The pregnancy that wasn't

It’s not her in the photo, but it could well be. She’s also from Guinea-Bissao, a petite very black woman, usually quiet and seldom smiling, when she does her very white teeth and suddenly bright eyes lighten her face. I’ve known her, and been her doctor, for a little over 10 years now. As many others, she had just arrived from Guinea, evacuated to Lisbon due to needing dialysis, unavailable in her country. That meant she had to leave home and family (she had a little daughter) overnight, to live in Lisbon, where she had to make a living, since the agreements between Guinea and Portugal cover just the medical treatments, and the patients have no support whatsoever from their government. It’s the plight of several people from former Portuguese African colonies – Cape Vert, Guinea-Bissao, São Tomé, Angola – who need dialysis to survive and so have to make a living in our country.

So, this girl, who was 26 at the time, found some work as cleaning woman and eventually built herself a new life, with a new partner, sending money home to her old mother and her daughter, who later emigrated herself to France. I always liked this woman; she was never very compliant with therapy, she was always stubborn and sometimes silly, but she was hard-working, she never complained, and she cared about her family. Once, when I complained about the amount of anti-hypertensive medication she kept asking for, she told me: “My mother takes Norvax… I send it to her”. – By the way, that’s not the only time I faced this situation, I remember a man from Guinea who sent his HIV medications to his wife because she wrote him she was ill.

She had lots of problems – hepatitis C, an abortion, a renal carcinoma – but she kept on working and looked always the same. And then, recently, she told me she had missed her period. Women with end-stage renal disease rarely become pregnant, but I have seen a few cases, so I ordered a pregnancy test, and it was positive. I was worried – the chances of a successful pregnancy on dialysis are thin, and this particular patient had a lot of risk factors besides her renal disease – hypertension, hepatitis C, previous miscarriage… I asked her if she wanted the baby, hoping she wouldn’t, but she said she did. Probably because it would be a child by her new partner, I don’t know. So, I changed her treatment plan, changed her medication, sent her to the Obstetrics high-risk clinic. I’ve had a couple of successful pregnancies on dialysis, but I had a bad feeling about this one, too many problems, and I feared it would all end in her losing the baby and getting worse in the way. But I complied to her wishes, and we would try.

Then the obstetric ultrasound was inconclusive, and so was the confirmation blood test, they thought she might have an ectopic pregnancy, then an ovarian tumor, then finally she bled again and it had all been false positives. I must say I was relieved by it – I knew it wouldn’t end well, and it was good she wasn’t pregnant after all.

I don’t know if she felt sorry for not being pregnant. She just looks the same, I talked to her and resumed her usual medication. I’m glad she was spared an almost certainly unsuccessful pregnancy, but I don’t know if she understands it, I don’t know how she feels. She just looks the same.