Parenting and the Feelings of Helplessness
Sometimes we identify too much with our patients and our advice becomes too personal.
Years later, I now wonder if I overstepped my boundaries.
Nancy was a pleasure to have as a patient. A physician's assistant in her early twenties, we often chatted amiably during visits. Our conversations ambled randomly between personal and professional topics. She had recently married and was looking forward to having children. However, her gynecologic history was complicated. After months of unsuccessful attempts to get pregnant, she consulted a local infertility specialist.
Although the workup was completely normal, one of her blood tests, while technically in range, was deemed to be "subpar." Her obstetrician sent me a letter asking if I would monitor her levels and adjust her medications accordingly. Appointments were made, labs were drawn and, a few months later, a pregnancy test came back positive.
Nancy was overjoyed. Every so often, I would receive a note from her gynecologist, documenting her progress. Ultrasounds were normal. A litany of screening tests uncovered no abnormalities. Everything was perfect. Or so I thought.
One morning, I was surprised to find Nancy sitting in my exam room on the verge of tears. Her gynecologist was struggling with her levels. Her previously "subpar" blood test was closer to normal range, but still had not met the magic number that her infertility specialist decreed was optimal. With skills honed from her medical education and training, Nancy had searched out a bevy of papers that suggested a correlation between low-normal values and poor pregnancy outcomes. Thirty weeks into gestation, she was now sure that she was in crisis.
While I was unconvinced by the tenuous connection, after reading the literature that Nancy had produced for me, I couldn't help feeling a lightning bolt of unease jolt through my own insides. How many times had I struggled over similar fears with my own children? How many times had I agonized over my little ones? Give vitamins or not? Treat with antibiotics or wait a bit longer? Every decision was dissected and second guessed, each time feeling so sure that my failure to decide correctly would mar my child for life.
Feeling tears of empathy glisten in my eyes, I explained to Nancy that having a child feels like ripping your chest open, leaving your heart exposed and unprotected. I told her that to procreate was to feel an uncertainty and helplessness unmatched by any other human experience, that she will try to control almost every part of her baby's existence — and that she will fail over and over again. And yet, most likely, despite all her failures, her child will be more perfect than she ever imagined. I told Nancy that she was experiencing the first pangs of parenthood.
We decided on a treatment plan. We scheduled a follow up visit for one week later. And then she left the office.
I never saw Nancy again. She cancelled all future appointments.