"It's spring! The rest of you guys may not be ready but the days are getting longer, the grass greener, the sun brighter. It is time to get out of that rut and enjoy the world. Follow me!"
Friday, May 2, 2008
Wednesday, April 30, 2008
Dangerous donations
The tall, shy, strawberry blond, freckled faced 15 year old seems strangely familiar. Her older sister was also a patient yet they seemed to have come from different families. Her sister was a petite brunette with olive skin and brown eyes like their mother. Both sisters were pregnant. Melissa, the oldest was a dental hygienist married to a dental student. Denise was, well, she was 15 and in high school. So was the father of her baby. Denise's mom came to all of the prenatal visits. Still, I felt there was family history that I did not know.
Both pregnancies were uneventful from an obstetrical standpoint. Melissa delivered first. Her due date was two months earlier than Denise's. Melissa had a healthy baby boy. She and her husband named him Jonathan. They brought a baby cap and blanket specially made for his birthday. Jonathan had a baby book with places for pictures and his new born foot prints. Grandparents from both sides along with close friends filled the waiting room on the night he was born.
Denise's delivery was more subdued. The father of the baby's parents were at odds with Denise's parents so they and the birth father stayed away. An adoption agency had been chosen. The case worker came to do the paper work before Denise was discharged from the hospital but neither she nor her parents wanted to see or hold the baby. Their plan was for Denise to sign away parental rights forty eight hours after the baby was born. The father of the baby had not decided about his rights. I suspected that he did not care but was using the fact that he had rights to get back at his parents.
When she was born Denise's daughter had her golden hair and fair skin. I handed the baby to the nurse as Denise turned her head away shaking it "No" when I ask again if she would like to hold her daughter. The fact that no one ran to the baby warmer to count fingers and toes or let the baby grab at a hand hurt my heart. The baby, "Little One", as I came to call her those two days she was in the hospital, cooed and gurgled as the nurse dried her off, weighed and measured her. Wrapped in a bundle of hospital blankets she made faces and sucking noises as if to say, "Where's dinner?"
I convinced myself that these sisters were so different because of their situations. One was married with a planned pregnancy. The other, still a youngster, still in need of adult supervision herself, was placing her baby for adoption. During Melissa's delivery I met the third child in this family, a brother, Timothy who was 13 at the time. Funny thing was I felt like I already knew him. He looked like a younger version of a friend of mine from residency.
Six months later I was seeing a work-in emergency for my senior partner. It was Melissa's and Denise's mother, Mary Ann. She had been a patient in the practice since her two youngest children, Timothy and Denise were born. Having delivered her grandchildren I was intrigued enough to look through the chart. "Secondary Infertility" was the diagnosis that brought Mary Ann in to see Dr. Banyon for her first visit. Melissa was ten and her parents had been trying for seven years to conceive. "Male factor" was noted at the end of the work up. There was a semen analysis with minimal sperm.
Minimal sperm on her husband's semen analysis but two children within two and a half years of her first visit. Then I saw it "AID" in fine print at the bottom of one of the pages. Artificial Insemination - Donor. "Excellent specimen, third year resident, red hair and freckles."
No wonder Timothy looked so familiar. Someone I knew, someone I had done my residency with was the father of Denise and Timothy. He was the grandfather of "Little one." I knew exactly who donated this sperm. I wanted to call him and tell him he had a grandchild. I wanted him to tell his children, all three close to the ages of these two kids, that they had two half siblings. Half siblings that they could meet. Half siblings that they could marry. Half siblings with whom they could make babies.
Both pregnancies were uneventful from an obstetrical standpoint. Melissa delivered first. Her due date was two months earlier than Denise's. Melissa had a healthy baby boy. She and her husband named him Jonathan. They brought a baby cap and blanket specially made for his birthday. Jonathan had a baby book with places for pictures and his new born foot prints. Grandparents from both sides along with close friends filled the waiting room on the night he was born.
Denise's delivery was more subdued. The father of the baby's parents were at odds with Denise's parents so they and the birth father stayed away. An adoption agency had been chosen. The case worker came to do the paper work before Denise was discharged from the hospital but neither she nor her parents wanted to see or hold the baby. Their plan was for Denise to sign away parental rights forty eight hours after the baby was born. The father of the baby had not decided about his rights. I suspected that he did not care but was using the fact that he had rights to get back at his parents.
When she was born Denise's daughter had her golden hair and fair skin. I handed the baby to the nurse as Denise turned her head away shaking it "No" when I ask again if she would like to hold her daughter. The fact that no one ran to the baby warmer to count fingers and toes or let the baby grab at a hand hurt my heart. The baby, "Little One", as I came to call her those two days she was in the hospital, cooed and gurgled as the nurse dried her off, weighed and measured her. Wrapped in a bundle of hospital blankets she made faces and sucking noises as if to say, "Where's dinner?"
I convinced myself that these sisters were so different because of their situations. One was married with a planned pregnancy. The other, still a youngster, still in need of adult supervision herself, was placing her baby for adoption. During Melissa's delivery I met the third child in this family, a brother, Timothy who was 13 at the time. Funny thing was I felt like I already knew him. He looked like a younger version of a friend of mine from residency.
Six months later I was seeing a work-in emergency for my senior partner. It was Melissa's and Denise's mother, Mary Ann. She had been a patient in the practice since her two youngest children, Timothy and Denise were born. Having delivered her grandchildren I was intrigued enough to look through the chart. "Secondary Infertility" was the diagnosis that brought Mary Ann in to see Dr. Banyon for her first visit. Melissa was ten and her parents had been trying for seven years to conceive. "Male factor" was noted at the end of the work up. There was a semen analysis with minimal sperm.
Minimal sperm on her husband's semen analysis but two children within two and a half years of her first visit. Then I saw it "AID" in fine print at the bottom of one of the pages. Artificial Insemination - Donor. "Excellent specimen, third year resident, red hair and freckles."
No wonder Timothy looked so familiar. Someone I knew, someone I had done my residency with was the father of Denise and Timothy. He was the grandfather of "Little one." I knew exactly who donated this sperm. I wanted to call him and tell him he had a grandchild. I wanted him to tell his children, all three close to the ages of these two kids, that they had two half siblings. Half siblings that they could meet. Half siblings that they could marry. Half siblings with whom they could make babies.
Friday, March 14, 2008
I almost missed her
E was a former patient and a labor-delivery nurse, the little sister of one of my best friends from high school. That early spring day in 2003 I would say former patient because she fired me. That is right. Two years earlier she became angry with me and requested her records to see another gynecologist.
When I learned she had been diagnosed with acute leukemia I spent a week using the excuse of a bad cold to keep me off the sixth floor where the immunosuppressed heme-onc patients stayed. Finally, on Friday I bought flowers and made my way to E's room. She was sitting at the head of the bed with her knees drawn up to her chest. I remember how thin and pale she looked with shoulder length, straight, blond hair. The oncologist had been there earlier in the afternoon. The diagnosis was ALL, acute lymphoblastic leukemia. The doctor explained that chemotherapy would come first then perhaps a stem cell transplant from one of her four sisters.
E spoke with me about all this while I stood across the room wearing a mask. She looked terrified as she should. The five year survival rate for an adult with her diagnosis was under twenty five percent. As I left one of my physician friends, an oncologist, asked me what I was doing on the sixth floor. Upon hearing that E was a family friend he offered his condolences.
I went back the next day and the next and then many of the days in the next six months as E completed the courses of chemotherapy. She suffered many side effects of the medications and many illness from her lack of an immune system. She lost her hair, her face became as round as the moon and on many days she had ulcers in her mouth that made it difficult for her to swallow. Yet it seemed the sicker she was the more she smiled and joked with me about people and events from our past. E's older sister and I had been extremely close in high school we both knew a great deal of each other's "family history."
The most important thing that happened in these months of battling the leukemia was E's persona changed. She went from that timid, huddling figure on the bed the first week, to someone who smiled easily. Instead of huddling in her bed and making visitor stand across the room she stretched her arms out to give them a tight hug, after they had washed, gowned and masked themselves of course. She was not shy with her physicians either. She demanded information every time one came to her room. One of the hematologists told me she was angry with him at one point and "fired" him. I welcomed him to the club and I also noticed that he continued to come by and see E even when she was on the transplant service and no longer under his care. Like me, he wanted to cheer her on against almost impossible odds.
While I think E knew that the odds of her beating the leukemia were almost impossible that did not seem to deter her from the fight. I had watched as she and her sisters fought growing up. Those battles now seemed like preparation.
Weeks and months stretched out over a period of two years. E's first remission was six months. The second, following the first stem cell transplant was a little longer. E went back to work. Life was a bit more normal for her family. Finally, the monstrous leukemia returned. It was just a couple of weeks before Easter 2005 when E became septic with a overwhelming infection that antibiotics and her body could not handle. She died on a Wednesday morning with two of her sisters, her three children and a close friend at her bedside. I was in my office seeing patients when someone from the hospital called. I ran the three blocks to the hospital but I arrived too late.
I have decided that it was OK that I had missed her that morning. There had been many other mornings, late nights and occasionally a long afternoon when E convinced me of the value of living every day for all that one day is worth. And when I think about how close I came to not going up to her room that Friday afternoon, I shudder. I could have totally missed her. My pride and the rejection that I felt when she went to another doctor might have prevented me from going to visit on that very first week of her illness. I will forever be grateful that I was able to move past that and into the space of friend.
When I learned she had been diagnosed with acute leukemia I spent a week using the excuse of a bad cold to keep me off the sixth floor where the immunosuppressed heme-onc patients stayed. Finally, on Friday I bought flowers and made my way to E's room. She was sitting at the head of the bed with her knees drawn up to her chest. I remember how thin and pale she looked with shoulder length, straight, blond hair. The oncologist had been there earlier in the afternoon. The diagnosis was ALL, acute lymphoblastic leukemia. The doctor explained that chemotherapy would come first then perhaps a stem cell transplant from one of her four sisters.
E spoke with me about all this while I stood across the room wearing a mask. She looked terrified as she should. The five year survival rate for an adult with her diagnosis was under twenty five percent. As I left one of my physician friends, an oncologist, asked me what I was doing on the sixth floor. Upon hearing that E was a family friend he offered his condolences.
I went back the next day and the next and then many of the days in the next six months as E completed the courses of chemotherapy. She suffered many side effects of the medications and many illness from her lack of an immune system. She lost her hair, her face became as round as the moon and on many days she had ulcers in her mouth that made it difficult for her to swallow. Yet it seemed the sicker she was the more she smiled and joked with me about people and events from our past. E's older sister and I had been extremely close in high school we both knew a great deal of each other's "family history."
The most important thing that happened in these months of battling the leukemia was E's persona changed. She went from that timid, huddling figure on the bed the first week, to someone who smiled easily. Instead of huddling in her bed and making visitor stand across the room she stretched her arms out to give them a tight hug, after they had washed, gowned and masked themselves of course. She was not shy with her physicians either. She demanded information every time one came to her room. One of the hematologists told me she was angry with him at one point and "fired" him. I welcomed him to the club and I also noticed that he continued to come by and see E even when she was on the transplant service and no longer under his care. Like me, he wanted to cheer her on against almost impossible odds.
While I think E knew that the odds of her beating the leukemia were almost impossible that did not seem to deter her from the fight. I had watched as she and her sisters fought growing up. Those battles now seemed like preparation.
Weeks and months stretched out over a period of two years. E's first remission was six months. The second, following the first stem cell transplant was a little longer. E went back to work. Life was a bit more normal for her family. Finally, the monstrous leukemia returned. It was just a couple of weeks before Easter 2005 when E became septic with a overwhelming infection that antibiotics and her body could not handle. She died on a Wednesday morning with two of her sisters, her three children and a close friend at her bedside. I was in my office seeing patients when someone from the hospital called. I ran the three blocks to the hospital but I arrived too late.
I have decided that it was OK that I had missed her that morning. There had been many other mornings, late nights and occasionally a long afternoon when E convinced me of the value of living every day for all that one day is worth. And when I think about how close I came to not going up to her room that Friday afternoon, I shudder. I could have totally missed her. My pride and the rejection that I felt when she went to another doctor might have prevented me from going to visit on that very first week of her illness. I will forever be grateful that I was able to move past that and into the space of friend.
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