16 JUNE 1990, Page 16

If symptoms persist . . .

SOMETIMES I wish I had the wisdom of Solomon: at any rate, my patients seem to expect it of me.

Last week, a husband and wife came to consult me. They were not of English origin and only the husband spoke En- glish well. The wife, it seemed, was depressed, weeping continuously and threatening to kill herself. She had lost a lot of weight and though pregnant was painfully thin. She had neglected her clothes and personal appearance, which I guessed was highly unusual for her.

She was miserable because she and her husband had given away their second child, born nine months earlier, to her husband's brother and his wife; the legal adoption procedure was grinding ahead inexorably. Now she wanted her second child back, but her husband said they had made a promise and must stick to it.

Naturally, I asked why they had given their child away. The husband answered that his elder brother had brought him up when they were orphaned by the early death of their parents; and he, the elder brother, was childless after 20 years of marriage. The husband had promised a long time ago that if ever he had children, and if his wife agreed, he would give him a child to adopt. Well, his wife had agreed (under pressure, I supposed), and so there was no going back.

They came from a country of which I knew nothing, and I asked whether this was a normal proceeding there (I once lived in a country where it was quite normal for parents to give their children away). It was not.

Her husband insisted that when their third child was born she would forget the second and recover her happiness. She, on the other hand, said she wanted a termination; she couldn't go through with another pregnancy in the knowledge that her second child was lost to her.

What was Ito do? I was convinced that her threats to kill herself were not idle: the suffering written on her face pre- cluded mere gestures in that direction. Her husband seemed oblivious to the seriousness of the situation; clearly very dominant, he spent much of his time travelling for business reasons, but in- sisted he was a good husband, giving his wife anything she wanted — except, of course, the one thing that would prevent her from killing herself.

Should she have a termination? Later she might be overcome by remorse; it might break her marriage, and life as a single woman, knowing no English and having no relatives nearby, would not be easy. On the other hand, who could blame her for not wishing to continue with the pregnancy? The simple solution — to have her child back — I suspected was impossible. The husband's code of honour was such that his word was much more than his bond. I looked at his wife and imagined her hanging herself. The problem wasn't a medical one, yet I had to do something. Solomon's solu- tion, you will remember, was to offer to cut the disputed baby in two. But this does not accord with NHS policy.

Theodore Dalrymple