Joss Wood - With Love From Cape Town

‘Don’t worry,’ Robina reassured her, ‘you’ll soon forget about the camera, believe me. And if you say something daft, we’ll edit it.’

‘I’m not appearing, if that’s okay,’ Mairi chipped in. ‘They say the camera puts on ten pounds, and with the extra weight I’m carrying already, I don’t think I could face it.’

Everyone laughed and a spate of good-natured teasing broke out.

‘Can we move on?’ Niall said when everyone had settled again. ‘We have a number of cases to discuss before I have to check on my patients in the labour ward.’

On top of his patients at the clinic, Niall still carried a full workload of obstetric cases. No wonder we hardly see each other, Robina thought sadly. Either she was working, or he was, and that included most evenings and weekends.

‘Annette is coming in for her seven-week scan this morning,’ Sally announced. ‘Keep your fingers crossed, everyone.’ The mood in the room turned sombre.

‘This is Annette’s third attempt,’ Catriona explained to Robina. ‘The first time the embryos didn’t implant, the second time, she had a positive pregnancy test, but her seven-week scan, the one we do to determine whether the pregnancy is ongoing, showed no evidence of a heartbeat. As you can imagine, she was distraught. She and her husband have agreed that this will be their last attempt—she was thrilled when this most recent pregnancy test was positive—but they are naturally extremely anxious. I think she might be one of the women who said they’d be happy to talk to you.’

‘Who’s doing the scan?’ Niall asked.

‘I am,’ replied Sally. ‘I looked after her through her other treatments.’ She chewed on her lower lip. ‘I don’t know how she’ll cope if we don’t find a heartbeat. And I will hate being the one that has to tell her.’

‘Let’s just wait and see,’ Catriona said soothingly. ‘There’s no point in getting ahead of ourselves.’

‘I have a patient I’d like to discuss,’ Niall said. ‘It is a difficult case and I’d like to know how everybody feels—particularly the embryologists—before I see this lady.’

Everyone turned curious eyes on Niall.

‘I have been approached by a woman who wants us to carry out PGD—pre-implantation genetic diagnosis,’ he said to Robina, for the benefit of the camera. ‘She has a family history of breast cancer in the family and all the female relatives in her family have either died or have had the disease. As a precaution, she decided to have a prophylactic double mastectomy when she was eighteen, after genetic testing showed that she carried the variant BRCA1 gene.’

There was a sharp intake of breath followed by a murmur of sympathy from around the room.

‘Now that Isabel has joined us…’ he smiled at the curly-haired embryologist sitting on his right ‘…we are in a position to offer this service. But I want to know how everyone feels about it.’

‘Could you explain what it involves, Niall?’ Robina asked, knowing that this was exactly the kind of thing her viewers would be interested in. She only had a vague memory from researching her book of what the procedure involved and progress in this area was rapid.

‘I’ll let Isabel explain, as she’s the one who’d be doing the procedure.’

‘I’ll try and make it as simple as possible.’ Isabel took a sip of water. ‘We stimulate the ovaries, in the same way we do for our infertile ladies, and then fertilise the eggs in the lab. Once the eggs are fertilised they start dividing—one cell becomes two, two become four and so on. We wait until we have eight cells, then we remove one and test for the BRCA1 gene. If it’s positive, we move on to the next embryo and so on until we find one that doesn’t carry the gene. When we do, that is the embryo we replace.’

‘Don’t some people think this is too close to eugenics?’ Robina asked. ‘As in designer babies?’

‘Not at all,’ Niall interrupted quietly. ‘This isn’t selecting embryos based on hair colour or intelligence or anything like that. This is selection that will prevent someone almost certainly suffering from breast cancer later on in life.’

‘I know some people find it distasteful,’ Isabel continued, ‘but the truth of the matter is that we select embryos anyway to put back.’

Robina was puzzled. ‘What do you mean?’

‘We add sperm to all the eggs we retrieve. Say we have fourteen. Out of those, sometimes only a proportion will fertilise. We study the ones that are under the microscope and grade them according to specific, recognised criteria. We select the ones with the best grades, and choose one from these to replace. So in a way we are already selecting. PGD only takes it a step further.’

Robina was fascinated and knew viewers would be too. Some might find it controversial, but she had never shied away from controversy. She would present both sides of the argument and leave people to make up their own minds.

‘Isn’t destroying perfectly healthy embryos wrong?’

‘Sometimes we freeze the leftover embryos—the ones that are of good quality, that is—in case the women want further treatment. If they don’t, then yes, we dispose of the remainder,’ Isabel continued, her face animated. It was clearly a subject that was close to her heart. ‘In many ways it’s no different to what happens in normal pregnancies. The ovary starts to produce several eggs, but there is always one dominant egg which then releases a hormone that stops the other competing eggs from developing further. In a way we are simply replicating nature.’

‘The issue I have is more of a scientific rather than a moral one,’ Niall said. ‘Not for this gene, which would be present in every cell of the embryo, but when we are testing for other genetic conditions, for example Down’s syndrome, there is the risk that out of the eight cells, we test the one cell that doesn’t carry the genetic abnormality and are led to falsely believe that the embryo is free of the condition. It is important that anyone considering PGD understands this.’

‘She wouldn’t be considering it if she weren’t desperate,’ Mairi interjected. ‘And she’s already shown how serious she is by having a double mastectomy. I’m not surprised she doesn’t want her daughter to go through the same thing.’

Robina leaned back as lively discussion broke out around the table. She wondered how it felt to have to make these kinds of decisions on a daily basis, knowing you held people’s dreams in the palm of your hand. Her heart went out to all the couples. The people in this room had such power over their lives. How could so many women bear to put themselves through so much potential disappointment and heartache? She knew she couldn’t put herself through it again. Never, ever. She had thought she would never get over the pain of losing one baby. How could she possibly risk doing it all over again?

‘Let’s take a vote,’ Niall said. ‘Everyone in favour of my seeing this lady, remembering I intend to make sure she understands the pros and cons before we proceed, raise their hands.’

It seemed that everyone was in agreement.

‘Let’s move on then,’ Niall said, but before he could continue, the receptionist popped her head around the door.

‘Annette has arrived for her scan, Sally. I’ve made her a coffee, but I don’t want to keep her waiting—she looks terrified.’

Sally stood. ‘Are you coming?’ she asked Robina, who immediately got to her feet. ‘Keep your fingers crossed, everyone,’ she added over her shoulder as Robina and her cameraman, John, followed her out of the room.

Sally showed Annette and her husband into one of the consulting rooms and then left them with Robina and John while she went to set up the scan.