Going for Donuts

“Can we go to donuts in the morning” Christian asked. About twice a month I take the kids to donuts before school. They ask more often but I try to limit it for nutritional reasons. My wife thinks that I take them too much as it is. So the other night when my son asked if we could go for donuts I said “maybe” and he knew that a maybe was as close to a no as he was going to get. He would ask again in the morning and I would say “Not today, bud, maybe next week.” Anyway, after asking he went to bed and I stayed up watching the television before going to bed myself.
The call from the hospital came at four in the morning. A woman with twins, one healthy and one with holoprosencephaly, had shown up in labor and they were going to perform a c-section. They wanted to know if I’d come in for the delivery. Of course I said. Probably the thing I like most in my work is attending a delivery. There is so much excitement in the room. If all goes well I get to see a life enter the world and be part of one of the most important events in people’s lives. If there is a problem and the baby is sick, well then I know what steps to take to hopefully make things better. For this case there would not be much for me to do, but I knew the nurses wanted me there to help things go smoothly.
In truth, I had forgotten that she was out there in the community. The mother with the twins. I had met with her a little over two months before the delivery. That was when the Obstetrician called me and asked if I would talk to a woman with twins. One of the twins was healthy and the other had holoprosencephaly. Holoprosencephaly is a deformity of the brain in which the cerebral hemispheres fail to divide. Like most conditions in medicine, there is a wide range in presentation with some babies looking perfectly normal and having mild mental problems to those that are severely affected with obvious physical and neurologic abnormalities. These severely effected babies often die shortly after birth. When I met with the mother two months prior she said she understood that her infant was severely affected and would not survive the delivery. I tried to explain to her that there were limits to prenatal diagnosis and that I had seen babies live up to a year even when they had major abnormalities. I explained that no one could predict how long her little girl would live. I then asked how she would like for us to care for her daughter and she stressed that we only provide comfort and not perform any resuscitation.
The delivery was by c-section and the boy was born first. He came out crying, active and pink. There was a quick cheer in the room and the Obstetrician held him over the curtain so the mother and father could see him. She then handed the little boy to a nurse who placed him under a warmer. I checked him out with the nursing staff. We warmed him, dried him and rubbed his back. We suctioned out his mouth, gave him a shot in the leg and one of the nurses made footprints on a thick, paper card. He was doing just fine. Next the Obstetrician pulled out the girl and handed her to a nurse who then laid her under the warmer. The newborn had a small, thin body. Her head, however, was quite large. She had hydrocephalous, so her face was of normal size but her head swelled out above her eyes. Babies with severe holoprosencephaly also have midline physical defects and this little girl had closely spaced eyes and a large cleft so that her mouth and nose came together to a central whole. Flaps would open and close around this central hole when she cried. Her cry was hoarse but she was quite active. “What should we do?” one of the nurses asked. “Well, we should rap her in a warm blanket for starters,” I said. We also put a cap over her head. I motioned for the father to come over. He was a quiet and gentle man. He looked at his son first. He placed his hand gently on his head and smiled. Then he asked if he could hold his daughter. I said of course and we handed her to him. He held her, looked into her eyes and told her that she was beautiful.
Before leaving I walked over to the mother who was lying on the operating table looking into a blue drape. I told her that her son was healthy and doing just fine. She smiled and I could see the joy in her face. Then I told her that her daughter was severely affected but alive. She was breathing on her own and active. We could both hear the girl’s raspy cry. I told her that I did not know how long she would live and that she was being held by her father. The mother’s smile vanished. For a moment she had forgotten about the second twin and was allowed to enjoy her son’s birth, but that moment passed quickly. I asked her if she wanted to see her daughter and she shook her head “no”. “I can’t” she said and then added “thank you” probably not really knowing what else to say. She looked away from me and into the blue curtain and I watched as a tear formed in her eye and rolled down her cheek.
I walked out of the room and looked up at the clock. It was a little before 7 in the morning. I had time to get home and get the kids ready for school before coming back to see my patients. On the drive back home all I could think about was the mother and her twins. Carrying them both throughout the pregnancy knowing that one was healthy and that one was sick. Then having to be in the delivery room, overcome with joy for the birth of her son and yet filled with loss for the terrible affliction suffered by her daughter. I thought of how fortunate I was to have five healthy children and I decided that I was going to take them to donuts.