Sharing Right

Dr. Tiny Nair

Property division is usually a hair splitting and stressful exercise, the dividing partners want their legitimate share every single bit. No compromise there.

In this case, it is even more crucial because their whole future depends on it. With their quota of allotted, the sisters slowly move away, reaching the two extreme ends of the arena. The chances of the separating siblings meeting again is unlikely.

Now they would build their own abode, with a plan to settle down of their own. Every single human chromosome, each one of the 23 pair inside the cell would split up into two as they divide.

But unlike the normal body cells which divide into two identical daughter cells, in the ovary the cell division is called a meiotic ‘haploid’ division. Haploid literally means ‘half-half’ because the ovarian cells have to meet their partner to fertilize in order to get the full complement of 23 pairs again. The meiotic divisions in the ovary are always perfect, almost always.

Once in 1000 pregnancies, it can go wrong. A small tag of the chromosome 21 clinging on to one of the dividing cells, can create a load of a miniscule of extra chromosome. Unknown to the pregnant mother, this little extra micron sized chromosome ‘tag’ goes on multiplying.

Nine months later the baby is born with a flat face, an upward slanting mongoloid eye, an abnormal thumb, a subnormal mind and and supernormal penchant for music. While the parents would continue to dote, pamper and hug the child, the rest of the world would know him as ‘Down syndrome’.

In India, adoption laws are slack; the centers let prospective parents take the ‘chosen’ baby for a medical check up, at a center of their choice; before finally deciding whether they would like to adopt the baby or not. As a part of the workup they are brought to the echocardiogram lab to rule out by-birth heart defects. I see half-a-dozen of them in a month as a part of my work as a consultant cardiologist; and that’s how the difference stuck me.

Unlike the normal ‘blanket-clad’, ‘balaclava-protected’, ‘grandma-carried’ babies whose shrill cry wakes up even the sleepiest resident in the room, the ‘adoption’ babies are different; they don’t tend to cry. They, kind of, refuse to cry, unless they are forced to. Years before our Echo-lab nurse told me that ‘adoptions babies usually don’t cry’ and she was right.

These are not the crying type. The stay at the adoption homes probably make these babies ‘resistant’ to sympathy-seeking cry; they quickly understand the futility of the theory that ‘cry-get-stuff’.

The sluggish movement of the mother carrying the child, the uninterested caretaker and the eager watchful expectant father told me that this was an adoption kid. The absence of a whimper under the blanket confirmed my suspicion. The caretaker who frequent our lab mumbled ‘adoption baby’ as the lady put the wrapped baby on the cot.

As I uncovered the sleeping 4 month old, I could see that the boy was a case of Down syndrome, not the classical full-blown ‘Downs’ but one with a milder physical variant. We call it ‘mosaic Downs’. These babies might look like normal to an untrained eye. The tell-tale sign of abnormal thumb and the simian crease was present.

The echo test showed that the heart was normal. The mother asked me ‘doctor is everything normal’? I said ‘yes the heart is normal’. I am a cardiologist and the baby is sent by the pediatrician for cardiac assessment. Medical ethics dictate that I restrict to my domain of expertise.

I didn’t know whether the expectant parents were aware that the baby has Downs syndrome.

The unfortunate kid had an entry into this horrible world by an accident. He is on the verge of getting a new home. Am I going to banish him to the dilapidated adoption center for the rest of his life by declaring the truth?  Withholding it, on the other hand might bring untold misery to the young parents.

I did what most doctors do when in a crisis. I referred them back to the pediatrician with the Echo report.

An hour later, there was a call from the pediatrician ‘Sir, that Down syndrome kid you did Echo – the family has refused to adopt it after I told them that he has Downs’.

I come home to see my son playing in the garden with his friends.

I felt so fortunate. Just because the property sharing went right.

(Dr. Tiny Nair, MD, DM, FACC, FRCP(E) is Head, Dept. of Cardiology, PRS Hospital, Kerala and he can be reached at )

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