Sunday, February 1, 2015

Baby saves mother's life

A friend at church this morning gave me this article. It was written by her brother-in-law, Dr. J.A. MacDougall who was an anesthestist at St. Martha's Hospital in Antigonish, Nova Scotia. `

That December, I finally had to tell her. Medically, we were beaten. The decision lay with God. She took it quietly, lying there, wasting away, only 23, and the mother of a year-old child. I will call her Eleanor Munro. She was a devout and courageous woman. She had red hair and had probably been rather pretty, but it was hard to tell anymore; she was that near to death from tuberculosis. Now that she knew it, she asked just one thing.
"If I'm still alive on Christmas Eve" she said slowly, "I would like your promise that I can go home for Christmas."
It disturbed me, I knew she shouldn't go. The lower lobe of her right lung had a growing tuberculous cavity in it, roughly 2 1/2 centimetres in diameter. She had what we doctors call open TB, and could spread the germs by coughing. But I made the promise and, frankly, I did so because I was sure she'd be dead before Christmas Eve. Under the circumstances, it seemed little enough to do. And if I hadn't made the promise, I wouldn't be telling this story now. 
Eleanor's husband had the disease when he returned to Nova Scotia from overseas service in World War II. It was a mild case and he didn't know he had it. Before it was detected and checked, they married. She caught the disease and had little immunity against it. It came on so fast and lodged in such a difficult place that it confounded every doctor who tried to help her.
To have a tuberculous cavity in the lower lobe is rare. When they took Eleanor to the provincial sanitarium in Kentville, it became obvious that the main problem was how to get at it. If it had been in the upper lobe, they could have performed thoracoplasty, which involves taking out some of the upper ribs to collapse the lobe and put that area of the lung at rest.  Unfortunately, this operation couldn't be used for the lower lobe because it would have meant removing some of the lower ribs, which her body needed for support.
With thorocoplasty ruled out, the doctors tried a process called artificial pneumothorax: Air was pumped in through a needle to force collapse of the lung through pressure. Although several attempts were made, this process didn't work either; previous bouts of pleurisy had stuck the lung to the chest wall, and the air couldn't circulate.
Finally they considered taking out the entire lung - but rejected this procedure (rare at the time) because Eleanor was too sick to withstand surgery, and steadily getting worse. The alternatives exhausted, Eleanor's doctors reluctantly listed her as a hopeless case and sent her back to her home hospital in Antigonish.
I was 30 when she arrived. I had graduated from Dalhousie University's medical school in 1942, gone into the Royal Canadian Air Force, and then completed my training as an anesthetist in Montreal once the war was over. A native of Sydney, N.S., I accepted a position with St. Martha's Hospital in Antigonish. I was to provide an anesthesia service and take care of the medical needs of the students at two local colleges. I was also asked to look after the TB annex at the hospital, a place for about 40 patients, most of them chronics with little or no hope of being cured. That's how Eleanor Munro came to be my patient in 1947. 
She had weighted 125 pounds. She was down to 87 the first time I saw her. Her fever was high, around 39 degrees. She was very ill, and looked it. But she could still smile. I'll always remember that. If you did her the slightest kindness, she'd smile.
Maybe that encouraged me. I don't know. But I did know that I had to try to help her. I phoned a doctor in New York who was experimenting with a procedure called pneumoperitoneum.
This procedure consists of injecting air into the peritoneal cavity  to push the diaphragm up against the lung. If we could get pressure against that lower lobe, we might force the TB cavity shut. If we could do that, nature would have a chance to heal the cavity by letting the sides grow together.
The operation took place the day after my phone call. We pumped air into the peritoneal cavity, but it nearly killed her. It was obvious that the amount of air she could tolerate would not help.
Every doctor in the room agreed we shouldn't try a second time. We were licked.
It was then that I told her medical science had gone as far as it could go. I told her that her Creator now had the final verdict and that it would not necessarily be what either of us wanted, but would be the best for her under the circumstances. She nodded, and then exacted from me that promise.  

Amazingly, she was still alive on Christmas Eve, but just barely. The cavity was still growing; she was so far gone that she had already had the last rites of the Roman Catholic Church. But she held me to my promise.
With renewed doubts, I kept it. I told her not to hold her child and to wear a surgical mask if she was talking to anyone but her husband. His own case had given him immunity.
She came back to St. Martha's late Christmas Day, and she kept ebbing. No one could have watched her struggle without being deeply moved. Every day her condition grew just a bit worse, yet every day she clung to life. It went on, to our continued amazement, for weeks.
Towards the end of February she was down to or below 80 pounds, she couldn't eat, and new complications developed. She became nauseous - even without food in her stomach. I was stumped. I called in a senior medical consultant; he was stumped too. But with a grin, almost facetiously, he asked me if I thought she could be pregnant.
I can still remember exactly how I felt. The suggestion was utterly ridiculous. Everything I knew about medicine added up to one conclusion: she was so ill, so weak, that she couldn't possibly have conceived. Her body just wasn't up to it. Nevertheless, I ordered a pregnancy test. To my astonishment, it was positive. On the very outer frontier of life itself, she now bore a second life within her. It was virtually impossible, but it was true.  
Legally, medically, we could have taken the child through abortion; it endangered a life that was already in jeopardy. But we didn't do it. Eleanor and her husband were against it. We doctors at St. Martha's were against it, not only as Catholics, but because we were certain that the operation would kill her. Besides, she was so far gone we were sure her body would reject the child anyway.
The struggle went on for weeks, and never once did we doubt that she was dying. But she kept living. And she kept her child. And in late June 1948, an incredible thing happened. Her temperature began to go down. For the first time we noted some improvement in her condition, and the improvement continued. She began to eat, and to gain weight. A chest X ray showed that the growth of the TB cavity had stopped. Not long after, another X ray showed why. The diaphragm was pushing up against the lower lobe of her diseased lung to make room for the child she was bearing. Nature was doing exactly what we'd failed to do. It was pressing the sides of that deadly hole together. The child was saving the mother.
The child did save her. By the time it was born, a normal, healthy baby, the TB cavity was closed. The mother was markedly better, so much better that we let her go home for good within a few months. Her smile had never been brighter.

Call it the will of God; call it human love; call it the mystical quality of motherhood, the turning in upon herself to fight still more because she had still more to fight for; call it what you will. It happened. And I still wonder at the unfathomable force it signifies.
I remember too, with delight, the Christmas cards Eleanor sent me for years afterwards. They were just ordinary cards, with printed greetings and her name. But to me they were monuments to a miracle.  

Copyright 1985 by J.A. MacDougall, M.D. Catholic Digest November '85




Elena said...

Ah, yes, the famous fr. Hattie story. I first heard this when I trained for Billings and I have never forgotten it. It reminds me of the more recent story of a pair of twins kicking their mother's tumour loose from her abdomen. Effectively, the babies performed the surgery that their mom had refused!

Julie Culshaw said...

I had never heard it before. The doctor was married to Evelyn Morris' sister. I was so touched when she brought me this in Mass yesterday morning, because she knew I would want to know the story. She also told me that Dr. MacDougall left one Catholic hospital in St. John when they began to do tubal ligations there. A man of principle. He had a stroke, and his wife cared for him at home for 10 years, he could neither walk nor talk. And he and his wife had 13 children!