April 2nd, 2007

Modern Art

"So how do we explain to the parents...?"

NICU stands for neonatal intensive care unit. This is where the sick babies go. It's an eerie place, as far as nurseries are, quiet except for the clicking of computer keys, the bells and beeps of the monitors. Preterm infants rarely cry - and when they do, it is a reedy, thready sound, quickly hushed.

I round on feeders and growers, for the most part - babies learning to eat so that they can go home, some of them finishing months-long stays. I do not round on the sick ones. Too complicated; no learning opportunities. But I watch them.

One day we had three babies - twins and a single - all twenty-four weeks gestation, just over half done. The twins had twin-twin transfusion syndrome; a condition in which blood is disproportionately shunted between them. They had had an amnioreduction with rupture of membranes at twenty weeks; the estimated weight of the smaller twin was 300 grams - about two-thirds of a pound. In our NICU, 400 grams is the very smallest possible survival weight. We came with two warmers but expected only one resuscitation.
Baby A, the donor (smaller) twin, came out at 525 grams; baby B came out at almost 700. "Call the NICU," one of the resuscitating nurses whispered to me. "Tell them we're bringing both babies."
I called. They scrambled. Fortunately, the parents didn't ask why one baby was on each wing of the NICU, so no-one had to tell them we thought one would be already dead.
They've since been rearranged; moving infants around in the NICU seems to happen regularly. Now there are three isolette warmers in a row in one wing - plastic boxes to keep the world out and the warmth in. I count them every day on my arrival, on my way to change into the scrubs I have been ordered to wear. And every morning I wonder if there will still be three the next day. They missed advantages, you see. Their mother opted not to get the steroids we give to all mothers with threatened preterm delivery, the steroids that are shown to speed fetal lung maturity and improve a baby's ability to breathe. Her membranes were ruptured for weeks prior to delivery, and by the time she presented in labor she was five or six centimeters, and there was no time to talk her into steroids.
I watch them - I think the NICU nurses are a little put off by my just hanging around, and more than a little annoyed at my questions - but I find it difficult to wrap my mind around the idea that something so small can be a living human being. They are just over a pound apiece, all three of them, tiny perfect beings whose lashless lids slitted open on intubation, skeletal arms and legs flailing in indignation. I had never seen a full resuscitation before, and it is a mechanical and strange thing entirely unlike an adult code. It involves tubes that would fit inside a drinking straw and tiny lights and the copious application of warm, dry blankets. It involves a limp infant the size of my cupped palms whose own respiratory efforts send the flesh of her chest sucking inward between toothpick ribs, so deep it seems there is nothing there but bone and skin. It is breaths with a bag and a mask to the endotracheal tube to oxygenate the baby well enough for a quick look by her mother, lying there in a drug-induced haze, just a "hi-here-she-is" and off we go to the unit next door, where tiny restraints are applied and catheters inserted and blood pressures checked with cuffs the size of band-aids and the very routine-ness of it made me wonder.
And now I watch them with fascination. They have gelid skin, a deep ruddy color, and they are lit with bright lamps and bili blankets that give off a surreal blue glow. I am reminded of a scene from Cocoon and it enthralls me. I want to touch them and inspect them, but I would not dare disturb the balance that keeps them clinging to life.
J was at the deliveries, J whose baby was within ounces of mine. We heard the weights and she turned to me, said softly, "That's one-seventh of our babies." And I recall the precious fragility of my own infant, eleven pounds now, and I cannot stop marvelling.

I always come back to the stories.
I feel rusty, my words hard-come and ill-crafted. There is more I want to say, want to talk about with a pressing intensity that has begun to drown me. There are images and ideas pressing on my tongue and piling up behind my fingers - the first entry the hardest, because I wonder what to write - what story is the most important to tell. And then I open a window, and I type, and it doesn't matter. It tells itself.

One word at a time.
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