Maternal-Fetal Medicine can be a rough business sometimes. The highs are great, but the lows can keep you down for days. I have always tried to abide by the admonition in the House of God that one should always remember “the patient has the disease,” but sometimes that really is easier said than done. I can usually keep things in perspective, explaining complicated problems to patients at most levels of understanding in a way that they can appreciate the basic issues, while maintaining a reasonable level of emotional distance myself, but the other day, I got blind-sided. It is a poignant story and is worth relating to my readers. Situations that tug at the heart remind us that feeling is a privilege that we should not take for granted.
I was called in to see a very poor Hispanic woman who was having her sixth baby. She had been sent because one of the baby’s kidneys could not be seen by ultrasound. She had had one son, the oldest child, about 11 years old, who was actually with her in the room as her only support person that day, followed by four daughters. She made it clear at the outset that she desperately wanted another son and had been told that this baby was, indeed, a boy. She was poorly educated, very frightened, and very anxious and communication with her, even with an interpreter, was limited because she spoke a ‘dialect.’
The ultrasound exam went very smoothly. The baby was appropriately grown and consistent with her ‘dates.’ She was about 33 and a half weeks’ and due on Christmas day. The baby was found to have a multicystic dysplastic (nonfunctional) kidney on the left side. But, the right kidney, ureter, and bladder were normal and all were working well because the baby had normal amniotic fluid (mostly fetal urine this late in pregnancy). The baby had no other visible abnormalities. In the simplest terms possible, I explained to her that the baby had only one kidney, but that he should do just fine after birth. Many people have only one kidney and this baby’s one good kidney had enlarged to compensate for the other kidney and should be able to support him through a long and normal life.
Despite my reassurances, and my insistence that I was not holding anything back, that we had seen many babies in this situation and all had done well, she began sobbing softly. I was at a loss for words but, at this point, her son reached out and grasped her shaking hand, softly stroking her fingers and telling his mother that everything would be all right, and that he could not wait to see his new brother and to help take care of him. She relaxed immediately with his touch, looked into his eyes, and began to smile herself. He was an angelic child, mature, handsome and soft-spoken, and he obviously had a much firmer grasp of the situation than his mother. I thanked him for his help and told him that his brother would be a wonderful Christmas present for him and his family and his eyes sparkled. I looked at him, nodded my head in gratitude, smiled, and then got up to leave. In the dim light of the exam room, I noticed that his skin was ashen and his lips were parched.
As I walked to the door, the interpreter came toward me and then clutched at my arm as I was going out the door. She thanked me for my help with the woman and then told me that she knew the family well. When I asked her if they were related, she looked back in the direction of the woman and her son and told me, “No, but you know that boy with her, he is her oldest child and her only son. She is upset because she really wants the baby to be normal. All the interpreters are close to them because her son is dying of leukemia and can’t have any more therapy. He just wants to live until Christmas to see his new brother before he dies.….”
I was glad I was at the door when she told me that. It had been a long week and I was tired, but the tears in my eyes would have been there regardless. And you know what; they come back each time I tell this story to someone, even now while I am writing it down. Life is short, and shorter for some than others, but we can all contribute something in our own way in the little time we have…