Update on "Mary"

Mary came into the office last week for her first offical prenatal appointment. That's the one we schedule at 12 weeks (give or take), right at the end of the first trimester. The reason this date was particularly significant for Mary was because the great majority of miscarriages happen before the end of the first trimester. She was past the first hurdle.

Her cone biopsy was 6 weeks ago. The margins were clear (i.e. they got all the cancer on her cervix). She hasn't had any bleeding or cramping, and has been feeling increasingly pregnant.

There are still more hurdles to overcome. She might end up with an 'incompetent cervix', which is a cervix that is unable to support a pregnancy to term. She is at high risk of preterm labour. There's no predicting how her cervix may respond to the weight of the growing fetus. She has opted to have a c-section to be scheduled a few weeks before her due date on the advice of the oncologist.

But we found the heart rate with the doppler. Mary's face softened as she heard the strong heart tapping away at a perfectly normal 155 beats per minute. She had already admitted to be that due to their reluctance to get too hopeful, her and her husband hadn't really let themselves get attached to this growing baby inside of her.

I asked her if she'd like an ultrasound. There isn't really a medically indicated reason for one at this time-- it's a bit late for a dating ultrasound, and far too early for one to check the fetal anatomy or the position of the placenta. But I thought she needed one for her own well-being... not just to confirm that all was well, but I secretly hoped that if her and her husband actually got to SEE this little miracle, they'd let themselves get excited about it. As though seeing it on a screen would make it real. She accepted.

So far, so good. In the words of Mary herself... cautious optimism.

Sometimes, life just isn't fair.

There is a patient in the family practice where I work-- I'll call her Mary, since it's the most normal name I can think of right now. Her and her husband have been trying to get pregnant for several years. They are both in their early 30's.

(As an aside, I can't believe how many young, healthy people suffer from infertility these days... until about five years ago, I figured that anyone who pulled the goalie would inevitably get pregnant within a few months. Has getting pregnant gotten a lot harder in recent years or is this just another subject upon which I've apparently been burying my head in the sand?)

So back to my story. So Mary and her husband have been trying to get pregnant. A lot. They've both been investigated, and neither of them has any physical reason preventing them from conceiving. So they're still trying.

A few months ago, at a routine physical, Mary has an abnormal pap. Not "Oh-My-God" abnormal, just "Hmmm" abnormal. So she gets sent to the gynecologist for colposcopy (where they take a microscope of sorts and take a closer look at the pathology in question). She tells the gyne that they're trying to have a baby, and asks if they should put their efforts on hold while this whole cervix thing is being investigated. He poo-poo's her concerns, and tells her that 99.9% of the time this kind of thing turns out to be nothing.

Not so much.

Invasive cervical cancer. The good news? Largely curable with a cone biopsy of the cervix. But only if it's done right away, before the cancer has a chance to spread to the uterus. Because if it spreads, then she'd need a hysterectomy and any chance of biological kidlets would be gone. So pretty straightforward, eh? Send poor Mary for a cone biopsy!

But oops. Mary hasn't had her period since mid-December. Mary is pregnant with the desperately wanted baby that they've been trying so hard to conceive.

What a horrible situation. She could still opt for the cone biopsy ASAP, knowing that it could compromise the integrity of her cervix and put the pregnancy at risk. Or, she could hold off until after the risky first 12-15 weeks (when most miscarriages occur) and have the cone biopsy done then, knowing that there's no way to tell if the cancer would have spread to the uterus in that time frame. Or, she could opt not to have it treated at all until she gave birth, but the pathology showed a cell type aggressive enough to think that this option may put both her life AND the baby at risk.

My heart was breaking for Mary and the decision that she had to make.

In the end, she opted for what I would have done under the same circumstances. She opted for the cone biopsy. She had it done two weeks ago. So far, so good. But when I saw her today and asked her about her pregnancy, she said she hadn't thought about it... she was scared to death to grow attached to the little being inside of her, knowing that there was a good chance it would never see the light of day.

I don't know about you, but I'm crossing all of my fingers for her.