Years later, I now wonder if I overstepped my boundaries.

Nancy was a pleasure to have as a patient.  A physician assistant in her early twenties, we often chatted amiably during visits.  Our conversations randomly ambled between personal and professional topics.  She recently married and was looking forward to having children.  Her gynecologic history was complicated and after a period of months of unsuccessful attempts to get pregnant, she visited a local infertility specialist.

Although the workup was completely normal, one of her blood tests, while technically in range, was deemed subpar.  Her obstetrician sent me a letter asking if I would monitor levels and adjust medications.  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 crestfallen, on the verge of tears.  Her gynecologist was struggling with her levels.  Her previously subpar blood test was closer to range, but still had not met the magic number that her infertility specialist had decreed optimal.  With her medical training skills honed from education, Nancy had searched out a bevy of papers suggesting a correlation between low normal values and poor pregnancy outcomes.  Thirty weeks into gestation, she felt like she was in crisis.

While I was unconvinced by the tenuous connection in the literature Nancy produced for me, I couldn’t help but feel a lightning bolt rush through my own insides.  How many times had I struggled with these same fears with my own children?  How many times had I painstakingly deliberated over my little ones ad nauseum.  To give vitamins or not?  To treat with antibiotics or wait longer?  Every decision dissected and second guessed.  Each time feeling so sure that my failure to decide correctly would mar my child for a lifetime.

My eyes glistened as I told Nancy that having a child was like ripping your heart out of your chest and then leaving it in the open unprotected by the strong bony architecture of your rib cage.  That to procreate was to feel an uncertain type of helplessness that is unmatched by other realms of human experience.  She will try to control almost every part of her babies existence and fail over and over again.  And yet most likely, despite all her foibles, her child will be more perfect than she ever imagined.

Nancy, I explained, was experiencing the first pangs of parenthood.

We decided on a treatment plan.  We scheduled a follow up visit one week later.  And then she left the office.

I never saw Nancy again.  She cancelled all future appointments.

Years later, I wonder how things went.

I often imagine her holding her baby lovingly.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.