There is a time and a season for everything: a time to be born and a time to die. In between are the seasons of life. When the time to be born and time to die are juxtaposed and intertwined, the circle of life is even more evident. The fragility of life is palpable. I experienced the profound, yet commonplace paradox for many women in medicine: caring for the dying while pregnant. I was pregnant as a pediatric-oncology fellow and a palliative care attending. Each time, the hopefulness of new life in the midst of dark illness impacted all involved, shifting focus to the here and now. It brought out what psychology calls interpersonal therapy, for the clinician, patient, and patient’s families.
Anticipating the death of one and the birth of another connects the clinician and patient’s family. We weep and rejoice together authentically. Other emotions emerge too, like anger. One mother wished that my child would never go through what her child was going through in the NICU. While it sounds loving, the tone was harsh. It cut deeply. My heart broke for her. As I always did, I listened. I shared how I wished her son and her family were not going through this horrifying journey. With great empathy, I questioned if it was good for a pregnant person to be near the dying.
In my palliative care oncology research, I learned that it could be beneficial. Serendipitously, the first patient to enroll in my study had a birthday on my child’s due date. The family was celebratory for both of us, while also acknowledging their child’s poor prognosis. Every time I met with them, they asked about how my pregnancy was going and expressed their anticipation of my child’s delivery with their child’s birthday.
Another mother had conflicting feelings. While her child was dying from a brain tumor, she confided in me that she terminated a pregnancy recently, sharing that she could not handle the care of a newborn and a dying child. She was now struggling with the loss of one child and the anticipatory loss of another. The pain in her eyes was real. It hurt thinking that my pregnancy reminded her of the losses in her life.
Patients and their families were comforting to me. Parents would impart parental wisdom, ranging from caring for well children, sick children, and deep insights on marriage and family. One mother shared her great love for all children. She asked her dying child to speak to the growing life inside me. When the child spoke, my unborn child kicked hard and seemed to jump inside. The touching communication brought smiles all around.
Pregnancy made me a unique and identifiable doctor, except to one patient who had significant encephalopathy. This young adult routinely said when I introduced myself, “Excuse me, ma’am. I don’t want to be disrespectful, but are you expecting?” It became the litmus test of how the young adult was doing that day, and also brought some humor to my day.
Joyful tears can quickly change to sorrowful tears. To keep from getting too low, I realized I needed boundaries during my second pregnancy. I requested to not see fetal medicine patients. I could not bring myself to go into that space, knowing the depth of desire the families had for the child who was being diagnosed with a life-limiting illness. It was too close to home for me to provide the empathy needed at that time.
When my due dates drew near, saying goodbye was often final. The paradox of having to tell a mother her child relapsed with a progressive brain tumor on my way to the delivery room highlights this challenge. However, I had to be a good mom. I had to let other excellent medical providers care for my patients and their families while I did what they encouraged me to do: be a mom.
Family importance shifted for me after each maternity leave, especially as my daughter’s voice became clear and my son would crawl to me, hold his hands up, and cry as I was leaving out the door. At a young age, children see separation as death. I shared with them my love, and recognized, all too dearly, the brevity of life.
I have consequently pulled back on my days at work. This has been so helpful for my family and patients. I have balance. I can connect with other moms over pumping, food parenting, sleep, etc. I can also be present for my children.
As a pregnant palliative care researcher or doctor, I learned an unwritten education, one of growing fortitude and comfort in being present with others. I have learned to cling to the transcendent rather than the transient.
If you practiced while pregnant, how did you see your pregnancy affect your patients? Share your stories in the comments.
Dr. Lanzel is a pediatric hematologist-oncologist and palliative care provider. She is the mother of two young children. She enjoys caring for patients, their families, and her own family.
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