Only the short fluorescent bar over the sink was lit; most of the room fell into brown shadows. The placenta in its pink tub had been carried away. The sterile instruments were gone, and the deep-blue cloths. My bed projected into the room like a high, narrow bier. I was supposed to be resting. I felt tranquilized, or stunned. I didn’t picture anything—what the baby looked like or where she might be, or even Fred walking down the hall toward me, though I was waiting in this blank place for him to return. I did not think, If the baby has a problem I will feel x9 if the baby is fine I will feel y. I could not imagine what was taking so long for Fred to come back, or anyone to bring me news, and I did not try to imagine. The nurse had cleaned up the room nicely, gathering bundles of bloody cloths, directing an orderly to mop the circles of blood on the floor. She’d placed a cup of ice water next to the bed. Now she sat in a low armchair, going through papers, making a note here and there. I closed my eyes. A wide fan of light opened them—Fred was back. He held my hand. “She’s on a respirator,” he said.
I struggled to sit up halfway. “It’s breathing for her.”
“The doctor said?”
“He said we have to wait and see.”
The room—with its beige walls, reflective beige linoleum tiles, vinyl-upholstered chairs, steel sink—felt sealed, too neutral. A good thing could happen here, or a bad thing. The room didn’t care, the room wouldn’t show a trace of it. I wanted out.
The blankness I’d kept so willfully had narrowed into a narrative line: First the baby was carried away by a nurse to be suctioned and cleaned up, then she wasn’t brought back to me, and now a machine breathed for her. Where was the line going? What would the history be? I was in a train accident once, a derailment outside of Philadelphia, and what happened wasn’t the worst—the car turned on its side and was dragged along the tracks. The sensation of hurtling without limit had scared me most. “Maybe we should call my mother,” I said. She ran the Washington, D.C., office of a pharmaceutical company. “She could call someone for advice.”
“Right,” Fred said, then whispered, “It’s not as if Bismarck Hospital has a good reputation.”
When he left, I went into the bathroom yet again and commanded myself to pee, and finally I did. I would be released into the outside light soon.
“How much do you think you did?” the nurse asked.
I wondered how much I was supposed to do, and how you could calculate such a thing. “A quarter cup.” That was an acceptable amount—she disconnected my IV line.
She called in the delivery nurse, who came in with Dr. Gregg. They picked up a clipboard holding birth information and a post-partum recovery checklist. Vital signs were stable, bleeding was normal, and voiding had been accomplished. The delivery nurse, plump, with short curly hair and round-framed glasses, resembled a child’s stuffed owl. She’d spoken to our childbirth class for an hour on the process of labor. We must have looked nervous, listening closely, our chairs arranged in a perfect U. So serious, she’d teased us: You’ll all survive. Now she ignored me. “You sign off here,” she said to Dr. Gregg, raising the clipboard up high. Dr. Gregg held her body tall. Her straightened hair was styled in a smooth cap, her dark-brown skin gleamed. She hadn’t spoken to me, except to say, Don’t push yet. She tilted down and signed. I rested on the bed, watching them. They talked to each other as they left the room. Why didn’t they speak to me, I wondered. Did they know how my baby was doing?
The delivery nurse came back in with a wheelchair, smiling, and said she would take me to see the baby. I said, “My husband’s on the phone. He’ll be right back.”
She said, cheerfully, “Oh, let’s go now.” She helped me in and put a blanket over my legs. The skin of my arms was mottled pink with cold; I’d always disliked the transparency of my skin. Did we have to go now because the baby might not survive another five minutes? She pushed me into the hall. The rubber wheels on linoleum made a seamless whispering sound. The hall was empty. It was after 10 o’clock; the baby had been born two and a half hours before. We turned a corner and there were windows into a room on my right. She pushed me through a doorway into a reception area outside the intensive care nursery. I sat up straighter in the chair. “There’s your baby,” she said and pointed to a group of people in front of a high table.
Fred appeared beside me. “There she is,” he said, and held my hand. He’d already been here. She lay on her back, with her limbs splayed and a thick plastic tube rising out of her mouth and curving away to a machine. It was hard to see, because the table was high, and on the other side of a window, and people dressed in blue scrubs clustered around adjusting machinery that flanked her table. Bright light shone down on her, on her body laid out flat, punctured with tubes. I couldn’t see what her face looked like; I couldn’t really see her hair.
The supervising nurse sat on a stool in the nursery, writing notes to be inserted in the medical record, which we would read months later. Our names were Fred and Kathryn; we were married, and English was our primary language. There had been no complications of pregnancy; the baby was delivered vaginally, with a delivery complication of meconium. The baby had grunted and flared her nostrils in an effort to breathe. Her body had been pink but her face was still blue when she arrived in the ICN. The baby could move all of her limbs, and was active, with a weak cry. Her immediate equipment needs were a ventilator and a warming bed.
“You can’t go in right now, her settings are still being adjusted,” the unit assistant told us. His blowdried yellow hair gave off a lacquered shine. He held a black telephone receiver with his shoulder. “Come back in a few, you can sit with her,” he said, then talked into the telephone. The anteroom was crowded with equipment, trash barrels, a scrub sink, a water dispenser; there was hardly room for the
wheelchair. I felt I would cry. I turned to Fred at my side and said, “Let’s go now.” Then I looked down at my lap so as not to see any more. He wheeled me out backwards, and down the hall.
We passed through the open central area of labor and delivery, where nurses watch the bank of monitors, and returned to the labor room to gather our things. Then a nurse led us to maternity room 314B, at the end of a hallway, and directed us to a bed at the right of the door. I had a wall lamp with an adjustable arm, a rolling bed-table, a sink. I’d never checked into a hospital room before. There was a box of tissues, a mauve plastic sitz bath, a one-quart container to drink out of with a straw, individually wrapped medicated tow-elettes, a squirt bottle, soap, a washcloth and towel, a box of surgical gloves for perinea! icepacks. Fred went to fill a glove with ice. On the other side of the room was a bed with a dark-haired woman asleep in it. Parked next to the bed was a clear plastic bassinet on wheels, in which a tiny baby wearing a knit cap slept. An empty bed was at the back of the room. Fred brought me the glove, lumpy with ice. We whispered. He pulled the white curtain that hung from a track in the ceiling. The room was awkward with too much furniture. Fred moved my visitor s chair to the foot of the bed so I could get to the bathroom more easily. He hung up my robe, put my hairbrush on the shelf, and filled the water pitcher. I asked for my ragged old bear, and hid it under the bedsheet. I used the bathroom, which was as small as a bathroom could be. I’d studied architecture, and I pictured the architect drawing the plan with a template, placing the toilet rim just 30 inches from the shower stall, the minimum allowable space. As instructed, I sprayed myself with the squirt bottle, then used a towelette instead of toilet paper. I ran it lightly over the stitches, feeling a large swollen ridge. There was so much blood in the toilet. I unhooked the bloody pad, threw it away, and attached a fresh one. The elastic of the belt was soaked with blood near the hooks. I pulled up my underwear, which helped hold the pad in place. I took a few careful steps out into the room to the bed, picked up the ice glove, and eased it into place. I walked to the wheelchair outside the door and sat down, with my weight on one side so as not to sit directly on the icepack. Fred put a blanket over my legs.
We rolled down the corridor, past the shut door of Labor Room I, around a corner. I felt awake, and more in control after having arranged my belongings in the room. The intensive care nursery wouldn’t be a shock the second time. From the nursery anteroom I could see her, alone now, on the high table. We washed our hands at the scrub sink, for the required five minutes for first-time visitors, then put on puffy yellow paper gowns. Fred wheeled me in. A pink card taped to the wall had “Baby Girl Rhett” written on it. She was almost four hours old. Light shone on her from two warming lamps mounted above the bed. She lay on her back, eyes closed, with a tube coming out of her mouth, strips of clear tape on her upper lip holding it in place. Her nose was unobscured by tape—it was so perfectly modeled, whole and unharmed. Dark brown hair matted against her head. A skinny tube curled out of her belly button. An IV was taped onto her right hand. An unfastened disposable diaper lay under her. Her left foot was wound with gauze, which held a round red light in place. The table was at chin level for me in the wheelchair, and had six-inch-high clear plastic barriers around the sides. I leaned closer. A man’s voice behind me said, “You can touch her.”
It was Dr. Hanover, stout, red-faced, white-bearded, in scrubs, who leaned against a sink and watched the baby. We introduced ourselves. He didn’t say much, but seemed friendly enough, though his big hammy arms stayed crossed on his chest. He explained that the baby had aspirated meconium deep into her lungs, and that her lungs had stopped working. The respirator breathed for her. She was being given a glucose solution through one IV for nourishment, and antibiotics through another to prevent infection.
“Meconium is nasty stuff,” he said. We nodded silently. She looked exposed, with no diaper or T-shirt on, no cap or socks, no blanket. We all watched her, her chest moving up and down rapidly. He told us she’d probably need a blood transfusion. “We’re giving her morphine, too.”
I turned halfway around in the chair. “Could she die?”
With his arms still crossed, he shrugged his shoulders. “Yes,” he said. He drew out the word as if to qualify it. “We have to wait and see.” He left the room.
The nurse gave us an information packet about the ICN. As we sat by the baby’s bed she went back to her clipboard, where she filled in our names on a checklist about impaired parent-infant attachment due to -hospitalization. Parents should demonstrate a parent-infant attachment by: holding/touching infant, calling infant by name, and making eye contact with infant. On a separate sheet, under the heading of Parent Contact, she wrote that both parents were at the bed-side for a short visit. We appeared calm at this time, but seemed to understand the situation. We had talked to the baby and held her hand. We’d both stated that we understood the baby’s present condition. Under the heading of Nurse’s Notes, she continued her detailed description of the baby’s status and treatment, how what they were suctioning from her breathing tube at regular intervals was turning from meconium to bloody secretions, from hemorrhage of the lungs. At 11 o’clock she wrote that the baby was asleep and quiet, and signed off for the evening.
We had to leave for change of shift, when one nurse would go off duty and another would come on for the overnight shift. “Please rest,” I said to the baby. “We’ll be back to see you soon.”
“Good night honey,” Fred said. He swiveled my wheelchair around, and pushed me out. We took off our yellow gowns, put them in the trash container, nodded to Dr. Hanover, and turned out of the anteroom.
“What do you think?” I said to Fred.
He sighed. “You need to sleep.”
I’d only slept a few hours the previous night, between early contractions. There were two parents’ rooms opposite the nursery, but both were occupied. Fathers were not permitted to sleep in the maternity rooms, so Fred would sleep in a waiting room near the ice machine. He wheeled me down the dark hall to my room. I felt overwhelmed by tiredness and pain. Whereas earlier I’d chosen not to think ahead, now I was unable to think of the future, of what her machines and tubes and needles foreboded. I would sleep first, think later. Fred helped me into bed. I lay on my side, the position that worked best to keep the icepack in place. He pulled the sheet and blanket up to my shoulder, kissed me on the forehead. “I’ll be back soon,” he said.
Mary Lee, a maternity ward nurse on night shift, described me in her notes as resting comfortably in bed, and in stable condition.
“The patient,” she wrote, “denies any discomfort at this time.”
“I’m sorry to wake you,” a voice said, “but I’ve got to take your vitals.” It was midnight. An obstetrician put a thermometer in my mouth and took my blood pressure. She turned down the covers, put her hand under my gown, and pressed her open hand on my abdomen. “Feels good,” she said. “Are you massaging that?”
“Some,” I said, which was almost a lie, since I’d practically forgotten about my uterus. She said someone would come in a while to show me how to use the breast pump. She left. I wondered how long a while would be, and if I had to wait in the room so as not to miss this breast pump person. It occurred to me that nights were like days to the night shift staff, that they scheduled appointments for 2:30 a.m., 4:15. How odd this was for the patients.
At 12:30, Mary Lee took my blood pressure. “How are you feeling?” she said.
“Sore. I think I need more ice.” She left and returned with a fresh ice-glove. The ice-gloves worked, though they seemed primitive. I tried for a few seconds to arrange the rubber ice-fingers so they touched my stitches. God, if I could just move the thumb off my thigh, I thought in frustration, and almost burst out laughing.
Mary Lee was serious. “Your baby is in the ICN?” she asked softly.
“Yes,” I said. Mary Lee went back to her desk in the hall. She wrote, “Encouraged patient to express her feelings,” an action required by the nursing protocol, in the case of an ill infant. “Patient stated baby was in the ICN,” she wrote.
Fred appeared at the door. “Can’t sleep?” he whispered, almost hopefully.
“I can’t,” I said. He helped me out of bed.
We were hungry. The maternity ward slept. A few nurses made notes on pads at their desks in the hall. Their reading lamps lit only the surfaces of the desks, and glinted off one nurse’s eyeglasses. We went through double doors and turned left to the elevators. Two floors up, there were vending machines for juice, coffee, candy bars and gum. A machine with revolving shelves offered yogurt, pastries, sandwiches.
“How much money do we have?” I asked.
“Get whatever you want.”
I said, “I don’t know what I want. What do you want?”
“I want a burrito.” He pushed coins into the machine. “And a raspberry seltzer.”
“That’s not really seltzer, it’s full of sugar. You don’t want that.”
“I want it. What do you want?”
In the adjacent snack bar the chairs were up on tables, and a janitor’s bucket and mop stood on the floor. We took our drinks and straws, napkins and food in crackling plastic back downstairs, to Fred’s waiting room. He turned on the lights and shut the door. We sat underneath a television set that winged out from the wall like an enormous dental instrument. We ate, with solemn concentration. We asked, “Are you all right?” to each other and said “Yes.”
“Piece of cake,” Fred said, with a short laugh.
“No problem,” I said. “I’m so glad we took that childbirth preparation class.” Then laughing burst out of us and we couldn’t stop. I laughed hunched over in the wheelchair, tilted sideways and holding my stomach, and Fred laughed with his head thrown back, wiping lettuce shreds from his mouth. The carpeted walls seemed to absorb and deepen the sound.
“Nearly dead baby,” Fred sputtered.” They ought to do a film on that.”
“With a respirator scene—we had no idea what to expect.” We were gasping.
“Shush,” I said finally. “I have to pee.” I went to the bathroom. I’d been drinking water all night. Fred sat soberly on the couch when I came out. “It’ll be okay,” I said, touching his shoulder.
Fred wheeled me to my room, and returned to his waiting room. I woke to light and voices at 2:30. “The baby was soaked.” An unfamiliar nurse scolded the woman in the other bed. “You’ve got to get up and change him.” The curtain between us was partly drawn. The mother was half-sitting up, and a nurse held the baby. The mother protested in a soft, foreign-accented voice, maybe Middle Eastern. Her long hair was falling out of its bun. She sounded exhausted. “Well, he was wet through,” the nurse declared. “And now he’s hungry.” The baby squalled, though not loudly. The nurse thrust him at the mother, and returned to her post outside the door.
I needed more ice, but I didn’t want to ask the crabby nurse. I got out of bed carefully, without sitting up, and put on my slippers. I shuffled in short sliding steps down the hall. It wasn’t too difficult. I could walk, wasn’t dizzy. At the tall aluminum machine, I filled a glass with crushed ice, then crossed the hall to use the sink and counter space, where I dumped ice in the glove, working some into each finger. I twisted the open end and wrestled it around my finger to tie it like a balloon. I felt competent, myself again. I eased open the waiting room door. Fred slept curled up on his side on the couch, his arms crossed. We’d brought a blanket his grandmother knit to the hospital and this lay over him. I pulled it up to his shoulders. I didn’t want to wake him. I closed the door behind me and shuffled back to my room. The woman slept. Her baby slept again in his bassinet. I slept, comfortably, according to Mary Lee.
At 3:30 I woke up and got out of bed. Fred came through the door as I was putting on slippers. “You’re awake,” he said.
“The nursery?” He helped me into the wheelchair in the hall and we went quietly down corridors and around corners.
As we passed Labor and Delivery, I whispered, “We should name her.”
Fred stopped the chair. “So soon?”
“What if she died without a name? It would be cruel.” Her spirit could pass from us, unclaimed, I thought. Unloved.
Fred stood in front of me, staring off to the side. “Maybe we should wait.”
“Until we know.”
“No.” We were immobilized in the hallway He thought naming her would finish her, close her like a box. He wanted to preserve an uncertainty for her. The gravestones of infants always had names. “We need to welcome her,” I insisted. “Call her to us. She’s our child”
“Will it be Cade then?” he said tiredly.
I conceded him that. He got behind the wheelchair and pushed. I wished for Lucy, or Jane, but Fred didn’t like those names. We’d recently agreed on Cade, my maternal grandfather’s middle name, with Emery, my father’s and my middle name. Fred’s family would be represented by the last name, and both sides of my divorced family by the first and middle names. Something for everyone. But what about something for her? We arrived at the brightly lit anteroom of the ICN. Fred pushed me up to the sink, and we scrubbed and gowned. The nursery was dark except for reading lights, monitors and the baby’s warming lamps. She lay on her back, her head turned to the left. The nurse stood, smoothing down tape around an IV on the baby’s hand.
“How is she?” Fred asked.
“She’s hanging in there.You all should get some rest.”
“Can’t sleep,” I said.
“It’s hard” She retreated to her chair.
We each put a finger on the baby’s right hand, avoiding the taped-down needle. Fred whispered, “We name you Cade Emery Leebron,” and I repeated it. “We love you,” he said. Did we love her, I wondered. How much? What sort of love was it?
A young woman in blue scrubs approached the bed. “You must be the parents,” she said. “I’m Karen Lu.”
“Dr. Lu is the resident here,” the nurse said.
Dr. Lu smiled and ran her fingers through her short hair. She’d been working for 20 hours. “She’s breathing more easily now than a few hours ago, so that’s good. We’re trying to stabilize her, and it looks as if she’s heading in the right direction.”
“Good” I said.
“Its difficult to say right now,” Dr. Lu said quickly, as if she were anxious not to mislead us. Her expression fell into a bland smile again. She was short and stocky, with a wide face, unwrinkled skin.
“Of course,” Fred said. “We understand.”
“Dr. Hanover explained we would have to wait and see,” I said.
“That’s right.” Dr. Lu looked relieved. “I was just going to check her breathing tube.” She stood still at the head of the bed.
“Oh,” I said, after a few moments. “Should we go?”
The nurse wrinkled her nose. “It’s best. Did you get an orientation packet?”
“Earlier, we did” Fred said.
“Usually when a procedure is performed, we ask that the parents leave,” the nurse said.
Fred leaned over the bed and whispered, “We’ll see you in a little while, sweetie.” He touched her forearm.
“Mom and Dad love you,” I said. I reached over the barrier to touch her, too. He wheeled me out.
My blood pressure was taken at 4:30, and then I slept until 6 o’clock, at which time Mary Lee noted that I was ambulatory in the hallway, walking with difficulty. I met a nurse wheeling a contraption toward me, and followed her back into the room. She stood next to a square metal box screwed onto a cabinet with wheels, the kind of functional blondwood cabinet you might see in an elementary school classroom. “Why don’t you sit in bed,” she suggested. She tore the paper cover off of a plastic box and began handing me things: clear rubber tubing, a funnel, a cup. I should pump for a few minutes on each breast to start, every hour or so, the nurse said, to encourage my milk to come in. By the afternoon, I should be pumping for 15 minutes on each breast every three hours. Watching TV might help me to relax. The nurse left. I fell asleep until 7:30.
The stitches hurt. A nurse’s assistant brought me an ice-glove. I worked the clicker near my pillow to raise the back of the bed. I could sit with my weight on one side. By leaning way over to the left, I could just reach the breast pump cabinet and maneuver it close to the bed. I attached the tubing to the pump and turned it on. Rroom, rroom, rroom, it ground out in rhythmic efforts. Hesitantly, frowning, I brought the funnel to my breast. Rroom, rroom, rroom—the nipple got pulled out toward the narrow bottom of the funnel. It didn’t feel so bad. I checked my watch to time five minutes. Maybe it hurt a little. I turned the dial back to “minimum “ A few yellow drops emerged and meandered unimpressively into the collection cup.
Breakfast arrived in an airline-style cart. The clatter of plastic trays woke the baby in his bassinet, and he cried a baby-cat cry behind the half-drawn curtain. His mother painfully eased her way out of bed. She looked over at me. “Caesarean,” she said. “The stitches.” She lifted her baby from the bassinet and held him against her shoulder. The orderly pulled the breakfast cart backwards out of the room, and then the doorway was full of people: another mother, a nurse, a tightly swaddled baby sleeping in a bassinet, and a husband. The nurse helped the woman into the bed at the back of the room. She pulled a long curtain across, blocking my view. I would have to pass through a corner of her area to get to the bathroom. I ate the sticky bun, cereal with milk, scrambled eggs and toast. I drank juice. it was lonely to be in this room without Fred. As if I’d been packed off to a strange overnight camp, I wanted to be sporting—eat the food, act cheerful, follow the schedule—but I really wasn’t in the mood to be a good patient, a nice patient, a patient at all. Was I supposed to make friends with my roommates? The mother next to me watched TV, with the volume on high. The newest mother’s husband talked excitedly into the telephone, in an unfamiliar language. I wanted to go home.
We visited Cade in the nursery, becoming marginally aware of the system of protocol, technology and personnel that we were now a part of. We got used to washing our hands at the large white scrub sink with red liquid soap, and fastening the yellow paper gowns. I put my hair back in a ponytail before I went in. We sat by the side of her table-bed, me in a wheelchair and Fred on a stool. Dr. Hanover had told us to touch her and speak to her because she recognized our touch and voices, recognized that we weren’t there to hurt her. Everyone else who touched her moved her breathing tube, or inserted needles. Fred reached over the plastic barrier and touched her arm. “Hi, Cade,” he said. “Your mom and dad are here.”
“We’re here with you, sweetie,” I said, smoothing her hair, which had dried in stiff points. A machine beeped, rapid high-pitched tones, and we both started and pulled our hands away. What had we done?
The nurse jumped up from her stool, looked at the baby, and hit a black button on a monitor hung near the foot of the bed. We stared at the black monitor screen, two sets of red glowing numbers. “What happened?” I said.
“That’s the heart rate and blood pressure monitor,” the nurse said. “Her blood pressure dropped.”
“Because we were touching her?”
“It would probably be best if you didn’t disturb her now.” We kept our hands in our laps. The blood pressure climbed. From then on, we restrained ourselves and gently touched her hand with our fingertips and whispered when we arrived and left. Surely we could at least let her know we were there.
The machines were bewildering at first. I thought about my sister-in-law Betsy, whose second son had been born early and put on a respirator. I would have to learn these machines and ask questions and be my baby’s advocate, as she had been for Jonathan. The respirator near the head of the baby’s table showed how many breaths per minute she was being given and the percentage of pure oxygen she was getting: 90 percent, as opposed to the air we breathe, which is 20 percent oxygen. Halfway down the bed, there was an IV cart with a bag of clear glucose solution hanging from it and a digital monitor the size of a television remote control that showed how much solution had been given.
The doctors, nurses and respiratory therapists all introduced themselves to us and encouraged us to come back when we left. We were aware of being in the way, though, our chairs blocking the narrow space between Cade’s bed and the sink; everyone had to pass through this space to get into the room. People squeezed past us to attend to the other baby in this room of the nursery, or to get to Cade, to wash their hands, to use the telephone, to get supplies from a large wall cabinet. We came and went, donning and discarding yellow paper gowns. It was Wednesday morning. Cade had been born 12 hours before, on Tuesday night.
We met with Dr. Beckman, the neonatologist on duty that day. He brought us into the office across the hall from the nursery, sat us down, and explained meconium aspiration and persistent fetal circulation. He quickly sketched the lungs, with blood vessels, on a pad, and explained that as blood passes through the vessels of the lungs, it is oxygenated. When our baby inhaled meconium, it went deep into her lungs and caused an immediate system shutdown. Her blood vessels clamped shut, and they still hadn’t relaxed open. As a result of the clamping shut, her body had reverted to a pattern of breathing she’d used in the womb, a pattern that wouldn’t work outside the womb, without an umbilical cord. This condition was called persistent fetal circulation, or persistent pulmonary hypertension. They had to try to get her blood vessels to open, which often was just a matter of time. Meanwhile, the respirator forced oxygen to circulate through her lungs. She was also being treated for pneumonitis, a chemical condition of the lungs, caused by the toxicity of meconium. It seemed like a lot of information to absorb. But we liked that Dr. Beckman sat down with us and talked. Unlike Dr. Hanover, he assumed we could understand him. Fred and I sat next to each other and looked at the sketches and asked questions.
Dr. Beckman asked if I’d had difficulties in labor, since babies typically excrete meconium when they are in distress before delivery When I described the epidural anesthesia with my blood pressure drop and fetal heart rate drop, he said, “Your blood pressure dropped to 72 over 40 and they proceeded with a vaginal delivery?”
“Yes,” I said. We stared at him, but he busily wrote on his pad. I thought of my baby waiting—in distress, in meconium-filled amni-otic fluid—two and a half hours for the drug to wear off and me to push her out. Dr. Beckman made no further comment on her delivery. In the months to come, we would discover that the doctor who delivered Cade was an intern, three weeks out of medical school, and that Cade’s injury had been preventable. We would meet with attorneys, and read through the 250 pages of hospital records that were being created now as nurses, doctors, lab technicians and respiratory therapists wrote laborious descriptions and entered test results.
Beckman outlined steps “down the road” in treatment. They would try to stabilize her, but in the coming days, they might have to use pavulon, a paralyzing drug, to prevent her from fighting the respirator. It was an excellent sign that she wasn’t on pavulon now. They might decide to use dopamine to raise her blood pressure. A last resort would be a lung bypass machine, called ECMO, at UCSF Hospital, across town.
Fred leaned forward. “What kind of treatment time frame are we looking at?”
“If everything went well,” I said.
He opened his hands and shrugged. We all just had to wait and see if she lived. The “if she lived” sounded overly stark and dramatic—even in my thoughts, I wanted to substitute more clinical language, such as “wait and see if she responded.”
We were visited by the birth certificate registrar, in my hospital room. He had the air of a traveling salesman, proceeding buoyantly from bed to bed with a large briefcase. He pulled up a chair to the side of the bed, took out a form, attached it to a clipboard, and set to work filling in blanks and black-bordered boxes. After we’d named Cade the night before, we hadn’t discussed it again. I wasn’t sure I liked it. But now we had to give our baby her official name, so we said Cade Emery Leebron, and he filled it in, along with the birth time, 7:24 p.m., July 28, 1992, and birth weight, 7.1 pounds. This transaction felt slightly unreal. He put the form in his briefcase, shut it, and clicked the brass latches. “You all call Public Health in three weeks, give or take,” he said. “You can go pick it up.”
“Great,” Fred said.
“Any problems, call me.” He snapped his fingers and produced a business card, seemingly out of his sleeve.
“Thank you,” I said.
“First baby,” he said, rising from his chair. “Hoo boy, nothing like it.”
“You bet,” Fred said, and the man turned and pretended to knock on the curtain in front of the newest mother’s bed. “Knock, knock,” he said, and started up again.
Before noon, an X-ray technician wheeled a machine into the nursery and photographed the baby’s chest. The breathing tube was still too low. There was a large amount of excess fluid in the right lung, a smaller amount in the left lung. A respiratory therapist pulled the breathing tube and cut it shorter, to four and a half centimeters “from lip to tip,” as the therapists said. The baby was agitated intermittently, with worsening oxygen saturation. Dr. Beckman came to her bedside at 2 o’clock, after seeing blood oxygen test results. He noted that the baby was generally swollen. Her oxygen was increased back up to 100 percent, and her breathing rate accelerated.
We met with the social worker attached to the ICN, Nina Coronaise. She explained that after I pumped my breast milk, I could put it in a sterile jar, to be stored in a freezer outside the nursery and given to Cade when she was ready. I should save every drop, and it would be fed to the baby in the order in which I’d expressed it.
She’d arrange for us to rent an electric breast pump. She asked how long I wanted to stay in the hospital; mothers usually spent at least two nights when their babies were in intensive care. But Fred wasn’t allowed to stay with me. I felt desperate for sleep and quiet, and since we lived near the hospital we could come and go easily. Nina said she’d speak with my nurse about an early discharge. We asked if we could stay in one of the parents’ rooms that night, but both were reserved. She leaned toward us. “And how is Cade doing?” Her voice had softened.
“Dr. Beckman gave us no prognosis,” Fred said.
“Critical,” I said.
“How difficult for you.” Her eyes widened. The sympathy felt real, but also practiced. We straightened in our plastic chairs.
“So I’ll check with you about the breast pump?” Fred said.
“Come see me.” She crisped up again.
She noted from our conversation that the ICN patient was our first child, a planned pregnancy. We’d lived in San Francisco for a year; almost all of our immediate and extended family were on the East Coast. My mother would be coming to help with the baby after discharge, sooner if needed. Otherwise, our support system consisted of friends. We didn’t practice religion. We were both employed. We were coping well, and had discussed the baby’s status. We seemed supportive of each other. We were appropriately anxious, and understood that the course of the next few days was unknown.
Fred called my mother, once to report Dr. Beckman’s information, and again to hear what the director of medical affairs at her company had said. Dr. Lilienthal said that it was good she was getting antibiotics. It was good she hadn’t been moved to UCSF; major medical centers had more infections, so it was better that she convalesce where she was, unless she worsened. If she wasn’t stable or improving, and the doctors would consider moving her within the next 24 hours, then maybe they should consider moving her right away, when she was stronger. If they waited until she was anoxic— not getting oxygen—even with 100 percent oxygen being pumped in by the ventilator, then there was a risk of brain damage, with an immediate evacuation from the nursery, a crisis situation. Better to make a calm move and give the people at UCSF time to review her chart.
“Did I mention Dr. Lilienthal used to practice at Bismarck?”
“No,” Fred said.
“In pediatrics. I feel I should tell you, he did imply that they might conceivably delay moving her to save money,” my mother said.
“They’d have to pay UCSF for the ECMO,” Fred said.
“Dr. Lilienthal said we need to make sure that pressure doesn’t factor in.”
“We’ll speak to Dr. Hanover,” Fred said. We were armed with our first unpleasant question.
In my room, between nursery visits, I was seen by an obstetrician, an anesthesiologist, a nurse. My stitches looked fine. I’d suffered no apparent complications from anesthesia. The nurse injected me with Rhogam, to counteract Rh antibodies. I used the breast pump while sitting up in bed watching the black-and-white television. I watched part of an unidentifiable movie and part of a talk show, on which unattractive teen-agers complained about their parents. “She don’t listen,” a hulking boy said. The pumping hurt, and I kept adjusting the black dial toward minimum. I felt self-conscious, because the newest mother’s husband walked in and out of the room past my bed and was clearly embarrassed, averting his head so far that he might have walked into a wall. I produced a small amount of thick yellow colostrum and put it in a jar, though I felt foolish saving the few drops. While I ate lunch, I read the hospital guide on taking care of yourself and your baby, which felt like a wonderfully normal activity. Of course I had to learn about diapering and bathing and cleaning the umbilical stump. The baby wasn’t with me just then, parallel-parked next to the bed in a plastic bassinet cart, but soon she might be with me, and I’d be lifting her up, one hand behind her head, as the guide instructed. I let myself relax and pretend for a few minutes. The day-shift nurse kept asking if I really wanted to go home. “Yes,” I said, “yes,” and she kept writing in her notes: “Mother still wants to DC this p.m.” She checked my blood pressure and okayed a 6 p.m. discharge. In the late afternoon, Fred went home to finish a free-lance project, arrange a rental car, and pick up a breast pump. He would meet me back at the hospital.
I had to call my father, though I didn’t want to, didn’t have the energy for explaining what I only partially understood. But the last news he’d had was the early good news phone call the night before. My stepmother answered. I tried to keep my voice even. “I wanted to let you know what’s happening with the baby. She’s not doing very well.”
My father picked up the extension, and I described the situation. At first they were silent. Then my father said helplessly, “I thought she was doing fine.”
“I thought so, too,” I said. I’d call them with any news. I got dressed in the clothes I’d arrived in the day before, feeling too dirty to put on my “going home” outfit. But I wore clean socks; yesterday’s were stiff with smears of brown dried blood. At her desk outside the door, the nurse noted that I talked on the phone and then dressed myself. When I eventually read my medical records for the hospital stay, I was surprised at how carefully the nurses had observed me. The details of the notes revealed a tenderness I hadn’t been aware of. At the time, I felt lonely, and annoyed at my physical pains; my baby was the patient, not me.
I piled my belongings on the bed, snapping shut the large plastic bag of supplies the hospital gave me. How comforting it was to have everything I needed: blue waterproof pads to put under me in bed so I wouldn’t bleed on my sheets, a sitz bath, extra sanitary pads and belts, medicated wipes, jars of sterile water. At five of 6, Fred returned and took my bags to the car. We were working together smoothly, each of us having accomplished our afternoon tasks, and I felt fairly calm. We went to check on Cade.
Dr. Hanover greeted us in the nursery. Cade was not stabilizing. They’d put her on pavulon, to prevent her from fighting the respirator. She was now paralyzed but conscious. Her eyes were closed, but she wasn’t sleeping. To be conscious but paralyzed was painful, so they’d increased the morphine dose. She was also being given dopamine, to raise her blood pressure. Dr. Beckman had described these treatments as “down the road,” but only hours after our conversation they were being used. “What about the lung bypass machine?” I asked.
“That’s nothing to think about now,” Dr. Hanover said.
“But that’s the next step, isn’t it?” Fred asked.
“Yes,” he said. “If she doesn’t respond to this.”
“We want to make sure she isn’t moved while in crisis,” Fred said.
“From what we understand,” I said, “it’s important to minimize the risk of brain damage.”
Hanover crossed his arms more tightly. “You don’t need to think about ECMO.”
“If you think she might need it,” I said, daring myself to make one more statement, “we hope you won’t hesitate to move her quickly.”
“We will move her if she needs to be moved,” he said irritably. “We will call you if we decide to move her.”
“I’ll check in later to see how she’s doing,” Fred said.
“Call here anytime,” Dr. Hanover said. I looked down; even his ankles were crossed.
The puffy sacs under the baby’s eyes had a yellow cast. Her chest moved rapidly up and down, while the rest of her body lay still. I didn’t want to leave and yet I wanted to, to rest, and be in our apartment with Fred. It’s hard to imagine now that we left the hospital. Surely we should have stayed by her bed, holding her hand and soothing her through the difficult night ahead. At the time, we felt exhausted, and thought we might as well start the routine we would live for the foreseeable future. We would call, we would come back soon. “Her face looks swollen,” I said.
“Around the eyes,” Hanover said, gentler now. He placed his large hands on the plastic barrier around her. “She’s retaining fluids, but that’s OK. We’ll just wait and see.”
We left him to watch over her. My perception of him would change over the next 10 days as he stood over her for hours at a time, adjusting settings and medications, allowing oxygen into her lungs, her brain. He would save her. A nurse escorted us to an emergency exit door behind the ICN, and we stepped outside. Fred helped me into the plush-velour front seat of the rental car, and I sat carefully tilted to one side. It seemed I hadn’t been outside, hadn’t seen trees or traffic or buildings, in a long time. For a few minutes, as we drove home, we felt untethered, and peacefully alone.