The Intern Blues(149)
It turned out that I was correct: Amy’s father no longer lived in New Jersey. The woman who answered the phone, though, had first-hand knowledge of where he was. She turned out to be his niece, the daughter of Amy’s father’s sister, and she and her family had been living in the Horowitz house for the past seven years. Her uncle, she told me, had retired and moved to Boca Raton, Florida. “And Amy’s been living in Israel for more than ten years,” she said. She gave me her uncle’s number, and after a few minutes on the phone with him, explaining who I was and why I wanted to get in touch with his daughter, I finally got the information I’d been searching for. So early the next day, I called Israel. The phone rang three times before Amy picked it up.
She and I had last spoken in 1989, and sadness had infused that discussion. In the epilogue of The Intern Blues, I wrote about the birth of Amy’s second child, a son named Eric, who had been born on November 12, 1986. After the two months of maternity leave and one month of an elective without night call, for which she’d fought so hard, she returned to residency full-time. In the last eighteen months of her training, Amy really put herself into her job. She worked hard and became a leader among the residents, and she had a good sense of what needed to be done for her patients and the ability to go ahead and do it.
In the late winter of her senior residency year, Amy had become pregnant again. This time, she’d planned the pregnancy to the last detail, being due to deliver three months after her training was scheduled finally to come to its end. “I’ve lived through a pregnancy as a resident,” she had told me when she called. “I never want to have to do that again.” She would finish her residency, spend the last trimester of her pregnancy relaxing, give birth, and spend the rest of that academic year being a mother to her three children. “We’ll be like a real family for a while. Then, depending on how things work out, I’ll either go back to work or I’ll spend another year as a mommy. We’re flexible.”
Right on schedule, on the morning of October 18, 1988, Amy delivered a beautiful baby boy. But within twelve hours, her family’s world was turned upside down. The baby developed perioral and acral cyanosis [blueness around the mouth, hands, and feet, often caused by heart disease]. The pediatric resident on call that night at University Hospital did an arterial blood gas, which showed an oxygen level of only fifty-eight in room air (a normal value would have been in the nineties). When the baby was placed in an environment of 100 percent oxygen, the level increased only to seventy-two (under normal circumstances, the oxygen level in the blood should have risen to more than 200). An emergency cardiology consult was requested. The cardiologist, who made it to the hospital at around 2 A.M., did an echocardiogram, which revealed the terrible problem: Amy’s baby had a hypoplastic left heart.
Hypoplastic left heart is a catastrophic congenital defect in which, for reasons that are never clear, the left ventricle, the chamber of the heart that pumps oxygenated blood to the rest of the body, doesn’t develop. During fetal life, the defect doesn’t create much of a problem. The fetus has a structure called the ductus arteriosus that shunts blood that would normally go to the lungs to the remainder of the body (fetuses don’t need to use their lungs; they receive oxygenated blood from their mothers through the umbilical cord). Soon after birth, in a transition from fetal to adult circulation, the ductus arteriosus closes, allowing blood to flow through the pulmonary artery to the lungs. In most babies, this change facilitates normal babyhood; in Amy Horowitz’s baby, however, the closure of the ductus arteriosus was a death sentence.
Amy knew all this. As soon as the cardiologist came into her hospital room and told her what was wrong, she understood completely the implications of the news. She knew that if left untreated, her son would be dead within thirty-six hours. She also knew that there was an option: Surgery could be done essentially to build the baby a left ventricle. The complete surgical repair would involve multiple stages. An initial operation would need to be done as soon as possible; a second operation would have to be performed later in the first year of life; and at least one other operation would be required when the baby was older. And this was not simple surgery: Each operation was fraught with risks. The first one alone had a 50 percent mortality rate. And even in the best case, even if her baby did manage to survive each of the stages of the complex repair, he would have a terrible first few years of life and would face an uncertain future.
In addition to all of this, Amy had to be concerned about the rest of her family. There were her other two children to think about. Surgery would mean an all-out commitment to this baby, who would spend the better part of his first year of life in the hospital, much of that time in the intensive care unit. Would it be fair to Sarah and Eric to deprive them of the love and attention of their parents during long stretches of time in order to provide for the new baby, whose future, under the best of circumstances, was far from certain?