Arresting Development

So yesterday I did an ultrasound on a Muslim patient who hadn’t had a period for three years. She came from several hours away with her mother to figure out why she hadn’t had a period in three years.

I did the ultrasound and then turned to her and her mother. “Alhamdullilah! Praise Good God, you’re pregnant! Just past 27 weeks! I don’t know why you were having issues with your periods, but this baby has a solid heartbeat and is moving around. Everything looks perfect! Congratulations!”

Neither one of them seemed terribly excited, or even convinced. She did seem a little under the weather and had a fever and positive malaria test. She also reported a little burning when she peed. I decided to admit her overnight for some IV therapy.

Today on rounds, I repeated this was the miracle momma, being six months pregnant after no period for three years! Still no smile.

After rounds, the mother of the patient asked to see me in private. I joked with her, “Well, my wife wouldn’t like me going into a room alone with another woman.” (This woman was old. I figured this was an obvious joke.)

She assured me that my nurse could accompany us and asked repeatedly that I pardon her for the intrusion. I assured her right back that there was no intrusion at all and I’d be happy to talk to her. Didn’t really matter medically, but I was curious to find out why they weren’t happier about the pregnancy.

Once in a vacant delivery room, the mother started by asking me to pardon her over and over again. I told her I pardoned her, but I’d prefer to know what exactly I was pardoning her from. Explain.

She told me her daughter was beat up by her husband three years ago, when the periods stopped. The patient’s father then repaid the husband the dowry to buy his daughter’s freedom.

Could this be the ex-husband’s baby?

I told her, yes, it absolutely could be the ex-husband’s baby! But not from three years ago. She got pregnant sometime about six months ago.

The mother told me it was impossible for her daughter to have gotten pregnant six months ago, as she hadn’t had a period in three years.

I agreed with her that it was odd, but still possible she had that solitary ovulation and got pregnant. I wondered, “How do you know your daughter wasn’t having her periods?”

“Well, in our family, if you have your period, you need to eat by yourself. She eats with us every day.”

Oh, I see. Scientific-like.

The mother continued, “Also, she says she hasn’t been having sex with anybody. How is this possible?”

Well, both the Qur’an and the Bible are in agreement Mary was a virgin when Jesus was born. So there’s been at least one case study. Nobody here owns a toilet seat or a swimming pool, so you can’t use that excuse.

“It’s medically impossible.”

“In our family, we all marry within the family.”

“Well, maybe she’s back with the husband, or a family member that’s too close, or somebody outside the family, or maybe a Christian, or who knows. But it’s highly likely she has had sex with somebody in the last year. I can put the odds of that pretty high.”

“Pardon, pardon, pardon, doctor. I’ll pay any amount. We can’t go back to our village with her. If they find her pregnant without a husband…”

Oh, boy. I cut her short. “I’m sorry. Abortions are illegal in Tchad. And while they’re legal in America, we still don’t do them unless there’s a risk to the mother’s life.” After a very short reflection, I added, “Unless there’s a medical risk to the mother’s life.”

“No, no, doctor! I would never want an abortion! That’s sin! I just want you to give her a medicine that will stop the pregnancy for a short time. Then after we can marry her to somebody, then she can stop the medicine and the pregnancy can continue.”

“Um, even in America, that doesn’t exist.”

“Ok, what about a cream or something you can smear on her belly to make it look smaller.”

“I assure you, if I had such a cream, I’d go to America and be a billionaire.”

She was definitely non-plussed.

I went on. “I’m sorry, but I don’t know of any means to stop her from delivering a healthy baby in a few months’ time. Even if she delivered now, some babies at this age survive. If she’s going to be killed by her family in three months for having a baby, we can hide you here in the hospital for three months. We can call your family and say she has a medical condition that will take three months to treat. After delivery, I can find a couple looking to adopt. We have so many couples with infertility who are wonderful people and desperately want a baby. I could find a very nice couple, Muslim or Christian, whatever you want.”

The mother opposed. “No, our family will come. Everybody knows our family. Eventually somebody would see her with a large belly and would discover her.”

We sat in silence for a minute while I thought of what else I could offer her. I quoted her the Qur’an, 

13.8

God knows what every womb bears, by how much they fall short of their time or number or do exceed. Every single thing is before his sight, in due proportion.

He knows the Unseen and that which is open: He is the Great, the most High.

She nodded her head in agreement. I wasn’t really sure what that meant, because there wasn’t much counsel in it, just comfort, or at least I hoped comfort. Reminder that there was a greater plan.

The grandmother-to-be decided. “Can you discharge us? I’ve heard of a Marabout (witch doctor) past N’Djamena who will either be able to suspend the growth of the baby for a time until she finds a husband or who can smear a cream on her belly to shrink it.”

Sounds reasonable. “Ok, but if that doesn’t work, you always have an open invitation to come hide here and we can find an adopting couple.”

“No. If he can’t do it, I will travel the entire country until I find somebody who can.”

“Ok, but travel quickly. She’s gonna be mighty large in a few weeks’ time.”

We had a most amicable parting. Walking away, I just shook my head. Five years ago, this would have deeply shaken me. Now… Just another day at the office. Just another prayer who’s end result I’d never know.