This piece was one of my first from years ago. I have revised it several times, but each time I read it, I still get a chill.
I chose the field of OB/GYN because I enjoy helping women through many life changes and, in the process, developing long-term relationships. My field can be fraught with many moral and ethical issues, but as a young new practitioner in the 1990’s, I wasn’t quite ready for the cultural issue that fate brought me.
A newly pregnant young woman from India sat in my office with her husband and 2-year old daughter. She was a petite woman struggling to control her active daughter. Her shy laugh didn’t cover up the smoldering anxiety and embarrassment of her headstrong daughter as she had hoped. Within minutes of meeting, her husband blurted out, “we are hoping for a boy.” I smiled, “yes, I understand, you want to even things out,” I said jokingly. He was the only male in the family, of course, he would want a son. I was blind to the fact that it was not just a hope for him.
Through the course of questioning her, I learned about her health and previous pregnancy. Her daughter was born in India where medicine is practiced differently. She didn’t understand some of my questions, like if she had ever had a PAP smear. I, in turn, was not always sure what she spoke about, even with her husband assisting with some translations. But by the time I was done interviewing her, I had a clearer picture of who she was. That is, except one glaring issue, that having a girl was not an option.
In residency, I had heard of some practitioners who would perform amniocentesis for the sole purpose of sex selection. Since an ultrasound is not always foolproof in determining the sex of a baby, an amnio was the only way in those days. If it was not the sex they wanted, most often girls, these patients would then terminate the pregnancy. Culturally, I understood the value and significance of a boy to them, but the opposite, the devaluation of girl, was hard to accept.
I completed this patient’s exam and ultrasound, had her stop into the lab for blood work, and bid them farewell until the next visit 4 weeks later. Before leaving though, her husband again reiterated “we are hoping for a boy. What tests do we need to do to determine this?” I stammered a little, “well, we will be doing another ultrasound in about 3 months and hopefully, we will see then. Your wife is only 25 years old, so there is no medical reason to perform an amniocentesis which is the only sure way to know the sex of your baby.”
That night, despite trying to leave my work issues at work, I couldn’t stop thinking about this family. I didn’t want my personal feelings to interfere with her care, but I wasn’t comfortable with the idea of sex selection. So, the next day, I called them. “I understand having a boy is of utmost importance to you. I respect your honesty with me and in turn, I honestly believe you would be better cared for by another physician.”
I expected they would take the name of the OB I provided to them and move on – after all, they had just met me yesterday. It is not like we had a long relationship. But instead, over the next few days and over several phone calls, they explained that they were committed to me being their doctor and insisted they were planning to continue the pregnancy regardless of the sex of the baby.
Over the course of my patient’s pregnancy, we gradually got to know each other better. Being young and healthy, she had an uncomplicated prenatal course. Her daughter and husband came to each appointment – her daughter always bouncing around the room during the visit.
Eventually, it was time for her 20-week ultrasound, the ultrasound they hoped would finally tell them what they were having. Of course, the baby was in a position that made it impossible to determine the sex and once again, the wait continued. I was worried that the couple would be disappointed at this news, but surprisingly, they were just happy the baby was growing well and that they saw it moving on the ultrasound.
However, for me, as the pregnancy progressed, I felt the weight of the baby’s life on my shoulders. What if it was a girl? What sort of life would she have? Would she be treated as second class or unwanted? Had I influenced them to keep a pregnancy they really did not want?
Finally, the day came – with the sex of the baby still in question – my patient was in labor. I was so glad to be on call and could be there for this birth. The patient’s husband was at her side constantly, offering her ice chips, a cool cloth, caressing her arm during contractions . When she began pushing, he supported her leg and was eagerly shouting “push, push.” In not too much time the baby was crowning and then one last push, out it came and I swiftly put it on mom’s belly. I let dad make the big announcement. “It’s a girl!” he shouted, with the biggest grin on his face. He followed the baby to the warmer and was the first to hold her before bringing her to mom. Such relief showered over me. A beautiful delivery, a beautiful baby, a happy family.
A year later, as I was working in my office, one of my staff came back and said there was someone who wanted to see me. The couple had come back with both their daughters. “We want to thank you for what you did a year ago, for giving us another daughter.” And every year on her birthday, they would come visit me.
Medicine is so much more than mechanics. I feel fortunate that early in my career, I had the opportunity to care for this family and learn the importance of communication, honesty, tolerance and acceptance. To this day, I still don’t know why this patient stayed with me after that first meeting, but fate gave us this moment and it grew to more than either of us anticipated. We became more than just patient and doctor, we became family.