My Perfect Patient

The majority of my patients here in China are the wives and partners of foreigners working here. About 20% of the babies I deliver are known as "joint-venture babies," the result of relationships between Western men and Chinese women. Of these, one of the biggest groups are the German/Chinese couples. German companies send single men out on expatriate assignments. They may leave Germany single, but a lot of social changes happen out here in Asia.

Wendy and her husband were one of these couples, and they came to see me when they were in the first few weeks of pregnancy. The first visit was fairly routine. The pregnancy was confirmed. A viable fetus was seen on the ultrasound. She did complain of nausea and vomiting, but it certainly did not seem to be worse than many other women who have this problem. A few days later, I was called by her husband who was very distraught. Wendy had been vomiting after every meal and every drink for three days and was now feeling very weak. He brought her in; she was indeed quite dehydrated, and I admitted her. A little anti-emetic and a couple of liters of IV fluid restored her to better health and humor. We discussed the problem and possible dietary strategies and treatment. I told them that, although she was now feeling better, there would almost certainly be other episodes and that it would last until she was out of the first trimester, when it would diminish or disappear. So much for my expertise.

Wendy continued to vomit every single day for the nine months of her pregnancy. I admitted her to hospital on several occasions for re-hydration. She preferred to avoid anti-nauseants. She learned a few strategies and felt that she was retaining a certain amount of food and drink every day. She never ate what anyone would call a meal during the entire pregnancy. She snacked, ate a meal a mouthful at a time over several hours, only took fluid a sip at a time, and found what she could tolerate and what she could not.

On two occasions during the pregnancy, Wendy and her husband went to Germany. On each occasion the journey was a nightmare. Some people travel Economy Class, some Business Class, and others First Class. Wendy traveled Toilet Class, spending the major part of the trip with her head over the bowl. Each time she arrived back in China we had to admit her.

The thing that made Wendy so special to me was not the natural sympathy I felt for her. It was her continuous good humor throughout the ordeal. Whenever I saw her name as one of the patients due to be seen that day, I would hope she was improving and that the vomiting had abated. In she would sweep with a smile on her face and greetings for all. "How are things, Wendy?" we would ask. "Oh quite normal" she would reply. "Any vomiting this week?" we would ask, hoping that by normal she meant what was normal for the rest of humanity. "Oh, yes, same old stuff, vomited every day, sometimes two or three times," and then she would smile and tell us we worried too much about her. A review of her blood chemistry and ultrasound evaluation of the baby revealed she was retaining some nutrition and that the baby was thriving. When she was reassured the baby was doing well she would depart with her usual noisy farewells, leaving us feeling helpless, apprehensive, and wretched.

Wendy had a total lack of self-pity. She accepted absolutely that this was the price she had to pay to have a child. Her good humor and her efforts to reassure us that she understood there was little we could do to help, made me feel I was privileged to be able to play some small part in the care of her pregnancy. I have seen this attitude many times over my years in obstetrics, but Wendy is the epitome of this fortitude and courage.

The pregnancy ended well. A wonderful beautiful baby girl. The Chinese say she looks Western and Westerners say she looks Chinese. That is always the case.

Wendy had a second pregnancy. It was a little better than the first. There were occasional days when she did not vomit. By her standards, this made it a pleasant, uneventful pregnancy. She was just grateful that since she was married to a foreigner she was allowed to have a second child. In these days of political correctness, I know I'm not supposed to hug patients. But I hug Wendy a lot.

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