A Question of Life

Doctors told Mark and Karla Miller their unborn daughter would face a life of pain and illness. Then, against the Millers' wishes, Woman's Hospital did everything it could to keep the newborn alive. Last month, after an extraordinary trial in a Houston co

At the time, however, there were dangerous risks associated with the use of terbutaline, which had yet to be approved by the Food and Drug Administration. Since the heart is also made up of smooth muscle, the most serious concern was that the drug could cause a rapid increase in heart rate, and that could lead to stroke. Still, the resident explained, it was about the only chance they had to save the fetus. Without hesitation, Karla agreed to take the drug. It was almost 6 a.m.

A few hours later, Jacobs arrived at Woman's Hospital. He examined Karla, and noted that the terbutaline appeared to be working. He ordered an ultrasound image to determine the fetus's approximate gestational age and weight, its position in the uterus, and to see how Karla's amniotic sac and membranes were holding up.

The situation was serious but, for the moment, stable.

Nothing in their pasts, either together or before they met, could have prepared Mark and Karla Miller for the next 15 hours. Karla's rising panic that something was wrong with her unborn baby was compounded by the strangeness of her surroundings. She had never been inside a hospital, and the only doctor who'd ever treated her was the family physician, back home in Jasper. Now, here she was, sick and in pain, surrounded by frightening machines that beeped and buzzed for inexplicable reasons. Worse, a swarm of strangers were urgently probing her most intimate regions.

An equities broker, Karla had worked for high-powered firms like Shearson Lehman Brothers and Smith Barney, but she never lost touch with her East Texas roots. She disdains the cool hardness of the big city and prefers room to breathe, fields to roam and horses to ride. A natural beauty with long, chestnut hair, high cheekbones and a graceful reserve, Karla was not yet 21 years old when a large, dark-haired man brought her a plate of food at a Christmas party in 1982.

"I haven't seen you eat anything all night," he said.
They were as different as they could be, but Mark Miller is a hard man to ignore. He stands well over six feet tall, with the physique of an offensive lineman and a personality just as large -- confident, a bit loud, with a penchant for wisecracks and earthy language. Raised in Pasadena, Mark started out in public relations after graduating from the University of Texas, but he eventually succumbed to a love of politics and worked as a consultant to various Texas Democrats, including former governor Mark White, before becoming a stock broker. He and Karla dated for almost five years before they married on November 14, 1987.

In April 1990, Karla learned from a home pregnancy test that she was expecting. She and Mark were ecstatic, and they immediately began planning a nursery and stocking up on diapers and supplies. At her doctor's recommendation, Karla began a regimen of prenatal vitamins and continued her morning walks to stay in shape. As summer began, she quit her job at Smith Barney in anticipation of the big day, estimated to be December 15.

In early August, Karla went to see Mark Jacobs for her monthly checkup. Everything looked fine, Jacobs was happy to report. The doctor had become fond of the Millers. Their excitement at the prospect of becoming parents was contagious. Jacobs rarely got involved any more than necessary in his patients' lives. But the Millers, he had to admit, were becoming friends.

But as soon as he saw the results of Karla's ultrasound at around 11 a.m. August 17, Jacobs knew it was going to be a difficult day. The fetus seemed fine; its heart was beating and there was movement of the limbs. The radiologist who analyzed the sonar results estimated the baby to be roughly one pound, four ounces and at a gestational age of 23 weeks and a day. There were no noticeable abnormalities.

Karla, however, seemed to be getting sicker. She was in severe pain and had a temperature approaching 100 degrees, both symptoms of chorioamnionitis, an infection of the membranes of the amniotic sac. She was also losing amniotic fluid rapidly. Jacobs tracked down Dr. Donald Kelley, a neonatologist from Baylor College of Medicine, who was doing a fellowship at Woman's Hospital. He briefed his colleague on Karla's condition and asked him to talk with the Millers about the prognosis for a 23-week-old infant.

At the time, Kelley had little scientific data on which to rely, but he was aware that survival at such an immature age was no longer impossible. In 1973, when the Supreme Court's Roe v. Wade decision held that states could allow abortions at 28 weeks of gestation, the survival rate of infants born at that age was just 10 percent. By 1990, that prognosis had been turned on its head, thanks to aggressive NICU techniques. Still, the very edge of viability was 24 weeks. A study published in the New England Journal of Medicine in December 1989 reported virtually no chance of survival at 22 weeks and only an 8 percent chance at 23 weeks.

But Kelley, a specialist in the delivery and care of high-risk newborns, did not waste time reciting research results for the Millers. His assessment of the infant's chances was almost brutal, and his clinical matter-of-factness is something Mark and Karla will never forget.

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