The Boston Globe Online, March 9, 2008
By Dr. Darshak Sanghavi

“Maria and Jose Azevedo had to choose: allow their baby to die a preventable death or save him while acting against their religion. The doctor who helped guide them shares their story.”

For Jose and Maria Azevedo, their beliefs left them little choice as they agonized over one of their children’s health. (Photo by Tanit Sakakini)

ALTHOUGH MARIA and Jose Azevedo didn’t know it back then - after all, they were children who lived on separate continents - their lives would be both changed and linked by the most mundane of events: a knock at the door.

 The solution offered by the judge was ideal. As a daughter of Portuguese immigrants, Maria was raised a devout Catholic (her step-grandmother, named Trinity, used to teach catechism), but her family life growing up in New Jersey was marred by an abusive father. When Maria was 8, her mother invited a Jehovah’s Witness proselytizing door-to-door into the home. Soon, her mother, Maria, and her sister began studying regularly with Witnesses, who questioned the existence of the Trinity and hell. Maria’s father was not happy about that. “Whatever rage he had just became worse,” Maria says. Still, Maria formally declared herself a Witness when she turned 13.

Thousands of miles away on the Ivory Coast in West Africa, Jose grew up in a French-speaking family that later immigrated to Connecticut. Jose’s father had converted years earlier, also after a Witness came to his door, and Jose became baptized as a Witness at 17. Several years later, he met Maria at a convention for Witnesses in Monroe, New York. Soon they were writing letters back and forth and dated for two years. At Maria’s high school graduation party in 1993, Jose proposed. She said yes. They had a son, Giovanni, and later moved to Fitchburg, where Jose started a floor-sanding business.

Last winter, when the family was preparing for a trip to Italy, Maria learned she was pregnant again. In the doctor’s office, Maria remembers the shock of seeing “two circles” on the ultrasound monitor: She was having twins. Later came terrifying news - one of the fetuses could have a heart problem. By then five months pregnant, Maria and Jose rushed to the UMass Memorial Medical Center to see the pediatric cardiac specialist on call. That’s when we met.

FOR AN HOUR that day, I glided an ultrasound probe over Maria’s abdomen and gazed at snowy images on a digital monitor. My own heart sank. Normally, a heart pumps blood first to the lungs, where oxygen percolates into red cells. Then, the heart sends the oxygen-rich blood to the body. But the connections in one twin’s heart were all wrong, so none of the blood could get to the lungs (a condition called “transposition of the great arteries”). That’s not a problem in the womb, since the mother’s umbilical cord sends all the necessary oxygen to the baby’s body. But shortly after birth, when the umbilical cord is cut, the newborn would suffocate and die. Unless, that is, an emergency open-heart surgery was done then to repair the heart defect.

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