Reflections from the Front: Pre-Marital Counseling

Reflections from the Front: Pre-Marital Counseling

The Doctor-Patient relationship, autonomy. Some times our patients invite us into places where angels fear to tread. We can’t rush in. But if invited in, we must consider carefully the sacred responsibility and the cowardice of refusing to attempt to help. God and society have granted us this position as a trust. We have no right to abuse this trust by acts of omission or commission. (CSP Vol. 43 No 2, 2000)


I am a neurologist.

I don’t do pre-marital counseling.

Yet, here they were in front of me: Tom and Sally.


Tom had been my patient for years.

He was partially deaf, and mildly retarded.

I treated his intractable seizures, and Migraine headaches.

Recently, we had proven that these all were part of a larger syndrome*—

That would kill him in the next few years.

He had called and asked if I would meet with them.


Sally was new to me.

She had cerebral palsy, with impaired legs, but a good mind.

Sally was plain, and vaguely eccentric.

But she had a good sense of humor.


Tom was her first boyfriend.

They talked on the phone for hours.

They both claimed to be in love.

They both had thought and prayed about this decision for weeks.

But Tom’s mother was quietly opposed.


What did I think?

They really wanted to know.


We talked for over an hour.

Were they unrealistic?

Were they blinded by their first love?

Could they imagine the pain they would share?

I probed as gently as I could.


No cliché–I felt honored and immensely humbled.


“No,” I told them.

“I don’t think you are blind or unrealistic.

But I think you have no idea how much pain you are in for.”


(Do any of us when we deeply love someone?)


Tom died in stages over the next two years.

But not before they shared true intimacy,

            Marital sexual union, and

                        Some good times together.


Sally said:

            “It was terrible, but wonderful.”


I thought:

            “How like the best of marriages.”


[* Tom had MELAS, Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like Episodes. MELAS is a maternally inherited, progressive, incurable disease.]


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Harry Mueller MD
Harry Mueller MD

Thank you for this post. This situation reminds me of being faced with a patient who had just been told that the child she was carrying had Down syndrome. She was a successful business woman and her dream of a perfect child had been destroyed. Society tells us that those of us with Down Syndrome will have a live of suffering and be a burden. She accepted that narrative and could not hear another story. I often wonder what joy, and sorrow, she would have experienced had she made a different choice.