A Parent’s Dread

A team of nine masked, rubber-gloved doctors and nurses seized Otto Timothy Richartz when he squeezed into the world at 11:06 p.m. on Aug. 10, 1996.

Just as his head appeared, they suctioned out his nose and mouth. As soon as he emerged from his mother’s body, they wedged a tube down his throat to suck fluid from his stomach. They poked him for blood samples, jammed an intravenous line into his tiny arm, and snatched away the placenta and umbilical cord to analyze.

Waves of terror swept over Otto’s mother, Kimberly Richartz, the same recurring panic she’d felt ever since she discovered she was pregnant. She could not help this baby. He was on his own. Such a beautiful infant, with an exquisitely shaped head, she thought. In giving him life, had she doomed him to an early death?

In the predawn hours after Otto’s birth, Kim prayed as she lay in her hospital bed, her green eyes closed and her straight brown hair limp on the pillow. Her husband, Joel, studying to be a schoolteacher, went to church the next day.

Then they braced themselves to wait for test results--the first set due in two weeks, the others to come monthly for the next half-year. Kim, a 31-year-old homemaker from Pomona, would not stop worrying for far longer.

Otto’s birth was a roll of the dice that some people regarded as foolish or sinful, because Kim has AIDS. As recently as four years ago, doctors routinely urged mothers like Kim to have an abortion. The odds of an HIV-infected woman passing the disease to her newborn were 1 in 4.

But advances in medical treatment have produced a stunning transformation. Today, with more effective preventive methods during a woman’s pregnancy, labor and delivery, those odds have dropped to 1 in 25--only 4%--in big-city hospitals.

With many HIV-infected women living far longer, benefiting from improved medical treatment, an increasing number are considering pregnancy.

To protect their babies, the U.S. Public Health Service began recommending in 1994 that expectant infected mothers take the antiviral drug AZT during pregnancy and delivery, and that their newborns be treated with it. The proportion of newborns given AZT climbed to 76% from 5% within a few years, causing the sharp dip in mother-to-child transmission rates.

The outlook in such cases is “more optimistic than it’s ever been,” said Dr. Yvonne Joyce Bryson, a UCLA professor of pediatrics and director of the Los Angeles AIDS Pediatric Consortium. “We’re busier than we’ve ever been.”

Kim, who discovered she had HIV in 1989 and developed AIDS several years later, never imagined getting pregnant. When she did, religious concerns made abortion unthinkable. Unwittingly, she entered a new ethical debate framed by questions like these: Isn’t it just as valid for a woman with HIV or AIDS to have a baby as for medical science to enable a woman to give birth at age 60? Or for actor Tony Randall to father a child at age 78?

And yet, what if the AIDS virus develops resistance to the current available mix of medications that stave off the disease? Are we allowing parents to plan families on false hopes? How can we usher a child into the world uncertain of whether his mother will live to see him enter grade school?

“I’m not surprised to hear people say, ‘It’s a horrible thing to do to a child,’ ” said Dr. Paul Krogstad, a UCLA assistant professor of pediatrics and infectious diseases. “On the other hand, if a woman may live another two decades or more, why shouldn’t she have an opportunity for something normal like being a parent?”

In an effort to protect her baby, Kim augmented the AZT with experimental drugs to fight the virus. Her doctors received permission to administer HIVIG, an anti-HIV immune globulin, to Kim monthly during pregnancy and to Otto within 12 hours of birth. (Initially hailed as a potential wonder drug, HIVIG was later determined to be ineffective.)

Kim also continued taking her usual medication, a protease inhibitor to rein in the HIV, during pregnancy--making her one of the first expectant mothers to take such a drug. She did this knowing that the lower the level of the virus in her system, the less likely she was to transmit it. But no one knew what impact, if any, the drug would have on her baby.

There is still little known about such long-term effects. Years from now, might one of these drugs be viewed as the equivalent of DES, a fertility and anti-miscarriage drug used in the ‘50s and ‘60s that turned out to cause reproductive problems in some men and women whose mothers took it? Might Kim and Joel’s baby seem fine now, only to be cursed later with some awful ailment?

“If a bus is about to run somebody over, you’ve got to push them out of the way,” said Dr. Michael Gottlieb, Kim’s physician. “You take a chance that there isn’t a car on the other side that might hit them and, if you’re lucky, there isn’t.”

Gottlieb was a pioneer. In 1981, he first identified a new syndrome striking gay men that was later named AIDS. He understood why Kim wanted every possible weapon to be deployed against the virus. She did not want to suffer the anguish and guilt of delivering a baby who got AIDS.

She’d already done that.

That was how she found out she had the virus in the first place.

Insistence on Getting HIV Test

Kim was 19 when she met Joel Richartz at Cal Poly Pomona. At first, she was not impressed, though he did have nice blue eyes. With long brown hair, he looked like a hippie. He always wore an Indiana Jones-style floppy hat, jeans and a jeans jacket. He sat in the back of class; Kim sat in the front. She wore stockings and makeup. Kim grew up knowing niceties; her grandmother had owned two charm schools and a modeling agency in Orange County.

They were married for a year before having Meghan, a spunky, adventurous child whose blond hair tumbled onto her shoulders.

Meghan was a pale, sickly infant who kept losing weight. She’d recover from one ailment and another would strike. The pediatrician told Kim that her 15-month-old daughter had a parasite that usually preyed upon babies with AIDS.

When Kim asked for an HIV test for herself and Meghan, the doctor protested. Here was a white, middle-class married woman who had never used intravenous drugs or had a blood transfusion. She was not considered at risk for a disease then thought to be ravaging mainly homosexuals and drug users.

Kim insisted. It would be one less possibility to worry about.

When the test results came back positive for mother and child, Kim and Joel were stunned. This seemed the unlikeliest of death sentences.

Kim believed she’d contracted the virus from a boyfriend when she was a teenager. Joel, it turned out, did not have the virus. Kim sank into depression. She believed she had been betrayed by her body and would die within months. She felt a pounding guilt for passing the virus on to Meghan. She figured Joel would leave her. How could he forgive her? They had only been married 2 1/2 years.

Joel was bitter, but he was not leaving.

“Kim did the same thing millions of girls did at that age--she had sex without a condom,” he said. “She was one of the unlucky ones. I never blamed her; I think she beat herself up enough.”

When Meghan wrapped her thin arms around him, Joel would melt. Kim and Meghan were his life. He could not fathom any other.

“This was not the way our marriage was supposed to be,” he said. “But my philosophy is: Marriage is a permanent thing.”

Kim’s mother, Nancy Clarke, a therapist, was in a counseling session with a patient when Joel and Kim phoned with the test results. Surely, there was an error, she thought. How could it be Kim, the shy girl with straight A’s who’d passed up a full scholarship to Mills College in Oakland to be closer to home?

Nancy blamed herself for not exercising enough oversight as a parent. She felt angry with Joel. She wished he’d been the one with the virus. She read books on death and dying. She figured Meghan would die first, then Kim. She made a bargain with God: “If you only let Meghan live until she is 7, I could cope.”

Meghan died of viral meningitis five years after her AIDS diagnosis. She was 6 1/2. By that time, she could no longer walk or speak. Her pancreas failed. She was on morphine. She and her parents had moved into Nancy’s home. Bone thin, Meghan mostly lay curled up on Nancy’s bed or in Kim or Joel’s arms wrapped in a blanket.

Nancy remembered her bargain with God.

“Why?” she sobbed. “Why didn’t I ask for longer?”

After Meghan’s death, Kim visited the cemetery every day. “How are you, pumpkin head?” she’d ask affectionately. She planted flowers of yellow lantana, set up pinwheels and brought tiny toys--a white ceramic rabbit, marbles, shells, rocks, a dog from the Monopoly game set, plastic strawberries, which Meghan had loved and called “babas.” When Kim left, she’d kiss her hand and pat the tombstone. “See you soon, sweetie.”

Kim and Joel remembered how some people wouldn’t let their children play with Meghan. They recalled the slap they felt when the pastor told Kim the church had a new rule: no young children infected with the AIDS virus allowed in Sunday school.

An idea began to take shape: They would become foster parents to children with AIDS.

“We gave Meghan the best life she could have had--why not do that for someone else?” Kim said.

Eleven months after Meghan’s death, two children came to live with Kim and Joel. They didn’t have AIDS. But they fell into the category of hard-to-place kids. The 6-month-old baby’s mother had a drug problem. And the 2-year-old had hyperactivity disorders and fetal alcohol syndrome; his heart had flawed valves, his septum was deviated and the walls of his trachea were too thin.

Just before the children arrived, Kim learned she was pregnant.

‘Mother Cannot Take Any More Heartbreak’

Kim and Joel were afraid to tell Nancy. They told Nancy’s best friend first. The friend was livid. What if this baby was sick too?

“Your mother cannot take any more heartbreak,” the friend fumed. “How can you do this to your mother? How can you do this?”

But Kim knew she would carry to term. Her own health was good, though she tired easily. Her mother had hoped she’d become a doctor, but as far back as Kim could remember, she had gotten a kick out of folding baby clothes.

She didn’t discuss her fears with friends. She didn’t want them to know how scared she was. She didn’t want people to feel sorry for her. And what could they say? The usual platitude--”Oh, your baby will be fine”--meant nothing. Maybe her baby wouldn’t.

She felt stung when she believed a friend’s relative had refused to let her borrow baby furniture because she disapproved of the pregnancy. She hated the raised eyebrows and sudden silence when acquaintances realized from her bulging belly that she was pregnant.

She vowed to do everything possible to ensure that her child did not acquire the virus. If he did, “it was going to be because that’s what was supposed to be.”

Her contractions began early in the morning. Her obstetrician, Dr. Pamela Boyer, met her at UCLA Medical Center. Kim wasn’t ready to deliver, but she didn’t want to drive back to Pomona. If that happened, she worried, she’d wind up delivering the baby before getting anti-AIDS medications. She was admitted at 3 a.m. and went to sleep.

Later that morning, Boyer began administering a labor-inducing drug. Two hours later, an intravenous tube was inserted to continuously feed Kim doses of AZT--a process that would last until the baby was born.

Kim was anxious, lost in a forest of unknowns: Had she taken enough drugs? Too many? Unbeknown to Boyer, Kim had taken an experimental drug given to her by another doctor.

Late that night, the baby’s head finally descended, the umbilical cord wrapped three times around his neck. Doctors cleaned out his nose and mouth, untangled the cord and wiped his face clean. Just after 11, Otto was born. He was 8 pounds, 4 ounces, and 22 inches long.

Boyer was pleased. The birth had gone smoothly, and she believed that Otto’s exposure to his mother’s bodily fluids had been minimal, an important factor in reducing risk of transmission.

In the hours after Otto’s birth, a syringe of sweet syrup containing AZT was discharged into his mouth--a drug he would take four times a day during his first six weeks of life. An intravenous line into his arm fed him another drug. Kim, true to her nature, panicked: Had they done enough? Maybe they should change hospitals. Maybe they needed more specialists.

Now they could only wait. Kim prayed every day. It would be two weeks before the first test results would be available, telling Kim and Joel whether Otto had acquired the virus in the womb. It would be an additional six months of monthly exams before doctors would say whether their baby had contracted HIV during delivery. It would be a year after that before doctors would be prepared to say whether the boy was completely out of danger.

Otto was a difficult infant. He didn’t like to eat or be held. Concerned about transmitting the virus, Kim did not breast-feed. After Otto was circumcised, Kim and Joel worried that he was bleeding too much. It looked like more than a few drops of blood on his diaper. They took him to the emergency room. He was fine. “Just two paranoid parents,” Joel sighed.

Two weeks after Otto’s birth, the first test results showed that he had not gotten the virus. Now Kim and Joel would have to wait for subsequent tests to confirm it.

Kim wouldn’t sleep the night before Otto’s visits to the doctor. Her stomach would ache and she would feel shaky. When she got to the doctor’s office, she found herself searching the face of the nurse. Was she hiding bad news? Why didn’t she smile or give a thumbs-up?

As much as Kim had looked forward to halting the oral doses of AZT that she gave Otto, it also made her nervous. Six weeks of medication seemed so random. How could you know that during his seventh week of life the virus wouldn’t bust loose?

Slowly, with every monthly checkup, Kim felt increasingly hopeful. By the time the last test was run at six months, Kim and Joel believed the doctors’ assessment: Otto would not develop AIDS. They took Otto and his foster brother out to dinner at Red Lobster. Kim ate fried shrimp. Joel, who’d insisted all through the pregnancy that their baby would be fine, had a big I-told-you-so grin plastered on his face.

Even after Otto’s first birthday, Kim couldn’t stop worrying. He was sleeping a lot. She thought he had difficulty breathing and swallowing. He had tremors--was that a quirk of babyhood or related to one of the drugs he’d taken? In her vigilance, had she given him potentially harmful drugs that might cause some terrible birth defect? “All I can say is my other child is dead, so I’ll be a little more cautious with everything for Otto.”

She can catch glimpses of Meghan in blond Otto, whose fat cheeks beg to be pinched. Maybe it’s the way he squawks at his foster brother, holding his ground despite being smaller. Or how his giggles consume his entire face, wrinkling his nose, making his blue eyes dance.

These days, Kim and Joel don’t visit the cemetery as much. It’s not that they have stopped missing Meghan. It’s just that Otto has begun to come into his own, burbling at Teletubbies on TV, swinging his plastic bat at a stationary plastic ball in a vain attempt to make contact, zooming his race car along the rug.

He’s not brave like Meghan. He doesn’t like going on rides. But Otto spills with exuberance. He refers to a telephone as a “hello” because that’s what people say as soon as they pick it up. He loves to draw, yet his pictures are a series of jumbled lines. He doesn’t talk in complete sentences, but he makes his wishes known.

Last summer he turned 2. His birthday party was small, just a handful of relatives in the backyard. Meghan’s birthdays had been extravaganzas, with ponies one year and a huge trampoline-like pillow another year. Kim always feared it might be her last.

For Otto’s celebration, a handful of red streamers adorned the garden shed and a Raffi tape played. The cake was left over from the day before, when Otto’s foster sister celebrated her birthday. Otto, dressed in yellow shorts with a matching red, yellow and white striped shirt, was a blur, blowing on the candles before they were lighted, straddling his tricycle, walking it backward.

“Kids,” Joel muttered lovingly, rolling his eyes as he thought about how the daily chaos of Otto’s life had overtaken the anxiety surrounding his birth. “We had a first life with Meghan. She’s gone,” he said. “Now we have a second life without her.”