Hard Cases: The Patient Willing to Die for Her Baby

This article is part of LinkedIn's Hard Cases series, where medical professionals share the toughest challenges they've faced in their careers. You can read more about it here and follow along using hashtag #HardCases.

?Pregnancy and birth, both natural life events. You would think by now evolution would have worked out all the kinks to make the process smooth. But mother nature makes mistakes and the reality is, procreating is fraught with problems at times. I have dealt with many challenging issues for patients in my ob/gyn practice, but this patient stands out among the rest. She was willing to die to have a baby.

Dark mascara and eyeliner shaped her eyes, tight-fitting clothes fleshed out her curvy body, and tattoos adorned her skin. She shook my hand firmly when I walked into the room and then sat forward as she spoke.

“I need my IUD removed. I want a baby.”

With no hesitation, she went on to describe her son, who now was a teenager. He was born ten weeks prematurely and now had many physical and mental disabilities which required him to use a wheelchair as well as needed constant care. The responsibility was a heavy burden, but when I asked her about how she managed, she shrugged her shoulders and said, “oh, it’s not so bad.” Then she smiled for a moment, giving me a small peek into her soft heart hidden under her tough armor. She now wanted, with her current boyfriend, a chance at a “normal” pregnancy and child.

When I examined her, I couldn’t see the IUD string. Her ultrasound revealed the IUD high up in the cavity of the uterus. I recommended I take her to the operating room to fish out the IUD with some anesthesia so she would be comfortable. Instead, she begged me to take it out in the office and avoid the time and money of going to the hospital. “I can handle any pain,” she said to reassure me.

And so I did as she asked and quickly learned how determined and tough she could be.

She returned within the year pregnant. She glowed with excitement after seeing her tiny 7 week fetus on the ultrasound screen. Because her first pregnancy was so many years ago, it was impossible to get her records and determine the cause of her early labor, but I promised I would watch her closely. And so we went forward.

Her first trimester cruised along without any issues. She finally reached her second trimester and she was anxious to find out the sex of the baby at the anatomy ultrasound. Much to her delight, it was a girl and she shed tears of happiness upon hearing the news. Her next appointment was in four weeks, but she didn’t make it to that appointment. Instead, she showed up in the emergency room, and as she put it, “I died and they revived me.”

She indeed had a cardiac arrest upon arriving at the hospital. After stabilizing her in the emergency room, she was transferred to the ICU. When I arrived the next day, I found her hooked up to several monitors and IVs, receiving various medications to keep her alive. Although every day someone listened for the baby’s heartbeat, our immediate need was to keep mom alive. By her bedside was a post-mortem c-section kit — if she were to die, we would have the ability to perform an emergency c-section at bedside because we would only have minutes to save the baby. Thinking about that possibility sent shivers down my spine. The situation was heartbreaking and, unfortunately, at that moment, we were not clear about why her heart stopped.

Each day that I visited, she would smile as I walked in. But sometimes, I saw her through the window before she saw me and I saw the strain on her face, occasionally tears on her cheeks. She didn’t have her usual makeup on, so her age and fatigue couldn’t be masked. We talked about how reaching the end of each day was a victory for her and the baby; one step closer to a full-term pregnancy. I found her courage and continued optimism inspiring.

Sadly one night soon after her admission, her body responded to all the stress and the need to care for only itself, by going into labor and delivering an extremely premature baby. The baby did not survive.

The cardiologist eventually determined that an irregular heartbeat was the cause of her cardiac arrest. She then had an ICD (implantable cardioverter-defibrillator) placed in her chest to help control her irregular heartbeat. She was told to never attempt pregnancy again as her risk of death was too high. She left the hospital empty handed and defeated, her dream of having a “normal” child dashed.

And then she disappeared.

It was about a year before I saw her again. She had spent the year seeing various doctors, trying to find clues about her heart issues. Overshadowing every step was the overwhelming desire to be pregnant. The words fell out of her mouth in rapid-fire as she recounted her journey, emphasizing her relentless struggle to find answers. In the end, her thyroid was the culprit. It had gone into overdrive, thus causing her heart to become erratic and fire signals haphazardly. Once she discovered this, she honed in on treating the thyroid. And now, as she sat on the edge of her seat in the exam room, her eyes wild with desire, she finished with “I want to have a baby now.”

In a flash, the memories surfaced and I’m back in the ICU, standing over her bed, hearing the beeping of monitors, praying she would survive. And now she wanted me to not only support her decision, but also care for her despite the risks.

I saw her desperation, her dream, her recklessness, her hope all clouding the facts of her medical history. But I also saw her determination to beat the odds. In myself, I saw hesitancy, concern, and biggest of all, fear of her dying. I had already lived through having a patient die and I didn’t know if I could do it again. Could I really be a co-conspirator in her fantasy? What was my obligation to her? And if I said no, would she find another doctor willing to take on the risk, especially after seeing her records and the words “DON’T GET PREGNANT AGAIN” boldly written? And if not, would she just go ahead alone, navigating the stormy waters on her own?

So many questions to wrestle with as I sat there with her. She looked at me unwavering, her eyes imploring me to take the risk and walk her through this journey fraught with danger. I told her I needed time, that this was not a small request and deserved a thoughtful response. I also wanted to review her records to make sure I understood her health issues clearly.

In the end, I couldn’t say no. Her diligence in knowing her health issues made it clear that her heart was an innocent bystander to the hyperactive thyroid. Once the thyroid was in control, her heart followed suit. I agreed to continue caring for her and she quickly became pregnant. Glaringly different than her first two pregnancies, this one went smooth as silk. She birthed a full term, healthy girl and had no health issues during this pregnancy — how nature intended it all along.

I will never forget this patient, so sure she could safely carry a pregnancy despite her sordid pregnancy past. I will never forget her determination despite all her risks. And I will never forget my struggle to decide whether I was strong enough to care for her.

See more articles from Dr. Eisenberg at www.secretlifeofobgyn.com