When the day for our twenty-week ultrasound finally arrived in January, we were excited to learn the sex of our baby, but I was also nervous in the face of this anomaly scan. I was about to turn thirty-five years old, and we had not waited as long as recommended to conceive after my miscarriage. I also worried that, statistically, four healthy babies was the most I’d be allowed. Why would I be granted yet another robust child?
At the appointment, I tried to be friendly, even neighborly, with the technician, but like all the previous techs, she did not smile much, having been dutifully trained to take but not interpret data. Instead of chatting, she focused on taking my baby’s measurements, as if appraising a room for carpet installation, apparently bored but also painstakingly precise. I tried to study her facial expressions, the way in which she measured or remeasured certain organs, and the pace with which she tapped digits into her system.
I lay back, sea-blue jelly warming up beneath the tech’s ultrasound wand. Occasionally she printed a photograph, a long stream of perforated photo paper flapping from a machine behind her computer. In the small, dark room, lit only by screens, I longed for a soundtrack, perhaps the first CD Ryan ever burned for me—Mazzy Star’s So Tonight That I Might See.
“If we have another boy, we can probably stay living in our house,” Ryan said. Aside from holding my hand and watching our baby roll and stretch, he too wanted affirmation. “There’s room for another bed in the boys’ room, though just barely. There wouldn’t be space for other furniture, of course. But if we have another girl, we’ll have to buy a new house, unless we want the baby to sleep in the bathtub or something.”
The technician smirked finally, a sort-of smile, and said, “Are you sure you want to know?”
“Yes,” we both answered in unison.
“Looks like you won’t have to move.”
“It’s a boy?” I asked, wanting to ensure nothing was lost in translation.
“Yup, I’m ninety-nine percent sure,” she said. “I’m not allowed to guarantee more than that.”
Ryan had given me a baby; and I had given him another boy.
“What about Gustav?” I asked Ryan. “As in Gustav Klimt, the painter. I’ve always loved his work.” There was also Gustave Flaubert, of course. Not to mention, as my musician friends pointed out, Gustav Mahler and Gustav Holst. I was ready to argue my case.
“Yes, absolutely, I love it,” he said. I was surprised, as I’d mentioned this name in pregnancies past and Ryan had quickly dismissed it as “too Old World.” By now, though, Ryan, having become a hockey aficionado, was deep into the NHL season, and one of his favorite players, Gustav Nyquist, was having a big year for the Detroit Red Wings.
We continued to play with variations on Gustav, simply for nickname purposes, thinking that Gusto would complement Leo and Franco, names that ended with little halos. We practiced using his nickname in silly sentences like Gusto hugged us with gusto; he lived life with gusto. From what we could discern, the technician had found all of our baby boy’s body parts and organs. Throughout my previous pregnancies, I’d often dream my babies were born without hands or feet, but there seemed to be confirmation here that nothing was missing. But when my midwife called the next day, she hesitated to speak, just as her colleague had dithered during my miscarriage. “Everything is fine, except . . .”
“Oh, no,” I said. “Just tell me.”
“The baby’s kidneys are measuring larger than they should,” she said. “It’s a condition called pyelectasis. If it were up to me, I wouldn’t even alert you to it because it usually resolves itself before the baby is born, but I’m required to tell you.”
“Well, what’s the difference between what his kidneys should measure and what they are measuring?” I asked.
“Between four and ten millimeters is the range for pyelectasis,” she said. “And your little guy is at 4.6 and 4.8. Not nearly as serious as it could be.”
As in all stories about medical diagnoses, we’d need to wait to learn more. In four to six weeks, we could repeat the ultrasound to remeasure Gustav’s kidneys. If his kidneys were increasingly dilated, this might indicate a urine backup; my amniotic fluid might even be low. But if his measurements diminished to four millimeters or smaller, we would be free to assume a normal pregnancy. As luck would have it, pyelectasis was much more common in boy babies than in girls.
Who in their right mind would wait six weeks when four weeks was the minimum? I asked my midwife to transfer me to a receptionist, who scheduled our follow-up ultrasound exactly four weeks from that morning.
The Internet is a dangerous place for anybody playing doctor. Pyelectasis might indicate all kinds of problems, ranging from a blocked ureter to malfunctioning valves in the urinary tract, all of which, if still present at birth, might warrant surgery. This seemed like an outcome for which I could brace myself, but upon further research, I began to see references to “soft markers” for Down syndrome too.
Renal pyelectasis
