God will take care of the baby'

Cancer: Faith and family support a Baltimore woman who underwent treatment for Hodgkin's disease during pregnancy.

November 21, 1999|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

Every day, she felt exhausted, sick to her stomach -- and thrilled. After six years of trying to have another child and finally giving up hope, Andra Bowles discovered she was pregnant.

But as the weeks passed last winter, she struggled to catch her breath. Soon, she couldn't even walk on her own.

Doctors finally found the problem: Bowles, 39, had a malignant tumor larger than an apple in her chest. The diagnosis was Hodgkin's disease. Her unborn baby was, medically, a complication.

As her physicians broke the news that Good Friday, Bowles' husband, Darrell, grabbed her hand and held it tight. Though Hodgkin's is considered one of the most treatable cancers, it still can kill.

"We couldn't move, and we couldn't talk," Andra Bowles said. "We were petrified."

While the combination of pregnancy and cancer is rare, it is happening to more and more women. That's because the risk of cancer increases with age, and more women are deciding to have children later in life.

The diagnosis jars women like Bowles from all the anticipation and joy associated with having a baby, to all the pain and fear associated with cancer. They are at once mothers-to-be and seriously ill patients, forced to make agonizing decisions, often with little research to guide them.

The Bowleses relied mostly on faith.

Initially, in accordance with National Cancer Institute guidelines, Johns Hopkins Hospital oncologists recommended that the couple terminate the pregnancy. Studies have shown that chemotherapy during the first trimester can cause miscarriages and birth defects, as well as make it difficult to treat the mother.

But there was also some evidence that if Bowles could delay chemotherapy until the second trimester, mother and child could both make it.

The couple, sweethearts since their days at Towson University, barely had to discuss it. They knew that their two sons, 10-year-old Yale and 9-year-old Chase, needed her.

"Who's going to love my babies the way I love them?" Andra Bowles asked.

So the couple decided to have the physicians treat her for her disease, a cancer of the lymphatic system, and not skimp because she was pregnant.

`A chance to live'

At the same time, they wanted this baby. And they believed that without the pregnancy, the slowly developing Hodgkin's disease could have been missed for a few more years. (Ironically, many cancers in pregnancy aren't picked up because the women dismiss any symptom they experience as related to pregnancy.)

"This child has given me a chance to live," Andra Bowles said. "I have to give the child the same chance."

The couple accepted that the medicine meant to save Bowles might harm their baby, and they vowed to love the child no matter what. "You treat the mother," they directed the doctors. "God will take care of the baby."

That began what would become months of a difficult balancing act for everyone.

"There is no textbook prescription as to what you do," said Dr. Rima J. Couzi, an oncologist involved with the case. Doctors weigh the diagnosis, the stage of the disease, the stage of pregnancy and the patient's wishes.

For women with less aggressive cancer, treatment can sometimes wait until the baby is born. In other cases, especially if the pregnancy is in an early phase, the pregnancy is terminated.

In Bowles' case, she was immediately admitted to the oncology ward and treated with multiple transfusions and steroids for a dangerous type of anemia often associated with Hodgkin's.

While her condition was being stabilized, enough time passed to ensure that she was out of the first trimester, when the baby's vital organs develop. Then she started chemotherapy.

During her first dose, Bowles lay in her hospital bed, hating the needles, trying not to imagine the toxic drug snaking its way through her body and into her child. She closed her eyes, whispering, "God, wrap your hands around my womb and protect this baby."

After just a few chemo treatments, her tumor shrank considerably. And she escaped some of chemo's worst side effects. She didn't lose her hair or suffer terrible nausea. It made her feel as though she didn't really have cancer. Things only got better after she went home to her West Baltimore rowhouse.

Brotherly love

Her boys were ecstatic about their future sibling. All summer, they peppered her with questions about what the baby would be like, if the infant would love them, if they could stay home and take care of him or her.

Yale often ran up to his mother, grabbed her stomach and announced: "Hello, baby! I'm your big brother Yale. I'm out here waiting for you. I'll be here to take care of you."

Bowles' 37-year-old husband, a Baltimore Gas and Electric Co. meter reader by day and bass guitarist by night, rubbed his wife's stomach, and attaching headphones to it, played light jazz to the baby.

Physicians were monitoring the fetus with frequent sonograms, and the child seemed to be developing normally. On July 31, a sonogram showed Bowles was going to have a girl.

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