Michael C. Lu, MD, MPH
Director of UCLA preconception care clinic
the greatest gift of all
My patient Paula taught me what heroism is all about.
One Sunday afternoon when I was away, I got a call from Paula.
“Michael, you’ve got to help me,” she said, sounding distressed.
“What’s going on?” I asked.
I’ve known Paula for a long time. She is a dear colleague and friend of mine. I had delivered her son J.J. three years before.
“I’m in the hospital,” she said. “I have severe preeclampsia and they want to do a c-section right away.”
At the time Paula was only 27 weeks pregnant with her second child. A baby born this premature can have a lot of long-term health problems and disabilities, including cerebral palsy and mental retardation. There was even a chance that a baby born this early might not survive.
“I don’t want a c-section right now,” Paula pleaded. “The baby is too premature.”
I called the perinatologist on-call. Paula’s preeclampsia was indeed very severe. Preeclampsia is a disease of pregnancy in which blood pressure goes up so high that it begins to cause damage to the body’s vital organs. The diagnosis is made with a blood pressure above 140 (systolic) over 90 (diastolic). Paula came in with a blood pressure of 180 over 110.
Of course, all the talk about an immediate c-section didn’t help the matter. She freaked out and her blood pressure shot up to 210 over 140. The perinatologist on-call wanted to do a c-section right away, but Paula refused. The perinatologist pleaded with me to talk some sense into Paula so she would accept a c-section.
I called Paula back. “Paula, we’ve got a problem.” I explained to her what could happen with a blood pressure this high. At 210/140, her brain could bleed and herniate. Her liver could rupture. Her kidneys could go into failure. Preeclampsia is an awful disease to get; it is a ticking time bomb. Preeclampsia is a leading cause of maternal death in the United States and around the world. It accounts for nearly 20 percent of all maternal deaths in the United States. I’ve seen four maternal deaths in my career; one of them was due to preeclampsia.
But I didn’t have to tell Paula all this. She was a doctor and knew preeclampsia only too well. She knew that her health, and possibly her life, was in jeopardy, but Paula wasn’t thinking about her own life. She was thinking about her baby—about the baby’s survival, and the possibility of a lifetime of health problems and disabilities from being born so premature.
Since I was coming back later that day, Paula and the perinatologist agreed to hold off the c-section until I returned. As soon as I got back to L.A., I went into the hospital to talk to Paula. After reviewing her vital signs and lab results, I walked into her room.
“I am so glad to see you,” Paula greeted me, a bit groggy from the magnesium infusion she was getting to prevent an eclamptic seizure.
I gave Paula a hug, sat down, and we talked for the next hour.
Walking into the room, I had already made up my mind what I was going to do. I was going to try to talk Paula into agreeing to an immediate c-section because the cure for preeclampsia is delivery of the baby and the placenta. Preeclampsia is a disease of the placenta. The placenta sends chemical messengers into the bloodstream (that’s why the disease used to be called “toxemia”—toxins in the blood) that initiate a cascade of biochemical reactions that can constrict and damage blood vessels, thereby causing high blood pressure. Impaired blood flow causes damage to the body’s vital organs, which can become permanent and irreversible if delivery is delayed for too long. Once the placenta is delivered, the disease process quickly reverses itself and the patient is cured. I was anxious to do the c-section because I took care of a patient who later died from severe preeclampsia during my residency training, and I didn’t want that to happen to my dear colleague and friend. Not under my watch.
By the time I walked out of Paula’s room, however, I had changed my mind. Instead of talking Paula into an immediate c-section, she talked me into waiting. What changed my mind?
Paula and I talked about a lot of things that day, but one thing she said really stood out in my mind.
“You would jump in front of an on-coming train to save Sasha if you had to, wouldn’t you?” Paula asked me. Sasha is my daughter. She and her younger sister Avery and my wife Jessie are the loves of my life. “Of course I would,” I answered. “Preelampsia is that on-coming train,” Paula said. “And I’m jumping in front of that train to save my baby.”
I will never forget that moment. There was an eerie calmness in Paula’s voice, the same kind of calmness that I’ve heard from patients with terminal cancer who’ve come to accept their imminent death. The magnesium hadn’t clouded her head; Paula knew exactly what she was doing. She knew she could go into kidney failure, her liver could rupture and her brain could herniate; there was even a chance she could die. But Paula was going to stare down the on-coming train for as long as she could. At 27 weeks, every day gained for the baby was a victory.
It became clear to me what I had to do. As Paula’s obstetrician my job was to push her out of the way of the on-coming train right before the train was about to hit her. Paula’s lood pressure had come down to 160 over 100 with blood pressure medications, which was still high, but in a range where I felt it was safe to wait. So I called off the c-section that day.
Paula’s pregnancy lasted another 21 days. She stayed in the hospital the entire three weeks. I monitored her vital signs and labs closely. We waited nervously for the on-coming train. We went from day to day, celebrating each day gained as a victory for the baby.
At 30 weeks, I heard bells and whistles coming loud and clear around the corner. Paula’s preeclampsia was worsening. Her kidneys started failing, and her blood pressure was getting out of control despite being maxed out on multiple blood pressure medications. So we went ahead with the c-section.
Paula delivered a baby girl weighing 2 1⁄2 pounds. Her blood pressure returned to normal within a few weeks of delivery, and her beautiful baby girl did remarkably well in the NICU and is completely healthy today, thanks in large part to those three extra weeks her mommy bartered with her own life and health.
“Giving birth is definitely a heroic deed,” Joseph Campbell wrote in the Power of Myth, “in that it is the giving over of oneself to the life of another.”
What Paula did was nothing short of heroic; it was an extraordinary act of self-sacrifice. As a doctor, Paula knew very well what she was doing. She chose to risk her own life for the health of her baby. But for Paula, this was no heroism. This was something that any mother would have done for her baby.
For the dads-to-be who are reading this book, some of you might have seen the movie John Q that came out in 2002. It was a cheesy movie, but it struck a chord deep within me as a dad. The story line is about a down-on-his-luck father (played by Denzel Washington) whose HMO insurance won’t cover his son’s heart transplant. He takes the hospital’s emergency room hostage until the doctors agree to perform theoperation. What about the heart? Where was he going to get a donor heart? It turned out that he was a match for his son, and so he was going to take his own life so that his son could have his heart. This is the stuff that makes great Hollywood melodrama, but there was something veryreal about it. This was something that any father would have done for his child. I’d gladly give my heart to Sasha or Avery if it means saving her life.
Most of us would jump in front of a train to save our kids. And most of us would readily give our hearts to our children so they could live. We’d give anything for their health. The good news is, as parents, you can give them good health. Not all of you can give your children a trust fund or down payment on their first house or a car for their sixteenth birthday, but all of you can give them the gift of health, which is worth more than any of these other gifts combined. Next to life, health is the greatest gift you can give your children.
