As December came upon us today, we were greeted with bitter cold and snow flurries, which inspired me to purchase a cinnamon flavored coffee. It seems odd to me that it’s that time of year again, already. Though I despise the cold and long for the return of summer, I fall for the allure of Christmas magic every year. I can’t resist singing carols, sipping cocoa and taking long drives to look at the neighbor’s Christmas lights. And as December was ushered in with the traditional snowy weather, the Christmas season, for me at least, was escorted by a rare Christmas Miracle. Interestingly, this particular miracle was a fantastic reminder of how all things, (like snow and cold and Christmas) come at the appropriate times.
Today, I had a patient encounter not unlike many others. My patient was to be arriving at the clinic with an unplanned pregnancy, and there was a high likely hood that this pregnancy would not be viable, or worse yet would be ectopic. (An ectopic pregnancy is a pregnancy that is located outside of the uterus, for instance in the tubes or near the ovaries, which is a VERY dangerous situation for the mother.) When the patient arrived, they walked apprehensively, hand in hand, clearly very distraught.
As we entered the room I tried to reassure them that the exam would be painless, and we would work quickly to get them the answers they needed to move on. As I began asking questions about the patients clinical history, she painted a very grim picture for me. This patient was over 40 years old. That, in and of itself, was a huge risk factor in pregnancy. Women with “advanced maternal age” (which is the vile medical term for ‘over 35 years of age at delivery’) have a largely increased risk for infertility, miscarriage, multiple gestations, Down Syndrome other genetic conditions…. and that small list doesn’t come close to covering it all.
Preemptive to her chronologically induced risk factor, mother nature had deemed her infertile. Upon investigation with a laproscopic surgical procedure, she was told that her fallopian tubes were completely blocked and there was no way that her body could produce an egg which could safely reach her uterus. Despite any evidence showing that she should have any trouble conceiving otherwise, she had not been able to achieve any pregnancy despite 4 rounds of invitro fertilization (IVF) during her 20s and 30s. (The idea being that if they bypassed the fallopian tubes and put a live embryo directly in her uterus, her body would carry a healthy pregnancy.) With all the very best medical guidance, her body still refused to make her a mother. Her and her husband gave up on the idea of ever having a baby born to them, and decided to instead to pursue adoption. They had a well established family with two daughters.
As the patient explained these circumstances to me, she reassured me that she was used to disappointment from ultrasounds. She explained that under no uncertain terms would she accept a sugar coated version of the truth. I agreed not to lie, sugar coat or otherwise get her hopes up about this pregnancy which by likelihood would not be viable anyhow.
As I got scanning, I carefully described her uterus and ovaries to her. When I finished, I turned my focus to the gestational sac, which was, despite all odds, in her uterus. We all breathed a sigh of relief to see what looked like a very normal gestational sac lodged just where it belonged. We were no longer rushing the clock to see which of her tubes were rupture.
And as if that silver lining wasn’t enough, that gestational sac had a small fetal pole. And, that fetal pole, which looked a lot like a small grain of rice, happened to have a flicker of a heart beat. And, when I had her hold her breathe, that flicker was very obvious and VERY audible with doppler ultrasound. As she and her husband held hand and listened to their baby’s heartbeat, their eyes both welted with tears and their look of worried turned more into a generalized sense of confusion. The more I scanned and explained what I expected to see, the more I saw what I what looked like a very normal, healthy pregnancy.
I still reminded them that though the pregnancy was in a viable location and looked as perfect as any 20 year old’s pregnancy would’ve looked, there were still some very big risk factors associated with being of ‘advanced maternal age’. They explained that this baby simply being in the uterus was for them a miracle. They said that they were simply going along for the ride, and that the journey thus far had been surreal.
They had waited over 20 years for that moment. They waited two long decades to hear a viable fetal heartbeat, despite longing and being sure that they should have been parents long before. I was reminded of how I was not ready to have Jake when I found myself pregnant, and how I often retell the story saying that all things happen for a reason, just when they are supposed to. Though my own personal circumstances were the reverse of theirs, I felt very much like I knew what they were feeling. We had learned in very similar ways just how little say we have in matters of family, and how though we cannot always understand the circumstances we are presented with, we can be assured they happen just as they must.
I pray that this Christmas miracle continues on to a healthy pregnancy for them, with no complication. I secretly hope that they are blessed with a little baby boy to even out their family. How wonderful would it be to be the baby brother of 2 adoring sisters and parents who had dreamed of you for over 20 years? What a wonderful moment to be a part of.
Here’s to hoping all of you get to witness a holiday miracle!