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Career Results: The Families in the Room

Abrams, who works for a nonprofit organization, said she worried in the early 1990s that fertility doctors wouldn't want to help a single woman have a baby. Still, she said, "Carolin made it feel so natural and so appropriate."

Ringwall said she simply believes in a basic right to have children. She wanted to become a mother so much, she said, that she would have used a sperm donor if she hadn't married. She's divorced with two grown daughters and two granddaughters.

"I think if someone wants to have a kid," she said, "then have a kid."

However, she said, she readily admits to violating a cardinal rule of nursing by becoming "too familiar" with her patients. "I threw that out the window a long time ago," she said. "People need a friend as well as a clinician, especially in this situation."

Colleagues said they frequently overheard Ringwall on the phone with health insurance companies, arguing loudly that they should cover a greater share of patients' costs, which can easily soar into the tens of thousands. After several patients told Ringwall that a pharmacy chain had given them the wrong medication, "she called and told off the pharmacist," said Lynn Warden, another nurse at the practice. "Then she went right on and called corporate."

Although Ringwall vigorously advocated for her patients, Warden said, she also leveled with them when necessary. Columbia Fertility doctors said they don't keep statistics, but Ringwall estimated that more than half of all patients walk away with a baby. That leaves a significant percentage who don't.

"She didn't pull any punches," Warden said. "If you were getting to the point where you were just too old, Carolin was going to tell you. If they were holding on to a little bit of hope, she could tell people when to let it go."

Ringwall said she is concerned that many women wait too long before trying to conceive, ignoring the "deadline" for their aging reproductive systems. Still, she said, she will never forget the feeling of helping a struggle end in success.

"I imagine it's kind of how an artist feels when his work sells for a million dollars," Ringwall said. "Especially when you've worked with someone a long time and know the hoops they went through to get there, and then you see this child. It's just amazing."

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