A Piece of My Mind
A Visit From My Daughter
During this long flight home from a national meeting, I find
myself thinking of my daughter.
On the day she was born, we named her Kelsey. I was half-
way through my intern year, and my confidence as an aspiring
physician was growing. My wife had been having labor pains
that afternoon and when they became severe, we called our
obstetrician, who advised us to come to the hospital.
I was both frightened and excited about the birth of my first
child. I imagined rocking her in my arms, teaching her the
ABCs, and watching her ride her first bicycle. Fellow resi-
dents teased that soon she would be reading Harrison’s Text-
book of Medicine. That would have to wait until she was at
least 3, I jokingly told them with pride. But most of all I imag-
ined watching my daughter graduate from high school. She
would be wearing a white holoku dress, as is often the tradi-
tion during graduation ceremonies in Hawaii. She would walk
across the stage, a beautiful, confident young woman, ready to
launch herself into the world.
The OB-GYN resident, our dear friend, looked worried. The
ultrasound machine was quickly wheeled into the room. My
wife was in pain. She had the look of distress I had come to
recognize during my early training. Something was wrong.
The senior obstetrician said, “There is no heartbeat.” These
words did not register with me. “There is a large placental
abruption.” She turned to me. “There is no heartbeat. There is
no heartbeat.” I looked at my wife. The doctor said, “A placen-
tal abruption occurs when the placenta. . . .”
This must be very hard for you.
“Was her blood pressure elevated during pregnancy?
Sometimes severe hypertension can lead to this condition.
Was her. . . .”
This isn’t fair.
“Were there any changes in her urine. . . .”
How can I help you?
When my wife’s systolic blood pressure dropped to 90 mm
Hg, I found myself telling the nurse to insert another IV and
open up the saline. She just looked at me, no doubt wondering
if she should take orders from a patient’s husband. Is it
because of my past medical history? my wife wondered aloud.
I touched her cheek. I should have known. I am a physician. I
should have known. What if I had brought my wife in sooner,
when the pain started? Could we have saved Kelsey? I should
have known.
It’s not your fault.
If there is no greater joy than watching the birth of your
child, then there is no greater sadness than watching your
child delivered, knowing she is already dead. When her head
appeared, I was sure she was alive. She seemed to change ex-
pression as she squeezed through the birth canal. Could the
Edited by Roxanne K. Young, Associate Editor.
JAMA, July 22/29, 1998—Vol 280, No. 4
ultrasound have been wrong? But when she was completely
delivered, my wife and I wept uncontrollably, as did the doc-
tors and nurses in the room. Kelsey was warm, like a living
child. But she did not move. “I felt you roll over in the womb,
my dear. Why don’t you move now?” Could the ultrasound be
wrong? I wrapped Kelsey in a soft, pink blanket and cradled
her in my arms, thinking I could never let her go. “Oh my child.
Oh my baby. I love you so much. I began loving you since I
knew you would be born to us. I have so much to teach you, to
tell you. Oh my baby girl. We have a crib for you, bought by
your grandparents. And a mobile hangs overhead. It will play
a lullaby to soothe you when you’re crying. Please come back
to me.” But when we drove home from the hospital, our new
infant car-seat was empty.
I wish there was a way I could bring your child back to you.
I took a photograph of my daughter, wrapped in her blanket
wearing a pink cap, lying in a white bassinet. Her funeral
helped us deal with her loss, but to this day, we have not been
able to part with her ashes. We begin to love our children be-
fore they are born and continue to love them long after they are
gone.
I know you’ll be a good father someday.
Several years after her death, I dreamed of my daughter. I
was at her high school graduation. It was exactly as I had
imagined, except that her dress was blue. She floated across
the stage like an angel. She’s so beautiful! I thought to myself.
Then she smiled at me. And I felt all the love and pride one
would feel for a daughter on this day. But as she walked toward
me, her vision began to fade. “Oh, don’t let this dream end!” I
pleaded. As her face disappeared, I remembered thinking,
She’s smiling. And from that time, my pain over her loss has
eased.
Let’s schedule a time to talk again soon.
I don’t believe I understand the meaning of dreams. Why
this one came to me I cannot say. Was it random neuronal ac-
tivity? Was it an illusion conjured by emotions I’ve kept hid-
den, or a ghost summoned by my guilt? I do not know. But I
choose to believe I was visited by my daughter on the night of
her graduation. What a grand event it was.
My two young sons wait anxiously for the arrival of my
flight. When I step off the plane they will run to me. I will lift
them each into my arms and our embrace will be longer than
usual. And one day I will tell them what I remember of that
evening with the sister they never knew.
Damon H. Sakai, MD
Honolulu, Hawaii
We welcome contributions to A Piece of My Mind. Manuscripts
should be sent to Roxanne K. Young, The Journal of the American
Medical Association, 515 N State St, Chicago, IL 60610.
A Piece of My Mind 321