After her husband and parents said their last goodbyes and after a priest offered a prayer -- words about weeping in a valley of tears -- Susan Torres, her improbable mission accomplished, was unhooked yesterday morning from the machines that sustained not only her body but that of her baby for the past three months.
The 26-year-old Arlington woman, who was felled by cancer and declared brain-dead in May, but who gave birth by Caesarean section Tuesday to the girl she had hoped for, died shortly thereafter. It was the end her family knew was inevitable, but it was no less difficult to fathom.
"We are thrilled with the baby, but this is a very difficult day," Justin Torres, Susan Torres's brother-in-law, said at a news conference at Virginia Hospital Center in Arlington. He added that years from now, he would certainly tell his niece about the woman who brought her into the world.
"I'm going to tell her her mother was one of the toughest women I've ever met, that she was absolutely determined in what she did. . . . And that, 'You cannot believe how many people fought for you,' " he said.
Jason Torres, who slept by his wife's side for three months, whose cell phone still carries her voice and who made the final decision to unhook the machines, stayed away from the cameras and crowds of reporters who had come to the hospital to find out, among other things, how his new daughter, Susan Anne Catherine Torres, was doing.
The answer, a team of doctors said, was pretty well.
At a gestational age of 27 weeks, at 1 pound 13 ounces, the baby came out crying, kicking and "very vigorous," said Donna Tilden-Archer, medical director of neonatology at the hospital. The infant is breathing on her own, receiving supplemental oxygen and pressure to keep her tiny airspace open. Her heart appears normal and is beating regularly.
An initial examination of the placenta showed no signs of the melanoma that had spread throughout Susan Torres's body, and further microscopic testing is being conducted, said Christopher McManus, the attending physician. There is no way to say for certain whether the baby will develop melanoma. In similar cases in which the placenta is afflicted with melanoma, babies develop the cancer less than 25 percent of the time.
The baby's premature birth presents additional complications, such as immature digestive, respiratory and immune systems, but again, Tilden-Archer said, the child who had about everything going against her now has statistics on her side: Babies born at 27 weeks survive about 90 percent of the time. "We are ecstatic she is here," Tilden-Archer said, "and that she seems to be healthy."
The decision to deliver the baby came somewhat suddenly, nearly three months after Susan Torres lost consciousness, was declared brain-dead and was left on a ventilator, IVs and other machines in the long-shot hope her baby might grow faster than her cancer.
Torres had had melanoma as a teenager but had long been given a clean bill of health; doctors said the melanoma apparently lay dormant for those years.
By the time she reached the hospital, doctors said, the melanoma had metastasized in her brain, and she was declared brain-dead within days. The cancer eventually spread throughout her brain, her lymph nodes, her lungs, her adrenal glands and her liver, and it had begun to spread even more quickly in recent days. Then her blood pressure dropped, her heart began beating irregularly and her white blood cell count spiked, raising concerns about infection.
After three months, it seemed that all the sophisticated machinery medicine had to offer could not overcome the momentum of her body. Ultimately, said Rodney McLaren, medical director for maternal-fetal medicine at the hospital, the risks of keeping the baby in her mother's womb outweighed the risks of delivering her prematurely.
And so, on Monday night, the decision was made.
About 7 a.m. Tuesday, Susan Torres, who had been a microbiologist with the National Institutes of Health, was wheeled into an operating room. Jason Torres and her parents were outside, and when the baby came, they were able to see her through a glass window, doctors said. She is 13.5 inches long.
Justin Torres said it was a wonderful moment and that his brother, who had not slept in days, was overjoyed. Everyone "took a real deep breath," he said, adding that Jason marveled at the size of his little girl's fingers and feet.
At the same time, Justin Torres said, "we knew what was coming next."
Only 12 similar cases have been reported in the medical literature since the 1970s.
Jason Torres met his wife in college and has said that he always admired her competitive spirit and strong will. The couple had a son, Peter, now 2, and were happy to get the news that another baby was on the way. When Jason Torres made the decision to try to save the baby in May, he was certain it was what his wife, who refused testing for birth defects, would have wanted.
In the months that followed, he slept by her side, held her hand and talked to her and their baby. He accepted the doctor's diagnosis that his wife had no hope of recovery, but talking made things a bit easier, Justin Torres has said.
Other things did, as well. Yesterday, Justin Torres said that the family, which is Catholic, had "literally been lifted up in prayer."
He said that he and his brother would sometimes sit in the intensive care unit and read letters sent from around the world and down the street. Besides money to help with staggering medical bills, people have sent such items as baby blankets. A woman sent them a series of photos of her baby, who was born at 26 weeks, showing how she grew up healthy and strong.
Yesterday morning, Torres said, his brother made the decision to turn off the ventilator and machines. The Rev. Paul Scalia offered Susan Torres the last rites of the Catholic church and said a prayer, "Hail, Holy Queen."
"Her passing is a testament to the truth that human life is a gift from God," Justin Torres said, "and that children are always to be fought for, even if life requires -- as it did of Susan -- the last full measure of devotion."