By age 35 I already had an 8-year history of trying to get pregnant. But even though the odds were against me, I was determined to have a biological child. My parents were my best friends, and I longed to see some of the traits I loved in them in my own children.
My journey had involved medications, ovarian cysts, and other complications. The act of getting pregnant was so intervention-intensive that I decided the birth of my (still theoretical) baby should be as natural as possible. I researched midwives and home births. My labor tools would include bathtubs, sacred music, and soy candles. I had mixed feelings about ultrasounds; by this point I had already seen enough ultrasound images of my uterus.
When I turned thirty-two, I ramped up my efforts. I started the IVF process. But a few weeks later, my father was diagnosed with cancer; I put IVF on hold.
Although we were told that my father’s illness was terminal, he was still alive two years later when my mother was diagnosed with cancer. The fact that my mother had a similarly dismal prognosis made me acutely aware of the possibility that my future children might never know their grandparents, and my parents might never meet their grandchildren.
My father passed away five months after my mother’s diagnosis. Words can’t describe how deeply I grieved for him. There was only one bright spot during that time: my mother had recently been declared cancer-free. Perhaps I felt my luck was turning around, because 10 months after my father’s death, I decided to start IVF.
I had no idea how long my mother’s remission would last, so having a baby took on a new sense of immediacy for me. I wanted a child more than anything, and I wanted my mother to be part of that. I knew the process would be difficult, but it couldn’t be any more difficult than what I had just gone through. I researched Lupron, a fertility drug, and logged back on to IVF boards, feeling ready to try the process. And then, two months before I was scheduled to start the IVF, I found myself pregnant.
Once I accepted the reality that my baby-to-be was coming, not a day went by when I didn’t consider my pregnancy to be precarious. If I wasn’t sick with nausea, I worried about my hormone levels. If my breasts didn’t ache, I poked at them until they did. But despite my worries, my pregnancy progressed uneventfully.
And then, just as the tricky first trimester ended, my mother began to have difficulty breathing.
A CT showed her cancer had returned. The prognosis was dismal: we were told she had four months to live. I had seven months before my due date. I’m usually excellent with numbers, but it took me a while to do the math. By the time my long-awaited baby would be born, both of my parents would be dead.
I adopted an apocalyptic mindset: I worried about my mother, my baby, myself. My perception of medical risk had changed dramatically over the past few years; if my previously healthy parents could become so dismally ill, then it seemed anything could happen. I was made aware of a world of morbidity that had previously been invisible to me. It occurred to me that maternal mortality has, for most of history, been the leading cause of death for women in my age group. In many parts of the world, it still is. And suddenly, these variables were no longer an abstraction — they were a real possibility.
Thus I began to suspect my medical group wasn’t a good fit. The gentle midwives didn’t seem concerned with the chance that everything could go wrong. The obstetricians only had admitting privileges at a community hospital, which didn’t have a NICU that could treat high-risk cases. I felt that there was a profound lack of understanding for how wrong things could go, and how quickly.
And so I went about the process of finding another obstetrician. This time, I didn’t care about bedside manner or warm eyes; instead, I wanted someone who could save our lives. I wanted someone who could, if necessary, cut me open, get my baby out, and get us both out of the hospital alive.
I finally found an obstetrician who practiced at an excellent private hospital with a high-level NICU. Most of Dr. Green’s Yelp reviews were stellar. The ones that were less than glowing complained her bedside manner was sometimes chilly. If she didn’t exude perennial optimism, well, that just meant that she and I would be on the same page. An abundance of caution was exactly the medicine I needed. Warmth, I thought, I don’t need warmth. What I need is not to die.
At my first appointment, Dr. Green came into the room and mentioned that she had just delivered a baby, but I would never have guessed it. Her hair was lovely and her face was calm in the way that I usually chalk up to Botox. This is the doctor for me, I thought. She listened to the baby’s heart.
“Everything looks beautiful,” she said. She asked me if I had any questions.
I didn’t tell her about my mother. It felt good to leave a doctor’s appointment with happy news of my baby’s health. It wasn’t how my days usually went; I spent nearly every day during my last two trimesters driving my mother to doctors’ offices or chemotherapy centers, or waiting for the results of scans that only confirmed her precipitous decline.
A few weeks later, at the end of another uneventful appointment, Dr. Green asked me if I had any questions.
“Actually,” I said, “I do have a question.”
I had just researched my mother’s new chemotherapy regimen. Chemotherapy drugs are by definition cytotoxic; they’re meant to kill growing cells. Some of the literature suggested that pregnant women exposed to chemotherapy drugs should exercise caution when handling body fluid. I had been taking care of my mother, and by this point, she was throwing up several times a day. I washed at least two pairs of pajamas and one set of sheets daily. She coughed constantly. It seemed impossible that I hadn’t come in contact the drugs. I asked Dr. Green if I should be concerned.
She looked at me with an expression on her face I hadn’t seen before. I decided she hadn’t had Botox after all. She asked me what drugs my mother was taking. When I told her, she assured me the baby would be fine, that, in fact, these drugs were given to pregnant women with cancer. She asked me how long my mother would be taking the drugs.
It took me an extra second to realize what she meant.
The drugs were palliative, I told her. My mother was only taking them to suffer less, not to get better.
Dr. Green sat there for a while and looked at me without saying anything. I left my appointment and didn’t mind that she was unable to find the words to express what she was thinking.
My pregnancy progressed uneventfully. My mother got sicker. When I was eight months along, a body scan showed her cancer had spread, much more than we had predicted.
At my next appointment, I told Dr. Green that we were considering home hospice. Again, she didn’t say anything, and finished her exam. I asked her if my pregnancy was on schedule. I was still trying to work out the numbers; I figured my mother could live another six weeks.
Dr. Green looked at me and nodded. (Apparently, she didn’t need to do the math.) And then she went to her desk and scribbled something on her prescription pad.
“We don’t always do this,” she said, “but I think it would be good to see this baby right now. To check her size.” She handed me the slip. “It’s always good to know if we are dealing with a big baby.”
I paused. She had never mentioned that my baby was big before. I asked her if she thought the baby was too big.
“Oh,” she said, “I doubt it. But sometimes you get a better sense from these ultrasounds.” She handed me the script. “They’re in 4D,” she said. “Maybe do it soon?” She paused. “Lifelike resolution.”
I got my ultrasound the next day and left the office with a CD of a baby with rosebud lips and round cheeks. I drove straight to my mother’s house. By now, she was in bed all of the time.
I tried not to make it a big production. I didn’t want to admit to her that this might be the only time she would see her granddaughter. I didn’t want to admit it to myself, either.
“I think she is going to be beautiful,” I whispered. My mother had fallen asleep, but she opened her eyes and looked at me.
“She already is,” she said.
My mom died a few days later. My daughter was born five weeks after that. It turned out that despite my fears, I didn’t need heroic interventions to give birth. The only reassurance I needed came on the day when my mother saw her granddaughter for the first and last time.
In a few days, my baby began to open her eyes and see her new home. I don’t know what she thought when she saw me, but when I looked at her, I knew she looked just like those pictures taken right before she was born, just like what her grandmother saw.