By Katherine Shaver
Washington Post Staff Writer
Sunday, June 15, 2008
Carolin Ringwall's eyes darted around the room, taking in the infants, toddlers and a teenager whom she had helped bring into the world -- a testament to her 18 years as one of the Washington area's most prominent fertility nurses.
"Oh my goodness! Oh my goodness!" Ringwall, 65, exclaimed as she entered a former patient's home in Northwest Washington yesterday. "Some of these babies I haven't even seen!"
The crowd of about 30 parents and children threw Ringwall a surprise party to commemorate her recent retirement and to show their gratitude for the families she had helped create. Although Ringwall said she "has never done the math," she estimates she was involved in four pregnancies a month. That adds up to roughly 864 children over her career. One partygoer called them "Carolin's babies."
Ringwall's former employer, Columbia Fertility Associates, is one of the region's best-known fertility practices. Its six physicians perform most of the medical treatments, such as surgeries and in vitro fertilizations. But many former patients say it was Ringwall who became most critical in helping them through one of the most emotional experiences of their lives.
While doctor visits came every few weeks or months, they said, they often saw Ringwall several times a week, over months and sometimes years. She drew their blood to test their hormone levels, showed them how to inject fertility drugs, conducted ultrasounds and, if asked, even helped select a potent sperm donor. She called with the happy news when their pregnancy tests were positive, they said, and hugged them or held their hands when the results brought only more disappointment.
Although many doctors' offices make them feel like a number, former patients said, Ringwall knew them by name and remembered details about their families and jobs. She was upbeat and funny when they needed a boost, they said, and frank but compassionate when becoming pregnant proved far more difficult than they'd imagined.
"I think for most of us, Carolin will always be there in our memory when we see our children or even our grandchildren," said Tamar Abrams, 51, who conceived her 15-year-old daughter, Hannah, as a single mother using a sperm donor in 1992. "She's central to the story."
Cathy Harris, 36, said Ringwall kept tabs on her long after she and her partner used a sperm donor to get pregnant with their daughter, who is almost 2.
"She really seemed to care about us and our lives and our children," Harris said.
Fertility specialists are in high demand, particularly as women age, doctors say. Across the country, couples are continuing to marry at an older age, government figures show, and the median age of women delivering their first child has climbed over the past four decades from 21.8 to 25 years old. In highly professional areas such as the District, doctors say, those ages can be much higher, particularly among women who have held off starting a family because of promising or demanding careers.
Ringwall did much of her work with patients who needed donor sperm. Because new technologies have made it easier for heterosexual couples to conceive, Ringwall said, most of her patients were lesbian couples and women who wanted to become single mothers.
Colleagues say her open attitude toward nontraditional families, especially when she started almost two decades ago, made her stand out early. Some fertility doctors still refuse to treat lesbian couples, Ringwall's former patients said, and those who do are sometimes criticized as contributing to fatherless families.
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."