Methodist Journal

FEATURED GUEST EDITOR

ISSUE INTRO

The Burgeoning Field of Cardio-Oncology

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RECOGNITIONS

Barry H. Trachtenberg Leads Issue on Cardio-Oncology

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REVIEW ARTICLES See More

Heart Failure in Relation to Anthracyclines and Other Chemotherapies

Heart Failure in Relation to Tumor-Targeted Therapies and Immunotherapies

The Role of Cardiovascular Imaging and Serum Biomarkers in Identifying Cardiotoxicity Related to Cancer Therapeutics

Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity

Cardiovascular Toxicities of Radiation Therapy

Electrophysiologic Complications in Cancer Patients

Vascular Toxicity in Patients with Cancer: Is There a Recipe to Clarify Treatment?

Future Directions in Cardio-Oncology

CASE REPORTS See More

A Rare Case of Pancreatitis-Induced Thrombosis of the Aorta and Superior Mesenteric Artery

Anomalous Origin of the Right Coronary Artery from the Left Main Coronary Artery in the Setting of Critical Bicuspid Aortic Valve Stenosis

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Do Not Pass Flow: Microvascular Obstruction on Cardiac Magnetic Resonance After Reinfarction Following Primary Percutaneous Coronary Intervention

CLINICAL PERSPECTIVES See More

EXCERPTA

Cardio-Oncology, Then and Now: An Interview with Barry Trachtenberg

POINTS TO REMEMBER

Onconephrology: An Evolving Field

POINTS TO REMEMBER

Herbal Nephropathy

EXCERPTA

Rolling the Dice on Red Yeast Rice

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

Vol 11, Issue 4 (2015)

Humanities Full Text

ESSAY ON BEING A DOCTOR

Defying the Odds

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Article Citation:

Jennifer Hopp. Defying the Odds. Methodist DeBakey Cardiovascular Journal. October 2015, Vol. 11, No. 4, pp. 257-258.

doi: https://doi.org/10.14797/mdcj-11-4-257

Through the generosity of Charles R. Millikan, D. Min., vice president for Spiritual Care and Values Integration, an annual award competition was established at Houston Methodist Hospital among the resident staff. To enter the writing competition, residents must submit a poem or essay of 1,000 words or less on the topic, “On Being a Doctor.” A committee of seven was selected from Houston Methodist Hospital Education Institute to establish the judging criteria and select the winning entries. The following is the third-place winning entry for 2015.

Since completing her primary care sports medicine fellowship at Houston Methodist Hospital, Dr. Hopp has accepted a sports medicine position at HCA Virginia Sports Medicine in Richmond, Virginia.

He is dressed in a thawb and she is in a black burqa with a veil; only her eyes eagerly look out at me as they sit side by side, without touching. She is 16. He is 17. “The test was positive. You’re pregnant,” I say quietly.

Jennifer Hopp, M.D.

For a moment he forgets his religious propriety and grasps her hand, wrapping his long arm around her in a side embrace. Her eyes twinkle, as I assume she must be smiling under her veil. It’s a finding I do not celebrate but frequently diagnose: teenage pregnancy. During their first visit, I determine that this was an unplanned pregnancy and they are not interested in abortion or adoption. They will have the child and raise it together. They each live with their families and plan to remain so during the pregnancy. They are ecstatic. I send her for blood work, set up appointments, and prescribe prenatal vitamins.

Over the course of her prenatal care, I palpate and prod her growing abdomen and listen to the baby’s heart rate. I also prod the couple for information as I regularly do with my pregnant teens, helping them navigate the WIC Program, find resources such as homeless shelters or food pantries, secure a restraining order when needed. However, this couple is surprising me with each visit. They are different from other teen couples. Her boyfriend attends every visit throughout the entire pregnancy. He has dropped out of high school and is working full time for an uncle. He saves money for the baby and buys diapers and clothing. She completes her current semester, switches to home schooling, and graduates from high school at age 17, just before her due date and a full year early. They have decided to stay at their respective homes and are waiting to marry.

I begin to believe that this teenage couple is different. She removes her veil for me at each visit, and I look forward to seeing her smiling face. I know her as a patient, as a caring and doting mother-to-be, as someone with a goal, determined to take care of her child. The father, so attentive toward his girlfriend, is so proud of her. At every appointment he holds her hand, asking questions and wanting to understand what is happening inside of her womb, where his child had just started moving and kicking. I begin to believe that this teenage couple is going to make it, that they will defy the odds.

I am called to the hospital for the delivery. It is a wonderfully uncomplicated vaginal delivery of a large, beautiful baby boy. Mom, dad, and son are happy and crying, and I am swept up in the joy, shedding a few tears myself. Now a father, he bends over his infant son within minutes of his birth and whispers a prayer to him. It is a tender, joyful, and serene moment in my medical career.

A few days later I see the family at the baby’s newborn visit and again at the 1-month visit. Everyone is adjusting well, and mom is adamant that breast feeding is best for her son. She has flourished as a mother and enjoys her time with her son. She prides herself on her son’s health, growth, and happy demeanor. Dad appears exhausted and no longer holds the mother’s hand, but he asks several questions about feeding times, growth, vaccination schedules, and appointments.

I see them again at the 2-month visit, but only mom and her son come to that appointment. Dad had to work and couldn’t get the time off. “Everything is expensive and he has had to work more hours to cover the cost of diapers, clothes, and the baby furniture,” she explained. She only sees him on the weekends, usually during the afternoon. They’ve been fighting. They still live with their parents and never moved in together, and it’s been hard taking care of him on her own. She’s started looking at classes. She wants to go to college. She asks, “Do you think I can do it?”

And then I don’t see her until his 9-month visit. She has brought him in for all of his routine well-child check-ups, but my schedule was full and she saw another provider. She’s a little late seeing me, and her son is 10 months old. “I waited because I only wanted to see you this time,” she says quietly while removing her veil.

“I need a letter from you,” she starts, and begins to explain what has happened since I last saw them. His father has left her. There is a new girlfriend who is expecting his second child. He spends all of his time with her now, and all of his money. His mother, the child’s paternal grandmother, is suing for sole custody of the child. “For the welfare money,” she states it so casually, “and I would be required to pay her child support. She’s done it before with two of her other grandbabies.”

The mother’s concern is that she is still breast feeding. She has raised this child on her own with no help from the father or his family. She has taken him to every doctor visit, paid every bill for him, ensured his safety, nutrition, and daycare while she began taking classes at the local college. “I want to be a nurse,” she smiles shyly, as I congratulate her on her determination.

I write her a letter to submit in the courts attesting to her being present at all physician visits, provide the documentation that is later subpoenaed, and she retains sole custody of her child. I realize, it wasn’t the couple who made me believe that this teenage pregnancy was different. It was this young woman, determined to give her child a better life. She is the one who made a difference. She is the one who has defied the odds.