Just as a runner passes on the baton to the next one in a relay race, so she gave birth to her daughter and died. In the antiseptic environment of an obstetric theatre, I witnessed this spectacle with the detachment of a duty conscious executioner. I had talked frankly with the patient in the weeks before, and had explained point blank the risks of continuing a pregnancy with Eisenmenger's syndrome.
She was a science graduate and had a clear understanding of the risks involved. To be sure, I had said, “Percentages apart, those who die, die fully.” Her husband, parents, and in-laws had also counselled her but could not persuade her to terminate the pregnancy. I vacillated between hatred for her obstinacy and respect for her autonomy, but she was resolute in her decision to continue. It is difficult to be sure if she really believed that somehow I could save her, or perhaps the desire for motherhood over-rode everything else. She continued the pregnancy for eight months with worsening cyanosis and decreasing effort tolerance. I watched her gradually moving towards death, but she seemed happy seeing the life inside her grow.
On that fateful night, several things went wrong despite our preparations. The epidural anaesthesia was tedious and suboptimal, the rigors were unwarranted, and the blood loss a little more than usual. She was awake at the birth and acknowledged the arrival of her “free spirit” by a feeble smile. I could not see her expression as her eyes were covered. Shortly afterwards she became hypotensive and hypoxic and then died.
She was waiting for a miracle that did not happen; or perhaps it had happened. While we were busy trying resuscitate her, the room was filled with the lusty cries of a newborn infant as if announcing the victory of life over death. “Death, be not proud.”