I was sitting in my gynecologist’s office, waiting to get my IUD removed so my husband and I can have a baby, when the woman across from me began telling a nurse about her daughter who killed herself the previous year.

“Her first boyfriend broke up with her,” the other patient said. “She didn’t think she’d get anyone else.” 

“Last year? You’re in good shape,” said the nurse. “I’d still be a mess.”

“Not mentally, I’m not,” she replied.

It was just the three of us in the small waiting room. The other patient turned a page in the magazine that she picked up from a side table. I slinked down in my chair and hid behind my cell phone, checking my email over and over again to avoid making eye contact. I didn’t want to disturb their conversation. I’ve been a part of these kinds of discussions before and I know that the polite thing to do is to try to make myself unobtrusive.

The other patient went on. Her daughter overdosed on sleeping pills. Before taking them, she called her ex-boyfriend 14 times, trying to get through so she could tell him that she wouldn’t do it if he called her back.

“She was beautiful, too,” her mother said. “Smart. Nice sense of humor.”

This is a lesson that I never forget: That not all pregnancies end with happy lives, that some beautiful babies grow up to be troubled adults. The leaves on my family tree, with its academic accomplishments and professional successes, mask that the effects of depression, domestic violence, and substance abuse have riddled many of the branches.

One of my paternal great-grandfathers fell to his death from the top of a silo at the age of 50, a likely suicide that his Oklahoma town generously deemed an accident. My grandmother, who said she was afraid that taking medication for her mental disorder would change her personality, once stood over my mother with a knife as she slept, contemplating murdering her in her bed. 

My own childhood was marred by domestic violence and witnessing alcoholism. For years, I didn’t wear jewelry on my wrists because it triggered memories of them being squeezed until they were black and blue—my first experience of abuse when I was 5 years old. I still don’t wear a watch and rarely wear bracelets.

Researchers have found that people with parents or siblings with depression are up to three times more likely to have depression than the general population, likely due to some combination of genetic and environmental factors. Children of alcoholics are up to four times more likely to become alcohol dependent than those with parents who aren’t alcoholics. About 30 percent of people who grew up with abuse go on to abuse their own children.

For those of us who come from troubled families, those statistics can be daunting. I don’t believe in genetic destiny, but by God, I’m afraid it for my kids and myself.

In 2013, I took a genetic test, which said that I, too, carry genetic markers associated with alcohol dependence. When I showed the results to my husband, I said only, “No shit.” I had suspected it since middle school.

The other patient was called into a clinical room before me, and I was summoned shortly thereafter. The nurse instructed me to put on the scratchy pink paper gown. After she took my medical history, she told me to wait for the doctor, who appeared about 15 minutes later. He’s an older man—a father of three grown daughters—and his hands and bald head are dappled with age spots. 

“Now, I tell all my patients this,” he began, pulling on the powdery medical gloves. “Don’t worry if you get pregnant and think, ‘ugh, what have I done?’ A lot of women feel that and the husband’s all excited, and she’s wondering if something’s wrong with her.”

I nodded.

“I’ve already experienced a little of that.”

“It’s completely normal.”

The removal process took only a few seconds.

“Cough,” the doctor ordered from the end of the table.

I worked up a fake cough and felt slight pressure in my side. Moments later, the doctor announced that he was done.

“Do you want to see it?” He asked mischievously. 

I laughed. He had anticipated my morbid curiosity. 

“Kind of!” I said.

He held up the IUD, and it looked like a small, weary cross. 

My therapist once told me that I can’t change what’s in my genes or history, but I’m generally mentally healthy and can control my actions. 

“You’re an adult,” he said. “You get to choose.”

Similarly, my children may be predisposed to depression, suicidal ideation, or substance abuse. They may not. The Mendelian shuffle is unpredictable. My husband and I can’t dictate our children’s genes or actions, but we can make healthy decisions that create safe environments and set good examples for them. We are helpless, we are powerful.

So, I choose where I can. I’m choosing constantly. I try to circumvent situations that are likely to trigger my weaknesses. I go to therapy to manage my anxieties when I’m confronted with unavoidable issues. Aware of my heighted risk for alcohol dependence, I have always tightly controlled my alcohol intake, and I’ll always have to. There are some seeds I must never allow to take root.

And my husband chooses with me. Over our five years as a couple, we’ve learned each other’s vulnerabilities and how to treat them gently. The first and only time he yelled at me, I replied, “You can’t talk to me like that. It’s too scary for me.” Neither of us has yelled since then. Our life together is peaceful. We know that every loving word or act we share is a step toward hope.

As I left my doctor’s office and walked to the metro, I dialed my husband at work. He had asked me to call him after the appointment and let him know how it went.

“IUD’s out,” I told him when he picked up the phone. “It took four seconds. Couldn’t have been easier.”

“How do you feel?” He asked.

“Good,” I said.

And I did. I do.