‘Her story is remarkable’
At West Penn, an unbelievable pregnancy becomes unbelievably complicated
Gevony Williams winced as she slowly lowered herself into a chair at West Penn Hospital, where her newborn baby, Dax, was being discharged that day.
Over the last few months, the 38year-old had endured three surgeries, two ruptures of her appendix and a five-hour intensive chemotherapy treatment.
Her take on it: “I’m lucky,” she said. “I only have one scar.”
Following more than two years of trying, including multiple miscarriages and a failed in vitro fertilization attempt, Ms. Williams had been told she wouldn’t be able to get pregnant.
She did anyway — and shortly afterward, her pregnancy went from unbelievable to unbelievably complicated.
The baby was due in September, and in February, she and her husband bought a house in Shadyside after moving from Asheville, N.C. Two months later, she started experiencing piercing, excruciating abdominal pain. Unable to do a CT scan because of her pregnancy, doctors used an MRI to see that her appendix had perforated. She received a standard procedure to drain an abscess and treat the appendix. And then, two weeks later, it burst again.
At that point, said Jason Tomsic, a surgeon at West Penn Hospital who was treating Ms. Williams, the appendix needed to come out.
A surgical procedure isn’t ideal in a pregnant woman, but while spontaneous labor on a non-yet-viable baby was a possibility from the surgery, that possibility was even greater if her appendix wasn’t removed and became infected. “We were all anxious about it, and she was extremely anxious about it,” Dr. Tomsic said.
“I woke up from that surgery just saying, ‘Is my baby OK? Is my baby OK?’ ” she said.
He was and she was, and when she came back two weeks later, at the end of May, for a follow-up appointment, she was “expecting the doctor to brag on how well she was doing,” said her husband, Chris Williams.
Instead, Dr. Tomsic asked her to sit down.
A routine pathology scan of her appendix had found a cancer called goblet cell carcinoma. “This is the first time I’ve seen one,” said Dr. Tomsic, who has been in practice for eight years. “It might be once in a career, three times in a career. It’s a pretty rare thing.”
What would have been a 10minute appointment under normal circumstances stretched for nearly an hour. Ms. Williams asked if she could call her husband, who was 15 minutes away. “I need you here now,” he remembers her telling him. “The doctor wants to talk to us. It’s a little more serious.”
Knowing they had just moved to the area, Dr. Tomsic started asking about their support system. Did they have family nearby that could help? Yes, Ms. Williams grew up
relatively close by in Fairmont, W.Va. Had they joined any religious organizations that might help? Yes, they had found a church in Shadyside. And with that, the doctor had one more question. “Do you mind if I sat down and prayed with you?”
Ms. Williams was then put in the care of hepatobiliary surgeon Suzanne Schiffman and gynecologic oncologist Thomas Krivak. Their first decision was, essentially, whether to treat one patient or two.
Ms. Williams’ cancer was “a fairly advanced case” and had spread into her large intestine — the sooner the surgery could be done, the better. But the baby was only 23 weeks, and her treatment would have to be delayed in order to give him time to grow viable.
“One of the options would have been to terminate the pregnancy and treat the advanced appendiceal cancer,” said Dr. Krivak. “The other was to do what she did. I’ve had patients who delayed their treatment and pregnant woman who elected to terminate. It’s never an easy decision.”
For the couple, the delay in treatment was well worth the risk of the cancer advancing. After years of fertility treatments, Ms. Williams had been told she couldn’t have children. They had planned to start looking for an egg donor after they arrived in Pittsburgh. And just before they were about to move, Ms. Williams unexpectedly found out that she was pregnant.
“They knew I couldn’t guarantee that things wouldn’t change,” said Dr. Schiffman, “but we knew this was a very wanted pregnancy, and we wanted to give the baby the best chance.”
In consulation with neonatologists at West Penn, the couple decided that their son would be delivered at 32 weeks via Caesarean section, long enough to let his crucial systems develop but still relatively soon to try to stop the spread of Ms. Williams’ cancer.
Ms. Williams found herself apologizing to her husband, and worrying about the future. “You didn’t sign up for this,” she would tell him. “You didn’t either,” he would say.
Dax Payne Williams was delivered July 18 at 4 pounds, 3 ounces. He was given steroid shots before birth to help his lungs to develop, and while he faced many of the breathing, feeding and growing challenges common to preemies of that age, “he did everything we asked him to do,” said Ms. Williams at West Penn as he slept in her arms. “He’s so laid back and we’re not,” she laughed.
Two weeks after his birth, Ms. Williams was taken into surgery again, this time for a grueling procedure known as hyperthermic intraperitoneal chemotherapy or HIPEC. Doctors re-opened her C-section scar for a complete hysterectomy, removed a third of her colon and re-routed her small intestine. For hours, Dr. Schiffman performed “tumor debulking,” scraping tumors off of her abdominal organs and removing the lining of her abdominal cavity.
After that, her abdomen was flooded with a chemotherapy solution heated to more than 100 degrees, with residents and medical students physically rocking her body for 100 minutes to make sure the solution reached every crevice.
In the eight days that she was in Allegheny General Hospital after the procedure, Mr. Williams was shuttling back and forth between her and baby Dax at West Penn, trying to do at least his 2 p.m. and 11 p.m. feedings.
As soon as she was stable, Ms. Williams was transferred back to West Penn so that she could recover in the same building with her baby. The staff at the neonatal intensive care unit greeted her at the elevator as she arrived, surprising her by wheeling Dax’s incubator with them — a moment she chokes up talking about weeks later.
The sleeper futon in Dax’s hospital room was taken out and replaced with a hospital bed for Ms. Williams as she recovered with him.
One day before Dax turned one month old, he was discharged from the hospital as Mr. and Ms. Williams signed endless forms and discussed whether she would ride in the back of the car to keep an eye on the baby.
She will receive scans every three months or so to make sure that the cancer has not returned.
“Her story is remarkable — the way that she fought, the way that she made her decisions,” said Dr. Krivak. “They have a healthy baby, and we want to go from there.”