“How long married?” I asked Robin, having arrived at the point of eliciting his family history. He was seated across my desk with his wife, who was also carefully listening to the details of his illness, which he was giving.
“Six years,” replied Robin.
“Any children?” I inquired.
“First one on the way,” Robin replied with the pride of a first time father to be, glowing on his face.
Seeking further elaboration, I asked. “Is your wife pregnant?”
“Yes she is,” Robin replied and formally introduced her to me. “This is Janet,” he said.
Since I did not see any overt signs of pregnancy, I asked her: “How many months?”
“Just two months,” Janet blushed as most women do while announcing their first experience of child bearing.
“Congratulations,” I said instinctively. Delving into Robin’s medical history and mulling over his doctor’s letter and some laboratory reports he had brought with him, I wondered if my congratulations were in order.
The doctor’s letter said: “Robin came to see me a month ago feeling unwell.
I found a trace of jaundice in his eyes and, judging by his age, I first thought of hepatitis. I did his liver function tests and they were equivocal. I gave him supportive treatment for hepatitis based on my clinical judgement.
However, there was no improvement and his jaundice was visibly deepening. I, therefore, did more blood tests and an ultrasound of his liver.
I was horrified to see the ultrasound image and did not have the courage to tell this pleasant young couple what Robin was suffering from. Excuse me for leaving that unpleasant task to you.”
Looking at the blood reports, I found that his alpha-foeto proteins, very specific for liver cancer, were high.
“Let us examine you,” I said in a dejected voice. As Robin went behind the screen, I took a peek at the ultrasound images of his liver. “Multiple irregular masses suggestive of Hepatoma,” the report said.
My examination yielded some valuable clues. Of course the jaundice was obvious. “You have lost some weight,” I said to Robin as I saw his shirt collar loose round his neck as he removed his shirt. My finding was further fortified by the hollowness above his collar bones and between his ribs.
“Am I hurting you?” I asked as I thumped his right lower ribs to elicit tenderness of his liver, which was not enlarged.
“Queasy feeling,” replied Robin.
At the end of the examination, I was more pained than Robin was.
Here was a young couple expecting their first child and I had the invidious task of giving them some terrible news.
“There is something going on in that liver of yours,” I was treading on egg shells. “I need to do a liver biopsy, but we have to do a clotting test on your blood first.” As they both looked puzzled, I explained: “I take a punch biopsy of your liver under local anaesthesia, an uncomfortable but not a painful procedure.” I then apprised them of its most dreaded complication. “If the clotting factor in your blood is low, as they can be in liver disease, you can bleed. Hence the need to check the blood for clotting before we embark on the test.”
“What do you think it is?” Janet asked.
“I am suspecting a tumor but let’s wait till the liver biopsy gives us a definite answer.” I knew I was postponing the evil day.
Four days later when the biopsy report came, I had no choice but to tell the unpleasant truth.
That night at 2am my phone rang. “I have with me a two month pregnant woman with what looks like a threatened abortion,” Dr Oloo, the Casualty doctor, said.
“Shouldn’t you be calling a gynaecologist?” I asked.
“I should,” replied Dr Oloo. “But the husband who is with the patient wants me to call you.” Dr Oloo then gave me more details and I realised that the patient was Janet.
“I am coming but please also call her gynaecologist,” I said.
“Anyone in particular?”
“Whoever Janet is under for her antenatal care,” I advised.
News for you
When I arrived in the emergency and accident department, I was met by Dr Mrs Muchemi the gynaecologist.
“I have good news for you,” she announced shaking my hand. “I have just done a vaginal on Janet and found that the cervix is closed.” This meant that the mouth of the womb was shut and the pregnancy could be saved. “With sedation, and bed rest, she might be able to retain her pregnancy,” Dr Muchemi added.
As I was driving back home in the early hours of the morning, I had time to ponder over the tragic triangle. Here I was saddled with a patient who had very little time on his hands, Dr Muchemi was fighting for the life of his unborn child and poor Janet caught in the cross-fire.
I was convinced that her threatened abortion was a result of the shock I gave her about her husband’s fatal illness that morning.
On the whole, Dr Muchemi had better luck than me. She managed to arrest the miscarriage and, after a couple of days, Janet went home. My patient, however, was in dire straits. As his offspring grew inside his wife’s womb, Robin was fading into a shadow of himself.
In the terminal phase of his illness, I admitted him, both to make him comfortable and also to relieve Janet, who was now in her seventh month and exhausted, from nursing a very sick husband. Sister and I agreed to waive visiting hours for Janet.
One evening, as I was leaving Robin’s room, I saw Janet waiting outside to see me. “Can I have a word with you?” she asked. I led her to the alcove where there was a settee and sat her beside me.
“I can see that I am losing my husband,” she said with anguish in her voice. “Is there anyway though by which we can ease the end?” I thought she was thinking of better pain control but I was wrong.
“His illness seems to take a second place in his mind to his obsession of becoming a father.” Searching my face for any reaction, she added: “First of all, he is convinced that it’s a girl. I wonder who she will take after in her looks and her temperament, he keeps on repeating. Another time he says ‘Tell her all about me and don’t let her forget me.’ His only wish now is to see his daughter before he goes.”
With tears glistening in her eyes, she pleaded: “Is it possible for him to hold on to dear life until I deliver?”
In my mind
“Well”, I stuttered
“it is difficult to predict the prognosis of a patient precisely in months and weeks.” I was pretty sure in my mind that Robin did not have two months to live. “We can only depend on his own determination to live to see his child.” Looking at her forlorn face, I added. “Needless to add that we will give all the support we can.”
Once again on my drive home the desperate situation in which Janet found herself kept haunting me. After arriving home, I rang Dr Muchemi. Susan had been attached to my unit for six months while she was doing her postgraduate in obstetrics and gynaecology and I had established a friendly relationship with her.
“Your science has made great strides,” I said after affectionately greeting her. “Test tube babies and now even producing a human clone. Have you made any progress in delivering a baby two months before it is due and keeping the infant alive?”
“Induction of premature labour is sometimes successful,” Susan replied. “Keeping a very premature baby alive may pose a greater problem.”
Then, as an afterthought, she added: “You know Dr Agada who was in the same batch as me and also your student? He went to McGill in Montreal for a couple of years and qualified as a neonatologist. He is back now and he could help.”
I had heard of this new super-specialty where a doctor looks after a baby up to the first year of its life and has special expertise in the care of premature babies. I assembled my two young colleagues and gave them the details of the case in hand. “I can’t delay the departure of my patient,” I said to Drs Muchemi and Agada. “Can we hasten the arrival of his baby?”
“Provided the parents are told of the risks and agree,” Susan, who was acquainted with the two main characters in the drama, replied.
“I can only involve one—the mother. For obvious reasons, I can’t include the father,” I replied.
We all talked to Janet and she jumped at the idea. “Nothing will make me happier than delivering our child earlier for Robin to see. It might even prolong his life,” she added.
When Dr Muchemi, Dr Agada and I took Robin to see the newborn in the “prem” unit, he kept on repeating: “I knew it was a girl and seeing her now, she looks the spit image of my mother.”
He couldn’t take his eyes off his own flesh and blood. When we took him back to the maternity wing where his wife was, he said to her: “Thank you for bringing my mum back. Let’s call her Beryl after her.”
Two days later, Robin slipped away in his sleep, the smile of a new father still lingering on his happy face.