At first there were twins, a girl and a boy.
Then one of the embryos divided.
Then it divided again.
And when Laurel residents Katie and Bob Poole returned to their doctor's office in Rockville near the end of January, they were told: Now you're going to have four -- identical triplets and a boy.
"I'm not coming back again next week. There'll be more!" Katie Poole recalls joking to her doctors.
But there was a serious downside to the 33-year-old woman trying to carry quadruplets to term -- a downside that was potentially "disastrous," warned Michael Gallagher, whose practice specializes in high-risk pregnancies. The risks were there with twins, would have been higher with triplets and were especially high with quadruplets.
Not only could Katie Poole lose her entire pregnancy, she also could suffer severe complications, the Pooles were told by Gallagher and his partners at Greater Washington Maternal-Fetal Medicine and Genetics. Two of the babies' umbilical cords could wrap around each other's necks, suffocating one or both. Premature births were likely and might mean multiple babies suffering from a variety of disabilities, including cerebral palsy.
"We sweat," Gallagher said in an interview this week, speaking only after the Pooles gave him permission. "We told her at the beginning, 'Nobody's going to promise you four healthy babies.' "
As the doctors advised the couple of the risks of keeping all four -- and of the possibility of reducing the pregnancy to smaller numbers by aborting some embryos -- the elation that Katie Poole had registered in her journal three weeks earlier seemed suddenly very far away:
"1-2-04 This day ranks right up there with the day your Dad proposed and the day we got married. I am so happy!!!" she wrote when she discovered that the in-vitro fertilization had worked, and she was pregnant. "It's a miracle. THANK GOD!!!!"
On the day she learned they were having twins, she wrote, in blue ink in the green composition book: "1/13/04 Wow -- there are two of you. I am so excited."
Exactly one week later, the journal entries turned more somber, more contemplative:
"1/20/04 We came back from a 9:30 appointment and got an even bigger surprise. . . .
"We were shocked once again," Bob Poole wrote, continuing the journal under Katie's words. "To say shocked for me would be an understatement."
Their doctors agreed it was unusual, but not astonishing. Because in vitro involves so much "handling" of the egg before it is re-implanted in the mother, some doctors theorize that the embryo's "zona pellucida," or covering, has been thinned enough that splitting into identicals may be more likely.
Katie finished that day's journal entry in the upbeat style that her friends, family and co-workers say typifies her optimism: "So in a few months and a lot of prayers later, we will know a lot more, and everything will be great."
"How could you ever choose?" Bob Poole asked his mother-in-law, Martha Burch. There was no way. The Pooles would keep all the babies.
Week to week, the trim, 5-foot-8, 128-pound Katie Poole saw her weight creep up, and up, and up, to 150 pounds, 165 pounds, 180 pounds.
As word spread that the Pooles were expecting quadruplets, their community of friends poured out to help. Bob Poole works as an account executive for Floors Inc., and Katie is director of public relations at Laurel and Pimlico racetracks. During Preakness week at Pimlico, the jockeys got together on "Hot Jocks Night" and raised $6,000 for the Pooles at Mount Washington Tavern outside Baltimore.
"The trainer of Smarty Jones was guest-bartending to help raise money," Katie Poole said.
A car dealership in Laurel cut the Pooles a great deal on a champagne-colored Town & Country minivan. Friends started putting together a list of dinners they could make and drop off, once the babies arrived.
Bob Poole pulled up the carpet in the guest room that was turned into the babies' room, installing hardwood floors and painting the walls green below the chair rail and sky blue above it. He installed shelves for the slew of stuffed animals that kept arriving as presents, and Katie Poole lined up clothes on tiny hangers in the closet.
Her weight kept rising, and the weeks passed. The doctors had anticipated an early delivery and thought the Pooles would be lucky if Katie carried the babies through her 28th week. But the mama-to-be was still carrying at week 32, then week 33, then week 34. Into her 35th week, when she weighed 194 pounds and was carrying four babies who, if stacked end to end, would be 5 feet 10 inches, the doctors decided: It's time for the C-section.
Time to see what 81/2 months of gestation had created -- and which was right: the doctors' pragmatic concern or the couple's hopeful faith.
'After You, Ma'am'
At 9 a.m. July 27, the Pooles arrived at Shady Grove Adventist Hospital in Rockville, and at 11:05 a.m., Mackenzie Margaret Poole was born: 3 pounds and 15 ounces. At 11:06 came Gabrielle Grace at 3 pounds, 5 ounces; 11:07 brought Danielle Renee, at 3 pounds, 11 ounces; and at 11:08, the lone boy, Robert Edward Poole III, arrived: 4 pounds, 13 ounces.
"He let all his sisters out first! He was quite the gentleman: 'After you, ma'am. After you, ma'am. After you, ma'am,' " Katie Poole said, sitting on the floor of the couple's Laurel living room this week, feeding a yellow-blanketed Danielle her bottle. Mackenzie, wrapped like a burrito in pink, slept nearby while Bob Poole fed little Bobby, whose blue cap was embroidered with a train.
"I'm dying to find out the color of their hair, the color of their eyes," said Martha Burch, Katie's mother, as she leaned into Bobby's face, making goo-goo eyes at him.
Katie said she knows that the relative ease and quiet of this week -- the second of the babies' lives -- is something to appreciate. They still sleep most of the time and haven't started wailing for bottles and diaper changes (Bob Poole calculated that they should go through 900 diapers a month) and attention.
They will grow up fast enough, requiring four highchairs for feeding and two twin-seater strollers to leave the house. A friend looked into a four-seater stroller for them, Bob Poole said, "but it cost $500 and was on back-order."
Katie's mother stared at the babies and suddenly announced, "Kate! Kate! They all have your nose." She paused. "It's a strong nose."