sadWe were studying a cross-table abdominal film - a picture of the baby lying on her back, taken from side to side. You could see slender ribs, little legs, and a crescent moon of black between the skin of the belly and the grey-white gradations of the intestines. That crescent moon - free air beneath the diaphragm - was the cause of the hubbub.
The abdomen, O Best Beloved, is a place of well-defined boundaries. Air belongs in the intestines. Fluid belongs in the bloodstream. The escape of either into the cavity surrounding the organs is cause for concern. In an adult, it can lead to pain or illness, and generally leads to surgery. In neonates, it means that the sacred boundary between intestine and abdomen has been breached - either spontaneously due to the immature gut or secondary to the dreaded illness of prematurity: necrotizing enterocolitis, or NEC.
After discussion, it was deemed likely that this was a spontaneous perforation. We don't have a pediatric surgeon here in $hospital - we're working on recruiting one but we don't have one yet. Free air is a pediatric surgery problem, and so it was off to $children's_hospital in Michigan for an abdominal drain. I spent my morning watching the nurses preparing baby B for transport: connecting tiny hoses to machines, cradling every precious life-sustaining cable as it was shifted to the mobile NICU.
Baby's mother was there, driving in as soon as she was notified, watching over the isolette, murmuring a litany of love words. "Hold on, baby. Be strong. Mama loves you." They beat the ambulance transfer up to $children's_hospital, leaving just before the transport team did, coming home that night to split their time between Twin A, still in our NICU and Twin B, now ninety minutes away.
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We tucked her into the mobile NICU on her sheepskin rug, tiny fragile thing, and ran soft Velcro bands over her belly to hold her down. For those of you who have never ridden in an ambulance, imagine riding in the back of a U-Haul truck. There are essentially no shocks. One and a half pounds of baby flying around in a plastic box could be potentially very dangerous.
Then I waved goodbye to the team - I was invited along, and considered it for a while, but hadn't made plans to be away all afternoon and into the evening - and walked back into the NICU. Two little isolettes. Two twenty-four week infants, clinging to life outside the womb. |
This morning, there was only one.
Baby A died in the early hours, after a night-long battle to maintain her. They changed ventilator settings, gave fluids, took X-rays and inserted chest tubes, but to no avail. The nurses were matter-of-fact: "It's a surprise she held on this long." I couldn't fathom how things had suddenly gone wrong. The NICU attending was surprised and saddened.
There is a radiant warmer covered in a blanket now where the isolette stood. It has an empty, waiting air. Babies move around in the NICU.
And I don't know how to feel. Be safe, Baby B. Get well.
