The Myth of Choice

Abstract

A woman meets a man, starts a relationship, wants a family. She comes to your hospital so pregnant that her belly is huge. She hasn t come before because she has no car. Her man works long days, paid cash for his labor. Turns out the baby has no brain, no skull. Only a stem. This condition has no survivors. None. You are in OB triage, crammed on a stool between the woman s stretcher and the wall. When you move, the stool squeals. Her hand rubs her belly. You find an interpreter, you sit beside her, you tell her congratulations and you are so sorry all in the same breath. The interpreter is a stranger on a screen, mounted to a pole on wheels. You try to angle the screen so the interpreter sees your face. He is aghast at what you ask him to repeat. The cadence of your words is carefully measured, but your beautiful cadence is mangled by his hesitation. You wait for the patient to break the silence. The baby s heartbeat trots through the monitors while you softly hold her gaze. Her eyes plead with you. End it. You talk to the obstetricians, because eventually it will end. But nobody will do it. Not in this state. Not in this hospital. And so, the mother goes home, pregnant and grieving. She returns a few days later. She s having a miscarriage. Her labor is managed just like that, like labor. The baby is born with no skull, eyes like gumballs too big for their sockets. Alive, briefly. It hurts to look. Grotesque is all you can think, but you cannot say it. Thinking it calms you inside so you can calm everyone else. That is your job. To lead, to calm. Because everyone is upset. Some of the nurses need you to fix it, to save this baby with the magic of medicine. You remind them that he is very premature, that he has no brain, that he cannot survive. This is not an ambiguous diagnosis. You encourage the mother to hold her child, but she does not want this bond. She cannot see the deformed creature she birthed, because once seen it cannot be unseen. It doesn t last long, these precious but vulnerable moments. Gently, the baby dies. He is warm, whole, and not alone. There are no doughnuts at the nurses station that night as this young mother is wheeled to a room in the back corner of labor and delivery, away from the other mothers and their pink, crying babies. She will walk out of the hospital with breasts swollen and weeping for her dead child. Her hips loose and large will force her pants to tug. She will struggle with her gait for weeks, punctuating loss in the waddle of each step, until, gradually, she retires her maternity pants and her steps become firm, upright, and forward. You ve done this before, cared for women whose wishes were warped by politics. You ve commanded millions of health care dollars on behalf of infants born with fatal diagnoses. You ve seen these infants cut, lanced, and battered in the name of intensive care. Do everything. Because who does not want to save her child? Sometimes all we can control is our grief. The middle-of-the-night pangs for a world where motherhood means potty training and muddy cleats. Sometimes the idea of choice is just a lie. And sometimes all you can provide is compassion. Dignity in grief is the gift. You ve enabled false hopes, not for cures but for time to bond, hope, and heal. It is the parents you are healing. The hopes false. All these children died in the end. Audio. Michael A. Lacombe, MD, Annals Associate Editor, reads The Myth of Choice by Anonymous