Woman’s miracle pregnancy after two courses of chemo

Both our daughter and son kept us waiting for a while before giving us our first grandchild. Naturally, Marie was concerned and complained often about it.

Irked by her persistent lament, one day when she raised the subject again, I told her: “If you want children of your own, I can help you, but for grandchildren, I feel helpless and we just have to wait until they decide to produce one!”

This spontaneous remark reminded me obliquely of what Phyllis, my patient, said when I told her that chemotherapy, which was indicated for her Hodgkin’s Lymphoma, was likely to knock out her ovaries and render her infertile, when she replied: “It will be a bigger blow to my parents because I am their only child, and they are looking forward to a houseful of grandchildren.”

Phyllis came to see me a few years back with a small lump above her left collar-bone and she said, “Being painless, I didn’t bother about it until my mum noticed it and insisted that I should see our family doctor immediately. I work as a marketing manager for an international tour company,” Phyllis went on, “and was due to go to Germany to boost our tourist trade. I told mum that I would see our GP on my return but my she insisted that I see her before I flew to Berlin. Just as well, I listened to my mum for once,” Phyllis added with a grin on her face, “because as soon as Dr Waswa saw this lump, her face dropped. She diagnosed it as an enlarged gland and advised that I see youmara moja.When I told her that I needed to fly to Berlin, to make sure that I saw you before I flew, she rang your secretary and made an urgent appointment for me to see you.”

“Wise girl,” I remarked as I felt the lump after obtaining relevant history from Phyllis. “It’s a long shot but this gland clinically looks like Hodgkin’s Lymphoma.”

“What’s that?” Asked Phyllis and added as an afterthought. “Please be frank because I can take it.”

I had heard that spurious claim before but I decided to be brutally frank with this brave looking 25-year-old girl. “It is a primary cancer of lymph glands.” I replied. “I am emphasising the term ‘primary’ because as you know lymph glands are secondarily involved in various cancers.”

Looking at her puzzled face at the unsolicited extra information, I went on: “To give you a common example, in cancer of the breast, often, the glands in the armpits are involved and enlarged.”

“How do we prove your clinical diagnosis?” She asked.

“By removing the gland and sending it for histology.” I clarified.

Phyllis agreed readily and I removed the gland under local anaesthesia in the ‘minor’ theatre and sent it for histology. “The pathologist usually takes four days,” I said while writing a prescription for pain-killers. “So can you make an appointment with my secretary to see me in one week’s time as you go out?”

On her next visit, Phyllis was accompanied by her parents, provoking me to say, “I see that you have brought your moral support with you this time. Just as well, because the pathologist’s report confirms my clinical diagnosis.”

TREATMENT

After a long question and answer session, in which the parents, mainly held the floor, we embarked on the discussion about the treatment, when I said. “Being a generalised disease, it needs a generalised treatment, which is administration of chemotherapy drugs. Looking at their raised eyebrows, I elaborated.

“As you know, we have glands in various parts of the body, like the armpits, groins, the neck, including above the collar-bone, also inside the chest and abdomen. I am pretty sure that Phyllis has Hodgkin’s in some or all these glands, a fact I will verify by CT scans of these regions. We will eventually end up with chemotherapy once those routine investigations are done.”

“I have heard horrible things about chemotherapy.” Phyllis lamented.

“We can obviate most of them by giving you additional drugs, but in your case, the serious file:///C:/Users/anini/Downloads/SURGE08-07.jpg consequence will be that chemotherapy drugs will knock your ovaries out and will render you infertile.” I gave this warning because the idea of removing ovaries before chemo and re-implanting them after their ill effects had worn off had not been researched yet.

That is when Phyllis said, side-glancing at her parents, “It is indeed a shock to me but a bigger shock to my parents, who are looking forward to a houseful of grand-children, since I am their only child.”

“Never mind the grandchildren, what’s the outlook for our only daughter?” Phyllis’ mother asked.

“The prognosis is quite good because we have now developed newer and more effective drugs.” I replied. It was agreed all round that Phyllis would start her first chemotherapy course immediately on her return from Berlin, a trip lasting no more than one week.

Dr Okach gave Phyllis six courses of the newest chemotherapy drugs and declared her in remission. When she came to see me after the course was completed, she looked very happy and her opening remark was. “I am flying to New York next week because we are soon starting direct flights from USA to Nairobi and my job is to develop a market there for the Americans to enjoy our beautiful beaches and unique game parks.”

“Good luck,” I said after checking that she was disease-free.

“I also want to tell you that I have met a nice young man and I have started a relationship with him.” She added with a blush on her face. “In view of what you told me about chemo rendering me infertile, do we need to take any precautions?” I took a little time to respond to this surprise announcement and frank, unusual inquiry.

“Because we get surprises occasionally, I think that you should take precautions until you are ready for a commitment.”

A fortnight later I was woken up in the middle of the night by a shrill ring of my mobile. “Excuse me for disturbing you at whatever time it is at home.” I recognised the distressed voice of Phyllis. “I am slightly disoriented because I have just come out of the oncologist’s office and he told me that I have got a recurrence of my disease in my chest. He wants me to start a course of chemotherapy to subdue glands in my chest.”

“Please get your bearings and tell me how you ended up with an oncologist.” I said, still in a daze.

“A week after I arrived here, I developed a cough for which I saw our company doctor. When he heard my story, he referred me to an oncologist, who after seeing CT scan of my chest broke the shocking news. He told me I could have the chemo in Nairobi.”

“Take the first flight home and let us sort out your problem.” I advised.

A MIRACLE

On her return, Dr Okach and I saw Phyllis together and the CT scan of her chest taken in New York. We agreed with the diagnosis and Dr Okach said. “A bit unusual so soon after completion of a course of CT but I agree with the oncologist that you need a course of a different chemotherapy, specifically focussing on glands in the chest.”

“This is exactly what Dr Wilkinson, the oncologist said.” Phyllis reported.

My contribution at that consultation was to repeat my warning to Phyllis. “I am sorry that if your ovaries were not flogged by the first course of chemo, the second course makes motherhood in your case a pipe dream.”

Despite that warning, which I had to give for medico-legal reason, I was glad to see that Phyllis started her second course, without any delay. I received regular reports about her progress but midway through the course, Dr Okach said to me in the coffee room.

“Phyllis is complaining of lower abdominal pain and I was thinking of sending her to you for a review.”

“Please do.” I replied nonchalantly.

I asked Phyllis only one question when she came for the review. “When was your last period?”

She replied. “They disappeared after the first course of chemo and in view of what you had told me, I didn’t worry about it.”

“I can’t find anything to explain your pain, but let’s do an ultra-sound and see what it shows.” I was suspecting glands in the pelvis.

I rang the radiologist and she said. “Send her right away. A booked case has failed to turn up.”

“I will bring her myself and have coffee with you.” I replied.

While the radiologist was applying cream on Phyllis’ abdomen, she whispered. “There are no enlarged glands as you are suspecting.” Then excitedly she added. “But I see a three-month-old pregnancy in that pelvis.”

“This is a miracle!” I said with equal excitement. “I haven’t seen a pregnancy after two courses of chemotherapy.” Turning to Phyllis, who was lying on the ultra-sound couch I asked. “Is that possible?”

“Not possible but very probable,” she replied. “After what you told me before I started the second course of chemo, we decided to throw away condoms and pills.”

“Just as well you told me,” I replied,” because I was going to label this the second immaculate conception and a miracle.”

The last word came from the radiologist, who after looking at her desk calendar said. “Judging by the duration of the pregnancy, it will still be a miracle and a Christmas baby!”