"Stronger Than You Think" by: Dr. MeiLan K. Han

You are stronger than you think. 

I always thought having children would be easy. After all, my mother had had four children, the last at age 39. They'd been easy pregnancies. I was in good shape. I thought starting to try in my early 30's was just right. Having married at the end of residency, my husband and I wanted a few years to ourselves before we started trying.  So right after fellowship seemed like the right time.  But after six months with no progress, we went to see a fertility specialist. This was the beginning of a six-year infertility saga that would involve three rounds of IUI and three rounds of IVF, all while trying to get my academic career off the ground. My bags of injectable medications went with me everywhere. My friends at meetings were drafted to help. I never could muster the courage to do the intramuscular injections myself. 

When I finally became pregnant at 39, I thought our problems were over. But in reality they were only the beginning. Early on I suspected something was amiss. Why were my beta hCG levels so high? Why was the baby’s heart rate so high? What was that extra shadow on the ultrasound that no one had been able to give me an adequate explanation for? We were finally scheduled for a more in depth ultrasound (US) where we received the diagnosis - TRAP. Twin reversed arterial perfusion, a rare complication of monochorionic twin pregnancies.  The embryo had split, but one of the twins had failed to develop.  The healthy twin was at risk for heart failure, pumping blood for both through a shared placenta.  My baby was also at increased risk for other congenital anomalies. However, after anxious waiting, additional ultrasounds and an amniocentesis, at 26 weeks we finally had good news. No fetal surgery would be needed, and I was cleared to leave the country to give an invited talk in Korea.

At two in the morning the night before I was to fly back home, I awoke to use the restroom and discovered that I was bleeding. I ran to the bed. I lay down and jostled my precious baby to make sure he was still moving.  Reassuringly, he kicked back at me.  I called the only person I could think of, my sister-in-law who through a minor miracle was in Seoul on temporary assignment.  Most importantly, she had a car. She rushed me to the same medical center where I had spoken earlier that day.  The sleepy resident came in to see me. Fetal monitor looked OK.  He thought the bleeding was normal and wanted to send me home. By now it was 6 a.m. and I called back to the hotel, reached a friend at the medical conference and asked him to alert the physician who was chairing the conference. Within an hour, an attending physician was now present to perform a US. 

I was hospitalized but the cause of bleeding was up for debate. Three days on a magnesium drip later, the bleeding stopped. My husband and I decided for me to leave Korea against medical advice. I lay flat for the tortuous 12 hour flight home. Within hours after arriving home I was back in the hospital. I would end up staying in the hospital until I delivered via C-section at almost 36 weeks, the longest they would let me go. While I passed blood every single day, somehow my son's non-stress test was always perfect. In fact my doctors would often tell me that he was “happiest baby on the block,” meaning the long-term stay wing of the maternity floor. I worked every day of my hospitalization. My secretary brought me work. I had my computer. I wrote a book chapter and my first independent NIH grant that successfully funded six months later. I missed my national conference but still gave one talk via Skype, for no other reason than to maintain my own sanity. With each passing day my worry for my little one eased, although my mental health suffered due to the prolonged confinement, although this experience would later give me new found empathy for my own patients.  Passes to leave the hospital for a few hours helped to preserve my sanity.  But when he was finally born, my precious baby was perfectly healthy.  No respiratory distress.  He would be fine. I would be fine. I never gave up, and neither did he. 

Now, when either of us are faced with some new challenge and I begin to worry, I just have to remind myself that we are both stronger than I'd ever imagined either of us could be. 

MeiLan K. Han, MD MS is a wife and mother who is an Associate Professor at the University of Michigan.  As a pulmonologist, clinical researcher and speaker she focuses on improving the lives of patients with chronic lung disease.