I have gotten this question a lot from people, and it is a fair question given what has been reported in the media.
Let me start by clarifying a couple of things. First, many people picture Andrea as a helpless woman who slowly deteriorated through the years as a result of being overwhelmed with more and more children. This is simply not true. Andrea is a very smart, conscientious person. She was valedictorian of her high school class, she was captain of her high school swim team, and she practiced as a registered nurse at MD Anderson Cancer Center for eight years.
Before we married, Andrea decided that she would stop working as a nurse when our first child was born, and we decided that we would have as many children as we were blessed to receive. When Noah was born, Andrea left nursing to become a stay-at-home mother. She absolutely enjoyed her role as a mother. Of course, things were busy with five children. At the same time, we were all very happy.
Also, Andrea only exhibited signs of depression after our last two children were born. She seemed very much herself after our first three children were born. In fact, I did not notice any changes in her appearance or functioning, and no one ever mentioned to me that she seemed depressed in any way. Andrea has told me several times that she felt fine after Noah, John, and Paul were born.
After Luke (our fourth child) was born in 1999, Andrea became very depressed. The depression started a month after Luke was born, and it gradually worsened over three months, until Andrea tried to commit suicide and needed to be hospitalized - twice. During this time, she slowly changed from a vibrant woman to a catatonic zombie. This was not a subtle change. She was a different person.
While she was sick, Andrea would only respond in 1-2 word statements. She walked around nervously. She seemed disorganized and confused. She scratched her head. Her leg shook uncontrollably. She carried Luke around on her hip and would not feed him even when he cried. She was unkempt. She would stare blankly into space for extended periods. At her sickest, she would not eat or drink, and she could barely walk.
Andrea was hospitalized in an intensive-care psychiatric unit. One day, I spent two hours pleading with her to start taking an antipsychotic medication that her doctor, Dr. Starbranch, had prescribed. Andrea said less than 10 words the entire visit. She was a zombie. After our visit, I spoke with Dr. Starbranch about Andrea's condition. Dr. Starbranch decided that it was an emergency situation and decided to give Andrea an injection.
The injection was a cocktail that included, among other things, Haldol, a very powerful antipsychotic medication, and Ativan, an anti-anxiety medication.
After Andrea received the injection, an amazing thing happened. Within 24 hours, she was on her feet. She was walking. She was talking. She was eating. To this day, I am utterly amazed by how much and how quickly she improved! It took a while to find a medication that worked for Andrea. Her family and I had started to lose hope that she would ever be herself again. Then suddenly, within one day, she was mostly back! There was hope!
After the injection, Dr. Starbranch continued to give Andrea Haldol. She also started to give her Wellbutrin, an antidepressant with some mood-stabilizing effects. Andrea did very well on both medications and recovered quickly. Dr. Starbranch discontinued the Haldol after Andrea had been stable for a couple of months. Andrea discontinued the Wellbutrin herself. For all of 2000, Andrea seemed well.
This had been an exhausting experience. Finally, things started to seem normal again.
Andrea and I discussed the possibility of having more children. We both love children, and we would have loved to have more.
Some of the biggest challenges in 1999 were: recognizing the symptoms of Andrea's depression, seeking prompt treatment, and determining which medications worked for her. Dr. Starbranch and her staff told us that if we had more children, then there would be a 50 percent chance that Andrea would become depressed again, and that if she did become depressed again, then she would have the same symptoms and require the same treatment.
Given these things, Andrea and I decided to have more children. If Andrea did become depressed again, then we would quickly recognize her symptoms and take her to a doctor; and her doctor would give her the same medications that had worked before. Therefore, we (in hind sight naively) thought that her symptoms would not be severe, nor last for long, because she would be treated quickly and effectively.
Here is an analogy: Suppose you could receive a beautiful new car in exchange for enduring the flu for two weeks. Would you do it? A child is much more valuable than a car. Also, two weeks with the flu is worse than what we expected. We had no idea that having another child could lead to such a tragedy. To us, it was a good trade.
Now, about our conversations with Dr. Starbranch. It is true that Dr. Starbranch recommended that we not have any more children, because Andrea could become sick again. When we told her that we wanted to have more children, she said that she wanted to put Andrea on medications during and after the pregnancy, and Andrea refused, because she was concerned that the medications could harm the baby.
During the course of Andrea's treatment, Dr. Starbranch never explained to me that Andrea had been psychotic and was potentially harmful to our children. She did explain that Andrea was depressed and was potentially harmful to herself. This is a key point. Apparently, Dr. Starbranch also wrote a comment in Andrea's medical record that Andrea could become psychotic again if she had more children.
I suspect that Dr. Starbranch withheld this critical information from me, because she has a duty to Andrea to maintain doctor-patient confidentiality. At the same time, she had a duty to Andrea and me to warn us if our children could possibly be in danger. On the whole, I believe that she is a competent psychiatrist. However, if she did believe that our children could be in danger, then she should have explicitly warned us.
To be complete, during the course of Andrea's treatment and through a lot of discussion, Dr. Starbranch did mention to me that it is possible for a woman to become psychotic and harm her children. However, she never warned me that Andrea herself was psychotic, nor did she describe the symptoms of psychosis to me. I did not know that Andrea was psychotic and posed a threat to our children in 1999 and 2001 until after the tragedy.
So what mistakes did we make? What could we have done differently?
Well, first, I do believe that Andrea and I treated her illness too lightly. We believed that Andrea had a routine case of postpartum depression, while in fact, Andrea had a very severe case of postpartum psychosis. Similarly, we expected that if Andrea became depressed again, then the progression would be slow as in 1999. However, what took 2-3 months to develop in 1999 took 2-3 weeks to develop in 2001.
Second, we naively believed that any psychiatrist could treat Andrea effectively. Dr. Starbranch did treat Andrea effectively; Dr. Saeed did not. While Dr. Starbranch found a combination of medications that worked for Andrea and fought our insurance company to keep her in the hospital until she was well, Dr. Saeed gave Andrea medications that exacerbated her condition and discharged her while she was still the sickest patient in the hospital.
If we had known these things at the time, then I think we would have decided to count our blessings and stop having children. At the same time, I feel blessed to have known Mary for the short six months of her life. She was a beautiful little girl.