She came to see me, alongside her husband. She was 26 years old, diagnosed with metastatic myeloma involving her bones, which had presented when she fractured her hip while jogging. Her disease had progressed on treatment and she was to start a clinical trial. Despite being pale, she looked well. I imagined she often heard, “Wow—you look too good to have cancer.”
She had been referred for issues related to sexual health. After telling her about the Oncology Sexual Health Clinic and my own practice, I asked, “What can I help you with today?”
"Well," she started, then stopped. She looked at her husband, as if to ensure they were on the same page before continuing. "I want to have a baby. I'd like to be a mom before I die."
I was not prepared for her question. My first reaction was visceral: “Was she serious? How can someone facing death be so unrealistic, even selfish? Why would you want to bring a child into this world knowing you will not be there?” I consciously tried not to convey this guttural feeling, hoping my external appearance did not betray me.
Before moving on, I tried to put myself in her shoes, see her side. It was evident by how she and her husband interacted that they had dreams—of marriage, family, and a home with a white picket fence. Even as they confronted metastatic disease, they were still trying hard to realize them, and they were not willing to abandon them.
“Tell me more about that.” I asked, and we proceeded to talk about her desires in earnest. This couple made me realize, once more, how horrible the disruption a serious and life-threatening illness is. Beyond the physical and emotional issues experienced by the one undergoing treatment, illness disrupts wishes and dreams, creating obstacles that seem insurmountable, and affecting those closest. While I came to understand what motivated her to become a mother, I could not help but think of the future life of the child yet to be born. That child would likely grow up never knowing his or her mom, and in essence, would be robbed of part of the very love that ushered him or her into this world.
I reached out to my colleague, Dr. Mary Sabatini, about this case. Dr. Sabatini is a fertility specialist who has become our resource for fertility and pregnancy at the MGH Cancer Center. I half-assumed she would respond to this case as I did—think it was not realistic for this patient to pursue parenthood, let alone pregnancy. Instead, Dr. Sabatini wanted to hear more about her, her husband, and their relationship.
"Well, from what you've told me, carrying her own child is not an option. Even if her ovaries were working after all of her treatment, she wouldn't be able to carry a pregnancy. But, there are other ways to become a parent."
I was a bit shocked that Dr. Sabatini entertained the discussion as "reasonable" and wanted to learn more about how she was approaching this issue. Here is what she told me, in her own words:
Despite my chosen profession, I have never been quite sure why people want to have children. As a scientist, I had previously assumed that it is a natural instinct that ensures continuation of an adaptable species.
In society, this desire is commonly considered “selfish” despite the fact that becoming a parent means putting aside most of the pursuits one had prior to having a child. On the other hand, I have also heard the argument that being childless is a selfish act because one is unable to put aside their concerns and interests long enough to contribute to our collective future. Whether becoming a parent is selfish or selfless is debatable, however, it is clear that, for those who want children, the intensity of that hope is unrivaled.
I don’t think it ever occurred to me when I started in OB/GYN as a resident that I would be able to glimpse at all into the nature of the “meaning” of being a parent in ways that I do now. I remember back to my first days of doing obstetrics. I had a new patient who had an unplanned pregnancy. She was considering termination and had made an appointment with the Family Planning clinic a few days prior to this, her first OB appointment. While I did not discuss whether or not she wanted to keep the pregnancy, I handed her a list of reading for newly pregnant women at the end of the visit. She looked it over and began to cry. I asked her what was wrong and she said “nothing.”
At our second visit she told me how here initial response to being pregnant was horror. With time, she became more ambivalent about it, and now had decided to “keep the pregnancy,” despite the fact that she was in school and had started a new job. She had looked over the list of reading materials I had given her; when she saw the final selection entitled, “When saying hello means saying goodbye,” she was overwhelmed by sadness at the thought that something about the pregnancy may not go “right.”
Ultimately she delivered a healthy baby boy. At her postpartum visit, she told me that she had called her mother shortly after delivery, told her she loved her as much as any daughter could possibly love her mother. She also told her mom how she had come to realize that her mother loved her more than she could even imagine, and that in turn, she would always love her son more than he could ever love her back.
“That’s what it means to be a mom,” she said.
Until recent times, there were only two ways to parent—you either had a biological child or you adopted. Today there are alternative approaches such as adoption or using eggs or sperm that have been donated to those in need and sometimes we parent to people who are in need. No matter how families are created, the fulfillment, love, and promise can be the same because there is so much more to parenting that passing along genetic information. It is that intangible part of ourselves that gets passed from one person to another that makes us a parent: our smile, our laughs, our temperament, mannerisms, and our thoughts and values.
The story came full circle to me recently when I visited my father who is in need of round-the-clock physical care. My brother is with him and is currently his caretaker. Despite his physical decline my father’s biggest trouble is “not feeling needed,” feeling as if he can contribute nothing to someone’s growth and well being. In short, I thought, he feels he has lost his status as a parent. I reminded him that he is still a parent to his children but that he is fulfilling different needs for us than in the past. He is profoundly needed. Recently, he, as a disabled veteran, started providing counseling via Skype to returning veterans. He is once again “needed” and gets up with a new sense of purpose.
Following my discussion with Dr. Sabatini, I understood that the desire to be a parent is an individualized one, motivated by so many different factors, and not easily abandoned, whether by issues of infertility, illness, or age. As clinicians, all we can do is provide information to the best of our ability, offer honest opinions when asked, and support our patients and the decisions they make. Regardless of whether or not my patient and her husband proceed in the process of becoming a parent, both Mary and I hoped that they left our office more informed about their options and more supported in whatever decisions they made, especially in light of the difficult journey she was already traveling.
NOTE: Specific details of patients mentioned in this piece were changed to ensure that anonymity was preserved.