Fatimah Shepherd knew she was not supposed to get pregnant — not now, while her illness was acting up, and maybe never.

Lupus, an autoimmune disease, was gnawing away at her kidneys, and doctors had warned her that pregnancy could tip her into full-blown kidney failure.

But in December 2023, there it was, a positive pregnancy test: two bold lines on the test strip, bright pink and indisputable.

“I almost passed out,” said Ms. Shepherd, 41, a New York City Fire Department dispatcher who lives in Brooklyn and had always wanted a child. “All I was thinking was, ‘What am I going to do?’”

For much of the 20th century, doctors instructed patients with lupus — a disease that strikes women during their prime childbearing years and that disproportionately affects Black, Hispanic and Asian women — to avoid pregnancy at any cost. The miscarriage rate was high, and pregnancy appeared to aggravate the disease.

That advice has changed in recent decades, as treatments have improved. But pregnancy can still be a precarious enterprise, and women with lupus that attacks the kidneys are advised to become pregnant during periods when their disease is stable and has been in remission for six months.

Ms. Shepherd’s disease was far from stable. Her kidney function was so compromised that she had started the process of getting on a waiting list for a donor kidney. A nervous Ms. Shepherd called her nephrologist, Dr. Mala Sachdeva, a professor of medicine with Northwell Health in Great Neck, N.Y.

But Ms. Shepherd recalled: “When I told her my news, she said, ‘Wow! Congratulations!’ And the way she said it, I could finally breathe.”

The doctor told her that pregnancy posed serious health risks, but that she had cared for other women who had done well and given birth to healthy babies. She told Ms. Shepherd, “We’re going to get through this.”

“It was a thing she said over and over again, throughout my pregnancy, every time I saw her: ‘We’re going to get through this,’” Ms. Shepherd recalled.

‘A lot to wrap your head around’

The team of doctors managing Ms. Shepherd’s care at Northwell Health — all women, most of them mothers themselves — met with Ms. Shepherd early in the pregnancy. They described in detail the risks that pregnancy entailed for both her and the fetus, and urged her to think carefully about whether to proceed.

The stress of pregnancy would almost certainly push her into kidney failure, and it could be permanent. Her high blood pressure could escalate out of control, which could restrict the baby’s growth. And she was at high risk for developing pre-eclampsia, a life-threatening condition that might force her doctors to deliver the baby prematurely.

“If her blood had clotting issues, if she had a seizure, then we would be delivering her to save her life,” said Dr. Hima Tam Tam, director of obstetrical medicine at North Shore University Hospital and Long Island Jewish Medical Center

A premature baby also would face risks. “There’s a risk of cerebral palsy; there’s a risk of blindness; there’s a risk the baby might have difficulty with ambulation,” said Dr. Dawnette Lewis, the director of the Northwell Center for Maternal Health.

There was also a risk the baby would not make it at all.

The doctors had several conversations with Ms. Shepherd because they wanted to give her time to process the information. “It’s a lot to wrap your head around,” Dr. Tam Tam said.

But they told her they would support any decision she made.

“And she definitely knew what she wanted,” Dr. Tam Tam said. “I knew that from the minute I saw her. I just wanted to make sure that she knew how long this journey was going to be.”

A room with a view

In January, Ms. Shepherd went on a planned vacation to the Bahamas. But a month later, when she came in for a checkup, the doctors were alarmed. Her potassium levels had spiked, which could cause cardiac arrest. Her blood acid levels were also high, putting the fetus at risk. She needed to start dialysis immediately.

Most kidney failure patients undergo dialysis three times a week. But pregnant women are recommended to have four-hour sessions, six days a week, in order to minimize fluid fluctuations that can restrict blood flow to the fetus. The fetal heart rate is monitored before, during and after dialysis.

Dialysis is exhausting, and Ms. Shepherd would be commuting from Brooklyn to Long Island for her care. All the doctors agreed: The safest thing at that point was to admit her to the hospital.

“We all kind of felt we wanted to just pack her up and take her home with us,” Dr. Tam Tam said.

But Ms. Shepherd had just come for a doctor’s visit; she didn’t even have a change of clothes with her. Still, she trusted the team. “It was their suggestion, but it was my choice,” she said. “And I said, OK, I’m going to do it. If you’re saying this is going to better for my child, I’ll stay here.”

She would remain at Katz Women’s Hospital at North Shore University Hospital in Manhasset for the next five months.

Ms. Shepherd was given a room with a view: on a corner, with large windows looking out over the parking lot on one side, where she could see the hospital staff’s comings and goings, and a small waterfall nestled in a grove of trees on the other.

She decided to make the best of it. She did her hair every morning and got dressed — no hospital gowns for her — and she took up painting. She had dialysis in the afternoons, and spent the mornings walking the halls of the hospital to maintain good circulation in her legs. Darnell Wilson, the baby’s father, came every Friday and spent the weekend with her; family members visited, and her colleagues from the Fire Department set up a rotating schedule of visits, so she was never alone.

When Ms. Shepherd was in her sixth month of pregnancy, she had a gender reveal party in her hospital room. She was having a boy, and she painted her nails blue in celebration. In May, she hired a professional photographer to do a pregnancy photo shoot of her.

“I kept myself busy,” she said. “I would take nice walks around the hospital and socialize with everybody. And I prayed every night and throughout the day. I had to keep a positive mind-set.”

Her doctors were checking her labs daily, constantly making adjustments in her medications and monitoring for any signs of pre-eclampsia. It was tricky, because lupus flare-ups during pregnancy can look like the condition, and when blood pressure spikes, it is not always clear whether it is from hypertension or pre-eclampsia. “You don’t want to deliver someone early because of a wrong diagnosis,” Dr. Lewis said.

“We were scared,” Dr. Tam Tam said, then corrected herself: “We were terrified.”

Ms. Shepherd’s official due date was Aug. 3, but her medical team planned to induce her on July 8, if she made it that far. But at 3:30 a.m. on July 5, Ms. Shepherd went into spontaneous labor, and Baby Oakari was delivered a couple of hours later via cesarean section.

Oakari was a healthy little boy who weighed five pounds at birth. Ms. Shepherd had carried him just short of 36 weeks. It was an incredible outcome: Most women with lupus whose disease inflames the kidneys develop complications and are forced to deliver much earlier, by about 33 weeks.

“She really beat the odds,” Dr. Lewis said.

But she wasn’t quite out of the woods yet.

The fourth trimester

As soon as Ms. Shepherd and her partner, Mr. Wilson, got their hands on an infant car seat, they took Oakari home. Mr. Wilson was on a few weeks of paternity leave, and Ms. Shepherd continued her dialysis treatments, now three times a week instead of six.

But in late August, Ms. Shepherd started having chest pain and shortness of breath. She went to the nearest emergency room, where she was diagnosed with cardiomyopathy, a disease of the heart muscle that develops in rare cases after childbirth, during the period known as the fourth trimester, which is fraught with risk for new mothers.

Ms. Shepherd was hospitalized for a few days, and then referred to Dr. Evelina Grayver, director of women’s heart health at Katz Women’s Hospital for a follow-up. But when she arrived on Long Island for her appointment in early October, Oakari in tow, she was breathing rapidly and gasping for air.

“My nurse, Paula, ran into my office and said, ‘There’s a new patient, and she doesn’t look good — she’s huffing and puffing,’” Dr. Grayver said.

Oakari had started crying, so Dr. Grayver scooped him up and held him while she examined Ms. Shepherd, who was struggling to breathe, and gave her oxygen.

“She told me she thought she just needed to go to dialysis, but I told her, ‘I think you’re going into heart failure,’” Dr. Grayver said.

Dr. Grayver called the transport services to take Ms. Shepherd to the emergency department, while Ms. Shepherd tried to reach her partner. But Mr. Wilson was on a job several hours away, and Ms. Shepherd’s sister could not get to the hospital right away.

“I was worried she would have to go on a ventilator, but the only thing she was worried about was the baby,” Dr. Grayver said.

Dr. Grayver went down to the emergency department, still holding Oakari. He was fussy, so the emergency nurses warmed a bottle for him, and Dr. Grayver sat herself in a corner and fed the infant.

“Fatimah was in such distress, and she saw the baby took to me, and said, ‘You’re so good with him,’” Dr. Grayver recalled. “So I said, ‘Do you want him to stay with me?’”

And that’s what they did. Ms. Shepherd got started on a nitroglycerin drip, and while a bed was prepared for her in the cardiac intensive care unit, she gave permission for Dr. Grayver to watch the baby until a family member could pick him up.

Dr. Grayver kept Oakari with her all afternoon, and her nurse practitioner took him whenever a patient came in. Dr. Grayver was preparing to take him home with her when Ms. Shepherd’s sister came to pick him up. “Just between us, I was secretly quite disappointed,” Dr. Grayver said. “He is such a cutie.”

Ms. Shepherd was fortunate. About one-third of patients with postpartum cardiomyopathy get worse, about one-third stay the same and about one-third improve. Ms. Shepherd improved. “I am beyond happy,” Dr. Grayver said.

Oakari is almost 2 now. He is walking — well, when he’s not running — and loves soccer and picture books and other children.

But Ms. Shepherd’s kidney function did not recover after the delivery. For a while, she hoped that a live donor would come forth to give her a kidney. Organs from living donors last longer, and the waiting time for a kidney can be up to five years.

But on Sunday, at 6:40 a.m., Ms. Shepherd got a call from North Shore University Hospital: A kidney from a deceased donor was available, and it was a good match for her. Could she get to the hospital in an hour?

She did, and by Sunday afternoon, she had a new healthy kidney. It was the ultimate happy ending.

Now she is looking forward to a taking Oakari to swim lessons, and to the many other things she could not do while on dialysis. Most of all, she said, “I want to get my energy back. and play with my son like a normal mom.”

In the middle of a spring afternoon near Lowden-Miller State Forest, Daniel Skinner poured a small pile of dried, yellow corn onto the ground.

Shouldering his .308 Remington rifle equipped with a thermal scope, he disappeared into a camouflaged ground blind in the middle of a cornfield. For eight hours, he waited for a white-tailed deer to approach the bait, hoping for a clean shot.

But the deer stayed away. At 10:30 p.m., Mr. Skinner, the forest wildlife manager for the Illinois Department of Natural Resources, called an end to the day’s culling and met up with several sharpshooters to compare notes. For that day, the tally was one deer among four groups. The same cull, a year ago, killed 10.

Over two decades, Illinois has been one of a number of states that have set up culling campaigns to slow the spread of chronic wasting disease, a strange illness that one expert likened to a “disease from outer space.”

“You would be hard pressed to come up with a disease, even if you were inventing one from scratch, that would be harder to manage than C.W.D.,” Mr. Skinner said.

But in mid-April, state officials decided to abandon the practice. The disease, they realized, had simply become too widespread.

“It’s harder and harder to throw troops at the front line,” Mr. Skinner said. “We’ve gone from one county to two counties to over 20 counties, and our staff has not increased twentyfold. We can no longer make a meaningful difference.”

‘There are no contingency plans’

Chronic wasting disease is a highly contagious, always fatal, rapidly spreading wildlife disease that has bedeviled wildlife managers in North America. It causes the deaths each year, directly or indirectly, of many thousands of white-tailed and mule deer. It infects all cervids — elk, moose, reindeer and caribou — and has been detected in at least 36 states, in Canada and in at least a half-dozen other countries.

Nicknamed the zombie deer disease, its symptoms are agonizing. As neurons die, brain function declines, and the animals slowly lose motor ability, resulting in stumbling, drooling and staring.

C.W.D. is one of a small group of known diseases caused not by bacteria, a virus or a fungus, but by a prion, an abnormal cell protein that causes healthy cells to misfold.

It has never been diagnosed in a human, but experts worry that it will become zoonotic, jumping the species barrier to infect people.

At least one prion disease, bovine spongiform encephalitis (commonly known as mad cow disease), has proved capable of crossing from animals to humans, though human cases have remained extremely rare.

First discovered in wild deer in 1981, chronic wasting disease has been shown to reduce infected deer herds by 3 to 20 percent a year.

The characteristics of prions complicate efforts to contain the disease. They last for years in the soil, absorbed by plants and persisting there.

Researchers are also worried that if the disease spread to species like cattle or hogs, it could endanger the food supply. Mad cow disease caused the deaths of some 230 people and led to a crisis in the cattle industry, as consumers lost confidence in the beef supply and sales collapsed.

A report issued last year by 68 of the world’s top experts on the disease urgently called for more funding and better surveillance to keep C.W.D. from contaminating the food supply and infecting humans.

“The bottom-line message is we are quite unprepared,” said Dr. Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, which prepared the report. “If we saw spillover right now, we would be in free fall. There are no contingency plans for what to do or how to follow up. It’s a slow-moving disaster.”

At a Senate hearing on Wednesday, Senator Raphael Warnock, Democrat of Georgia, criticized Health Secretary Robert F. Kennedy Jr.’s proposed budget cutbacks that include eliminating the prion disease surveillance program at the Centers for Disease Control and Prevention. Georgia alone has 600,000 hunters, the senator said, and their families would be most vulnerable through contact with infected animals.

Hunters have also been advised to avoid eating the meat of infected animals, even though the disease is mostly found in the brain and spine

Besides culling, states have taken a variety of approaches to try to curb the disease: lengthening deer hunting season; increasing the number of deer that can be killed; requiring carcasses to be destroyed. Some allow more does to be hunted to control herd growth and to reduce the potential for mother-to-offspring transmission.

States have also banned the baiting of deer to keep them from gathering and infecting one another.

But so far, there is no known method for eradicating C.W.D. in the wild, “and that’s the problem,” Dr. Osterholm said.

The nature of prions may be evolving. For the first time, researchers were able to infect a mouse that had been grafted with human cells and tissues to mimic human physiology, Dr. Osterholm said.

Other experts are skeptical that the disease will leap to humans. In her lab, Cathryn Haigh, the chief of the prion cell biology unit at the National Institute of Allergy and Infectious Diseases in Hamilton, Mont., oversaw research that created organoids from stem cells to mimic human physiology. They then exposed these humanlike tissues to the disease, as a test for whether the disease was likely to jump the species barrier.

“We literally let them swim in C.W.D. prions,” she said. “They got the biggest exposure you can imagine tissue getting. They didn’t see any transmission. That suggests a very strong barrier, and in the real world, there are even more barriers.”

The $22 billion question

C.W.D. was first detected in deer in 1967 in captivity in Colorado and then in the wild in 1981, and it has been slowly spreading ever since. In March, it was discovered in two white-tailed deer in Gettysburg National Military Park in Pennsylvania.

Yellowstone National Park wildlife managers became concerned after an infected deer was found there in 2023, threatening tens of thousands of elk, deer and moose in one of the most wildlife-rich areas in the United States.

Some wildlife biologists believe wolves may reduce the incidence of C.W.D. by targeting many weak and sick animals, that are likely to be infected, something known as the predator cleansing effect.

Some experts suggest that deer hunting helps to limit the disease’s spread by reducing herd density.

Concerns have been voiced about how the spread of C.W.D. could have a serious economic impact. In many states, deer hunting is a multibillion-dollar industry. Direct spending nationally by big game hunters, mostly of deer, totals $22 billion a year.

“White-tailed deer are put up on a pedestal,” Mr. Skinner, the Illinois wildlife official, said. “For people that hunt, this is the No. 1 game species, and entire economies depend on the hunting of this animal.”

Annual events for deer hunters as well as taxes on equipment also contribute a great deal of funding for conservation efforts.

The issues of C.W.D. and how best to manage it have split the hunting community between those who are concerned about the illness, including some who have quit hunting, and those who think it’s a hoax of some kind. The rock guitarist Ted Nugent, an avid hunter and a gun rights activist, has assailed efforts to contain the disease.

“C.W.D. is a scam by untrustworthy, corrupt criminal bureaucrats that must be defied,” Mr. Nugent said in an email. “The only test that matters and has concluded that we kill millions of deer, eat millions of deer, and nobody has ever contracted C.W.D.”

Many in the hunting community, posting in online forums, share similar views.

But some are being careful. Alan Pierson takes official measurements of trophy deer for the Pope and Young Club, which gathers statistics on deer and other animals killed with bows. He said that he would eat meat that tested positive but took precautions to avoid cutting through bone and brain material.

“No human has ever got it, but I don’t want to be the first,” he said.