My
nurse alerted me that our waiting room was filling up with patients, but one
patient's appointment was too crucial to cut short. I had finally convinced her
to come in for her prenatal visit after several weeks without seeing her.
Over the past few years, I had been seeing Diane for routine gynecologic care.
A friendly, down-to- earth person, her sincerity and warmth made her very
likeable. When she told me her news, I was delighted for her.
"Doctor, I met a wonderful man. He's an attorney, 28, the same age as me. We're
getting married
this summer. Hey, you never know - you may be delivering our baby someday." Her
big smile and bright eyes reflected her happiness.
Diane and Scott were married in July 1996, and their lives were moving forward
positively. With two successful careers, a strong and loving relationship, and
everything ahead of them, they seemed destined to enjoy a long and happy life
together.
Married only 7 months, the young couple's picture changed drastically when
Scott was diagnosed with metastatic colon cancer, stage IV. The prognosis was
not favorable, Diane told me when she called. Devastated, the couple wondered,
How could this be happening to them? Their dreams were evaporating
rapidly.
When they came to see me soon after our phone conversation, they did not look
like the same couple I had come to know. The strain of the diagnosis was so
evident. A subdued mood replaced the one I had usually associated with
them.
"We were going to wait to have kids, but now we want to get pregnant as soon as
possible," Diane told me. "Once Scott starts his chemotherapy next month, his
sperm will be affected."
They said they had evaluated all of their options and considered their decision
carefully. They were certain that the choice was the right one for them, even
though he might never get to see his child. I raised a number of issues,
particularly my worry that she could experience difficulty being a single
mother with a full-time job. She assured me that she possessed a strong support
system, including parents and a sister who lived close to her.
"If we are successful, I realize that I'll be raising our child as a single
parent, but at least a part of Scott will live on. When I look in my child's
eyes, I will be reminded of Scott," she told me in a soft voice. Her husband
was solemn as he assured me that he wanted this baby too. Tears welled up in
their eyes as they spoke.
I found myself identifying with Scott. I was reminded of my own mortality and
the realization
that we are only here on earth for a short time. The continuum of life seemed
particularly clear to me: as loved ones die, new loved ones are born. It seemed
fitting that as the couple came to terms with Scott's death, they were thinking
about a new life. I could see why he would want this pregnancy. I would, too.
However, if I had been in his position, I am not sure I would have arrived at
the same brave choice. It takes an unusual couple to forge this idea. I might
have thought that in having a baby alone, my young wife would carry too heavy a
burden. Conversely, I could imagine that if I were going to die at such a young
age, I might want to try to perpetuate my life by having a baby.
During this month, Diane would ovulate only once, allowing but one chance for
conception to take place naturally. We discussed ovulation prediction and
intercourse timing. It was their dream to conceive on their own, but as a
secondary plan, they decided to store Scott's sperm before the chemotherapy
began. The stored sperm was never used.
On the very day that Scott started chemotherapy, Diane came in for a pregnancy
test. I could barely contain my excitement as I told them, "Your pregnancy test
came back positive." They were thrilled. They had conceived naturally.
Diane's pregnancy was progressing well, but after 6 weeks of chemotherapy,
Scott's condition was worsening as the cancer spread. It was a harsh contrast
to see him growing weaker while his baby grew stronger. Diane maintained a
vigil at his bedside. To be with him, she was neglecting to come in for her
prenatal visits. Her devotion to him was fierce. When I tried to reach her to
persuade her to come in, she called me back on my cell phone. "I don't want to
leave him. He doesn't have much time left." (Like many of my patients, Diane
had my cell phone number. I worry about my patients if they miss or cancel
appointments, and I want them to know they can contact me if they need
me.)
Her family urged her to see a more conveniently located obstetrician -
gynecologist, but she refused. Although my office was an hour's drive away, she
did not want to make any changes. She felt her life was in too much turmoil
already.
Worried that she was not getting the prenatal care she needed, I promised her
that if she came in for a checkup, I would perform an ultrasonogram of her
fetus and make a video that she and Scott could watch together. She made an
appointment, cancelled it, then made another, and cancelled it yet again. At 19
weeks of gestation, she finally came in, accompanied by her sister.
Diane almost cancelled this appointment too. Scott had been discharged from the
hospital to spend his remaining time at home. "What if I get back and he's
gone?" she asked. On reflection, I realized she believed that if she left his
side, he would die - and she couldn't bear not to be there with him when he died.
Although I understood how she felt, I reminded her that she and their unborn
child needed care as well. I was also concerned about the extraordinary stress
this difficult scenario was causing.
At our appointment, we discussed his feelings - his fear of death, his pain, his
sadness. They had not explored these tender issues openly. "Talk about his
prognosis," I advised. "Expressing yourselves freely lets you share the pain
completely and brings you closer." (I am accustomed to offering this type of
guidance, as couples so often avoid addressing "the elephant in the room.") She
agreed that it would be important to initiate this type of dialogue with her
husband.
After we talked, I performed the ultrasound examination, which is one of the
things I enjoy most in my practice. Diane and I spent a long time looking at
the baby's face, the beating heart, the little legs kicking, and the tiny hands
and feet. At one point she exclaimed, "The baby is praying!" And there was no
doubt about it; the hands were poised, hand to hand, in a prayerful
position.
She took the video home with her and played it for Scott that same evening. The
next day, she called to thank me.
"I took your advice and had a heart-to-heart talk with Scott last night. Then
we watched the video together. My sister, my mother, and Scott's mother were
there, too," she began.
"He has been in so much of a daze the past several weeks that focusing long
enough even to read a simple greeting card has been too difficult for him. But
he watched the video, all 35 minutes of it, and was completely entranced. He
couldn't take his eyes away from it. He kept saying how beautiful our baby was
and how lucky he was that he could see our child before his own death. We were
together as a family - father, mother, and baby. I feel that Scott truly
achieved peace of mind."
She paused, crying. I cried too when she said, "and then in the middle of the
night, Scott died."
I cry rather easily, so I was not surprised at my own tears. I was relieved to
release my emotions in that way. I was overcome with sadness, because her loss
was also my own. I was awed, and even felt a physical chill, when I realized he
had died just hours after watching the video of his baby.
Sometimes, when patients are suffering from a terminal disease, they may be
holding on for a reassuring event or a sign of some kind. After that occurs,
they can let go and die with a peaceful heart. That is what I feel happened
when Scott died shortly after watching the video. The significance here, for
me, was that the video, which was my idea and something that I had made, had a
major effect on this family.
I was touched by his death for a very simple reason. We are all vulnerable to
experiencing the pain of the death of someone else because we are all mortal.
When someone dies, at some level we realize that it could just as easily have
been us - or someone we love dearly - and although I consider all of my patients
to be like family, perhaps the ones who endure more tragedy become even closer
to me. Dana was born 17 weeks later, on December 21, 1997. I am in frequent
contact with Diane, and she remains my patient. She recently told me that, in
addition to the videotape, I had given her some still pictures from the
ultrasonogram. One of these, a picture of the fetus' hands together, was so
meaningful to her that she displayed it at her husband's wake and placed it in
the casket. Diane also placed a copy of this picture in their baby's room,
where it has remained ever since.
About 3 years ago, I received great news from Diane. She had been lucky enough
to meet another wonderful man. I met Andy when Diane came in for an office
visit. I was impressed with how attentive and caring he was toward her. When
they married, in September 2006, I felt unexpectedly relieved. I realized that
I had been carrying the weight of worrying about her, simply because she and
her daughter had become so special to me.
Her daughter had longed for a sibling for many years. During a visit to my
office, Diane and Andy revealed to Dana that she would finally be getting a
brother or sister. She was almost 10 years old at the time and reacted with
delight, with a big smile, and said, "Mommy, you're pregnant!" as she saw the
ultrasonogram of her sibling-to-be on the monitor and saw the embryo's heart
beating. In May 2008, Diane gave birth to a boy, and now Dana has a little
brother,
Matthew.
Scott's family was found to have an altered gene, which was responsible for the
colon cancer. This will have a continued effect on my relationship with Diane
and Dana as we closely monitor Dana's health as she grows.
Although it has been 12 years since Scott's death, Diane and Scott's story
remains vivid. The experience of knowing them, and being privileged to
accompany them on their journey, still evokes gratitude in me. I believe I
became an obstetrician, in part, to help this family. As a result of knowing
them, I started taking a deeper look at the big picture, at the role I play in
the lives of my patients.
A case like this one emphasizes the importance of the personal relationship
between doctor and patient. The message for all of us as physicians is that you
gain a great deal if you allow yourself to become involved, to be touched by
the people you care for.
Obstetrics &
Gynecology.
Vol.115, No. 2, Part 2, p. 479-481, February 2010
John
S.
Weitzner, MD
1725 West Harrison Street, Suite 838, Chicago, IL 60612