But when I went in for my six-week scan, the technician balked when the screen showed my grey-pixelated insides—revealing that the embryo hadn’t made it to my uterus. My pregnancy was ectopic.
Every other day, I went back to the fertility clinic so the staff could monitor my vitals and draw blood. Traveling the familiar subway route on autopilot, I grieved the life waning in my fallopian tube and feared the outcome. Ectopic pregnancy can be dangerous, even fatal, for the mother. All the while, MyChart messaged me daily: a reminder on appointment day and my lab results the next day. The preview text of those emails carried a harsh and consistent reminder: “Pregnancy: ectopic, UNVIABLE.”
Advertisement
Advertisement
Advertisement
Stress hurts your chances at pregnancy. So why, in the pursuit of making life, are we using a system that causes it?
MyChart’s reminding me that I was not one of the legion of women who seemed to be getting pregnant around me added insult to injury. It took a toll on my mental health. Once it was clear I would not need medical intervention to safely terminate the pregnancy, my husband and I went to his grandma’s house in the woods. There, as we hid from the world and MyChart, the pregnancy passed on its own.
We pressed on in our pursuit to conceive, but after an unsuccessful first round of in vitro fertilization, the words “may affect egg quality,” from two years prior, kept ringing in my head, and my depression diagnosis was fully back in my life. My husband and I decided to take a break from the clinic and MyChart to rebuild our mental health before trying another egg retrieval. I could hardly take another disappointment delivered with a cheerful chirp to my inbox.
Advertisement
One evening, during our “fertility break,” my husband suggested I take a pregnancy test, as my period was a few days late. This annoyed me. Ever since my ectopic pregnancy, my cycle had gone haywire. Plus, I had only ever been met with failure in this arena since we had started trying three years earlier.
Advertisement
Advertisement
As soon as my pee hit the test, two bright blue stripes appeared. That positive test was the most beautiful thing I’d ever laid eyes on. Once the shock cleared, so did the tension in my chest I’d held on to for years. As opposed to what I found on MyChart, I didn’t mind this kind of immediate digital diagnosis, because it was born largely from the absence of technology.
My story proves that everyone’s favorite piece of unsolicited advice when you are trying to conceive—just relax!—isn’t unfounded. Stress hurts your chances at pregnancy. So why, in the pursuit of making life, are we using a system that causes it?
I had hoped MyChart would again become an anxiety-free zone once I became pregnant, but one day early in my second trimester, I checked my email while taking the subway to meet a friend at the Metropolitan Museum. The week before, I’d had some tests done out of an abundance of caution after I developed a rash. Once the rash disappeared, I’d assumed there would be nothing to worry about, but when I opened MyChart, it informed me I had “abnormal” parvovirus results. Between stations, I messaged my doctor, then anxiously researched parvovirus. For a pregnant mother, parvovirus can be devastating. I messaged her a second time, feeling increasingly alarmed.
Advertisement
Advertisement
Advertisement
I let the quiet of the Met and the swirl of van Gogh’s brushstrokes quell my nerves, until my phone rang. My OB-GYN sounded worried. She told me I needed to come in immediately and that I would need to come in every other day to be monitored. In the corner between two cypresses, I crumpled into a squat and cried. I was so scared to lose this baby.
It turned out she had read my message before reviewing the results herself. By taking my word for it, she neglected to notice that the test showed only that I had once had the virus—not that I currently had it. Something I wouldn’t have known how to decipher. But there I was, just like I had been at every nerve-racking turn in my journey to become a mother: just me and MyChart.
And, as if for its final trick, through the preview text of my lab results, MyChart spilled the beans about the sex of my baby. Once you read “female identified,” you can’t unread it.
Now my daughter has her own profile in MyChart. I hope, once she has control of it, our patient portals are a little more patient-friendly.