part0022

Stella and Leo, Kate’s parents, were fully enmeshed with their daughters’ lives. Their eldest, Miriam, had married and moved to the West Coast, where she was a loving, Jewish daughter with a three-hour time change and a costly flight separation from her parents. Kate’s younger sister, Jenny, moved out when she started college, and for the past two years had been teaching English in Japan. This left Kate in the role of the “family daughter.„

Growing up with Stella and Leo could not have been easy. Their marriage was fraught with discord. Stella found Leo’s difficulty in communicating frustrating but understandable. His frequent visits to the casino or to the race track, where he spent more than the family could afford, fueled arguments. While as small business owners the family never really suffered, it was financially tighter than it should have been. It was hard for Stella to be too upset with Leo’s lack of communication. Leo was a child of the Holocaust. His parents lived in France during the rise of Nazism. When the inevitable became apparent, they arranged to have Leo hidden as a Catholic student in a boarding school in France. As a young boy of 12, Leo never saw his parents or any other member of his family again. Leo rarely talked about this part of his life. Only in the last five years had he begun to let his family into this portion of his history, and this was only because his life had started to unravel.

Five years ago, Leo and Stella both confronted death head-on. Leo had a successful resection of his colon due to cancer at the same time that Stella was diagnosed with breast cancer. In the light of their threatening illnesses, together they started to peer more deeply into themselves and their family life. They attended couple therapy and were somewhat successful at beginning to diffuse the major problems in their relationship, but the entanglement with their children’s lives, and in particular, Kate’s, remained.

While both of Kate’s parents were battling cancer, Kate and Sam, her husband, became pregnant with their first child. Sam was a solid rock in Kate’s life. She had managed to marry the opposite of her parents, and as a couple they were very happy. While Sam did not always appreciate the involvement of his in-laws, he was benignly tolerant of them. The pregnancy was a happy event for the family and provided a buttress against the fear and anxiety of the cancer. Stella attended most of the prenatal appointments with her daughter and was present at her grandson’s delivery. Baby Ayden’s safe arrival brought joy to a family engulfed by worry. Stella and Leo continued to do well in couple therapy, and they both went into remission. Stella finally admitted to a depression provoked in part by her breast cancer and started medication.

As Ayden grew into a delightful toddler, Kate and Sam planned their second child. Kate’s period was late, and an early ultrasound for nuchal translucency revealed a spontaneous miscarriage. Kate recovered well from the D and C, but when six months later, an anticipated pregnancy had not occurred, she became anxious. Kate had a profound sense of her own personal timetable that was not dependent on nature’s agenda. Finally, a third pregnancy materialized.

All went well into Kate’s pregnancy, and Stella and Leo were delighted because Miriam, their daughter out West, was also due around the same time. Miriam’s pregnancy was of some concern, as increased levels of fluid were building up around the baby and an early delivery was planned. Fortunately, the baby was just fine. Stella and Leo travelled to help Miriam with their new grandchild when Kate was 32 weeks pregnant. When Kate appeared for her office visit the day after her parents left for Miriam’s, the physician could not detect a fetal heartbeat. An ultrasound confirmed the horrific news. Kate and Sam’s baby would be stillborn.

As with all stillbirths, the delivery was a sad event. The delivery itself was easy. Sam and Kate chose not to look at the baby or even know its gender. The baby was buried as per Jewish custom. Kate and Sam remarked at the time that this was in some ways a positive experience for them, as it was the first time they had had to deal with a crisis as a couple. With Kate’s parents conveniently away, they felt closer together than before. Medical workup of the still birth suggested antiphospholipid antibody syndrome as a cause, and everyone felt better that at least in this case there was a reason for the poor outcome.

Six months passed after the stillbirth, and Kate became anxious about not conceiving. Kate felt strongly that she could not grieve her stillbirth until she had a new baby in her arms. She implored her perinatalogist for help. Kate was given Clomid, and a triplet pregnancy resulted. On the advice of a new perinatalogist, the pregnancy was reduced to a twin pregnancy. At 18 weeks, Kate started to spot, and despite a short course of bed rest, she delivered her two 18-week-old sons into the toilet at home. The entire family was devastated .

As if things could not get worse, Kate’s benign intracranial hypertension, dormant for years, reactivated. Kate mourned the loss of her twins and started again the intensive follow-up to ensure that the increased pressures in her brain did not lead to blindness. Kate agreed to postpone another pregnancy for at least a year. During that year her coagulation disorder stabilized and her benign intracranial hypertension resolved. As Ayden got older, Kate worried about his lack of a sibling, but used the year to get her life back in order. She and Sam even discussed the possibility of no more children. Kate started to make peace with the idea that she had to give up her agenda and accept the lack of control that she had on the events that surrounded her. But Stella and Leo continued to fret over Kate’s health.

Finally, Kate became pregnant. The new perinatalogist agreed to follow and deliver the baby. The hematologist gave clearance for Kate to use heparin during pregnancy to reduce the chance of a recurrent loss, and the neurologist gave a clean bill of health regarding her cerebral hypertension. Kate had lost her job due to company downsizing, but the couple took this as a positive sign because she was able to easily attend all of the medical appointments necessitated by her high-risk pregnancy. Kate successfully resisted her mother’s attempts to accompany her on these visits. Instead, Sam was at Kate’s side. Stella and Leo remained well, and Stella continued her antidepressants, fearing a relapse in the context of her anxiety about Kate’s pregnancy and her overall health. To everyone’s delight, baby Jade arrived safely and in perfect condition.

As Kate has reflected on events, she feels that she needed to go through all of this to get where she is today. She and Sam delight in their daughter and in their completed family. She has been able to mourn and to let go of her previous losses as well as move forward from an enmeshed relationship with her parents. While she certainly hopes that this is the end of her losses for now, she feels in her own words, “I am ready for whatever life may throw at me!„