In Shock Read online

  I found it insulting and condescending to assume that he could reassure me simply by stating that he wasn’t worried. I thought maybe he needed more data to decide if he should be worried or not. “So, the placenta is actually laying exactly over the area in which you would make your incision.” I paused, waiting for some reaction. I got nothing in return, so I continued. “Did you know I had a vertical incision during my crash C-section before?” I again gave him an opportunity to respond. He stared at me silently. “So, hypothetically, if you found that scar intraoperatively and decided to make the same incision, you’d cut through the placenta. Did you know that? No, how could you if you hadn’t seen the scans? Do you know my history at all?” I was angry.

  Randy observed my tirade calmly, seeing clearly I had found my voice and could advocate for myself.

  When the obstetrician finally spoke, there was no conciliatory acknowledgment or apology. Instead he was full of arrogance and self-importance. “Listen, you can’t be a passenger and pilot at the same time. And just so we’re clear, I’m the pilot.” It was the first time he made eye contact with me, and it was clear he was using it to intimidate me.

  I allowed five seconds to silently pass, and I held his gaze while I weighed my options. Fire him and have no one on staff to deliver me that night if needed, or accept his dismissive posturing and swallow my discomfort.

  “You will not operate on me, and you can leave.” I was done. I was done tolerating patronizing physicians. I was done being made to feel as if I should accept that I could not trust the person whom my life depended upon. I called my OB and begged him to promise me that this doctor would not be in the OR, no matter what.

  “I do not want that man operating on me.” I was indignant. “I’m not trying to be difficult, but I honestly don’t think I could do it. I don’t trust him.”

  “If I have to come in from home, I will. I will be the one to deliver your baby,” he promised. He confided, later, how concerned he was that he would not be alert enough to drive in if I needed him before morning. He was on call the previous night and had not slept in forty-eight hours. He hoped I would get through the night, and he could get sufficient rest to safely deliver our baby the following morning.

  And he did. At 7:45 a.m. he delivered by C-section a premature but healthy 3-pound, 11-ounce baby boy. The moment I first heard his screechy, vigorous cry I let out a breath I felt I must have been holding for at least two years.

  He was here.

  And in that moment, I was transformed again, this time into a mother.

  Ten

  Deliverance

  The tiny baby was examined, bundled and held near my face for a moment before being transferred to the Neonatal Intensive Care Unit. He was not breathing well at all. The delivery had been difficult. When my uterine wall was exposed, they found it thin enough to see through, like a transparent film of red velum.

  Understanding the potential trauma conferred by a high-risk delivery, my obstetrician had attempted to prepare Randy for every contingency prior to going into the operating room. “If you hear me say kind of lightly, ‘Hey, why don’t you go to the waiting room?’ it means things are OK, but I don’t want you to worry. And if you stay, I know you’ll see and hear things that will make you worry. But on the other hand, if you hear me say in a serious tone, ‘I think you need to go to the waiting room now,’ I want you to leave the OR and go to the waiting room. It means I don’t want you to see what might happen. It means I think we are in trouble and you don’t need to see. Do you understand?” He modulated his tone, demonstrating what urgency would sound like, versus a casual sort of request. We were primed for drama, and we both half expected to hear him say that Randy needed to leave immediately. We understood that if we heard that, he would be performing an emergency hysterectomy due to impossible-to-control blood loss, and that I could still die.

  He never needed to use his secret code, but what we did hear him say repeatedly with an escalating sense of urgency was, “I need working suction. I need working suction. Why isn’t the suction working?” I had lost a liter of blood, briskly, which obscured the operating field, but he managed skillfully to gain control of the bleeding.

  The spinal anesthesia had the effect of making me feel as if my diaphragm were paralyzed and I couldn’t breathe effectively. With my body flat and my arms secured to the table with heavy straps, my mind insisted on recalling that the mechanism of death in crucifixion was suffocation. It was a dry sort of drowning, a useless effort to draw in air. I thought of my friend trying to breathe against the wind as he fell from his apartment window to his death. I felt my heart race and beat heavily in my ears. I was reassured by the anesthesiologist that I was not in danger, even as they placed supplemental oxygen on my face.

  I was grateful when the spinal anesthesia began to wear off, though it meant I began to feel each stitch as it was placed. I felt the needle puncture my skin, felt the thick cord-like suture pull through, and the needle pierce the other side. I could appreciate the tension placed on the string as my tissues were brought together. It wasn’t painful, but the surreal experience of being awake as someone stitches you back together was disorienting. I waited it out as six or seven sutures were placed, before I announced casually to the surgeon, “You know I can feel your stitches.” He redoubled his efforts to close me quickly.

  In the controlled chaos, the baby had managed to get two big inhalations of amniotic fluid into his premature lungs. I saw the harmful effects of this when I was moved and situated on the postpartum floor. Randy arrived and proudly showed me cell phone video of the baby in the sterile NICU incubator, and all I could think was He needs to be on a ventilator. “Why isn’t he on a ventilator?” I asked, watching the spaces between his ribs retract with the effort of breathing and his lips go blue, understanding the extent of his respiratory distress.

  He was placed on breathing support within the hour and given a viscous injection called surfactant into his airway twice, in an effort to help his lungs inflate. I was wheeled from my room to stare at this miniature being, red and feisty, connected by threadlike wires and electrodes to monitoring equipment. He had an impossibly thin line entering through his umbilical cord site. He had tiny goggles to protect his eyes from the UV light they were administering to help with his jaundice. His feedings were measured in milliliters and his weight gain in grams. Everything struck me as incredibly minute and precise, like wiring a dollhouse for electricity.

  Though I didn’t continually draw associations between the prior pregnancy and this one, it became clear that the NICU nurses did. Like a colony with a shared memory, they all seemed to be aware that I had lost the first baby, a few of them having been present at the emergency C-section. They generally seemed unsure that I would want to be reminded of that event, and they were mostly right in their conclusion, though their logic was flawed. I felt by focusing on the prior loss that they were missing some broader perspective. They saw only the delivery of a premature twenty-seven-week baby that didn’t survive their efforts to resuscitate her. That event, admittedly awful if judged independently, couldn’t be viewed in isolation. It deserved to be enveloped by the larger context of my critical illness. It was there that it gained meaning. I had survived both. I was whole and I was well and I was profoundly grateful. I couldn’t see talking about one without also acknowledging the other.

  When an NICU nurse tentatively mentioned to me that she had been there at the first delivery and began retelling the events from her perspective, I recognized immediately she had been the one who had been so disappointed when I wouldn’t hold the dead baby.

  “That was a bad night,” she said tentatively.

  Yes, I remembered, it was a bad night.

  “This is going to be better,” she reassured me. I attempted to judge the extent to which she believed her own statement by studying her expression. But like a flight attendant during heavy turbulence, she did not allow her face to betray her worry.

  Perhaps
unsurprisingly, she was the one who advocated, early and often, for me to hold this baby, even though he seemed remarkably fragile to me and I was sure it was a terrible idea. She warned that his skin was still delicate and I shouldn’t apply any transverse pressure as his skin could tear. This description, of course, reminded me of the awful decomposing baby. She maintained that despite the fragility of his skin, holding him would be good for me and for him. It struck me as so odd that the same generic sentiment that a mother should hold her baby, if at all possible, could be projected onto such a different situation.

  Holding him was logistically challenging and required an orchestrated effort to accomplish safely, all of which the nurse did uncomplainingly and with great efficiency. She untangled and secured his various wires and tubes, instructed me on how to sterilize myself thoroughly. It was then that I was handed the lightest possible version of a human. He felt like a bird in my hands, as if his bones must be hollow and that he might at any moment take flight.

  She was right, of course, that it was tremendously beneficial and reassuring for me to hold him to my chest and feel the weight of his being in that tangible way. He was our levity and our gravity, lightening our burden while simultaneously firmly anchoring us to the earth and to each other.

  “Hey buddy,” I whispered to him. “We’ve been waiting for you.” In that moment I understood our mutual dependence. I felt our small family being bound together and entwined by graceful, invisible stems. I understood that my body no longer defined the outer perimeter of my being. There was a part of me that occupied a space in the world that wasn’t contiguous with my physical self. We would forever inhabit each other’s orbit, held together by gravity, love and other unseen forces.

  We somehow managed to avoid the many truly terrible events that can befall NICU babies. Debilitating hemorrhages into soft brains, heart defects that aren’t compatible with life—truly gut-wrenching, scarring, life-altering horrors. We had none of that, thankfully. What we had were trivial, minute dramas that played out mostly in our heads, fueled by anxiety and the perceived tenuousness of a life so small.

  We learned, for example, that premature babies have such poorly developed centers of respiration that they frequently stop breathing, events referred to as apneas. When they stop breathing, their heart rate declines sharply. NICU nurses are adept at responding to this, and often the baby will simply need stimulation to begin to breathe. They will jostle them, rub them and press firmly on their feet, and often that’s enough to bring them back, to remind them they need to breathe. Sometimes the nurses uttered things under their breath like, “You aren’t going to crump on me, little guy, are you?” I silently wished they wouldn’t say such things, as this added weight to our fears that something serious was about to happen. Because while typically harmless, some apneas are in fact evidence of an infection or something worse.

  When he was finally taken off the mechanical breathing support and left with only a miniature oxygen cannula, I would sit and watch as multiple times an hour he would have these long pauses in his breathing, and his heart rate would drop. Each time, it seemed I was watching him nearly die. I knew cognitively that wasn’t the case, that this was common and expected, and in many ways part of the maturation process. We understood this in large part because this was anticipated for us. The beauty of the NICU is that for the patients there, the problems are somewhat limited in scope. They are all, to some extent, premature babies. While they each have some element of uniqueness, and varying degrees of illness, the problems they might have can be anticipated in a way that is not possible in the adult ICU. Many of them have a somewhat predictable course. This allows for true prognostication. The doctors and nurses were able to tell us, “Because of _______, we are worried X could happen. If X happens, we will respond by doing Y.”

  This engendered a kind of trust I hadn’t known was possible. The very transparent discussions, the follow-through, the constant communication and disclosure created a cocoon of safety around us. I was able to leave him there at night and know I could absolutely trust them to care for him, to anticipate and respond to issues, and to communicate the results to me.

  Despite this, there were moments of true anxiety. And those moments were enough to cast a dark shadow over that time. One of his apnea episodes was particularly refractory, and he was placed back on breathing support and given antibiotics in acknowledgment that his deterioration might be due to an infection. In that moment I wished more than anything that I could be the “sick” person again. Watching helplessly as he deteriorated was far harder on me than anything I had been through. I was embarrassedly aware of the privileged position I had occupied and how difficult it must have been for my family, watching me struggle through illness and setback after surgery.

  I stared at the Santa ornament hanging on one corner of his small incubator, willing it to be a talisman, or at the very least to only be an ornament. I tried visualizing it hanging on our future trees, imagining its importance diluted by hundreds of other ornaments crowding the branches. I wondered why it had to be the exact same size as the teddy bears that accompanied the dead baby pictures. I didn’t think I could survive leaving the hospital again with a box of haunted objects.

  The nurses sensed my apprehension, my fear that we wouldn’t be taking this baby home either. Though they couldn’t concretely reassure me, as they never wanted to give the suggestion of false hope, they shared anecdotes and axioms. “There is something you can just tell about babies that are going to stay, they have this energy to fight right from the beginning. We look for that, and when we see it, it’s very reassuring.” They described babies born without that energy, without that light behind their eyes that declared an intention to remain. “The ones that are going to leave, it’s almost like they were never even here. There is just something that somehow didn’t make it into them in their journey to us, some spark that just didn’t take.”

  I studied him in the light of these bits of insight. I thought I saw lots of energy, lots of light emanating from him. He was red and feisty and seemed tougher than his size would allow. He recovered from the setback. In fact, he improved steadily and was quickly transferred to the step-down portion of the NICU, to learn to eat and grow. For weeks he was unable to coordinate the combination of sucking, swallowing and breathing necessary to thrive. Then one day, just before Christmas, he finally figured it out. We learned then that we could take him home.

  His nurses sent us off with warm hugs and genuine wishes. One nurse told me, “I will never forget waiting for him to be delivered, and you were on the table. The doctor kept asking for suction, because the suction in the operating room wasn’t working. And I hear this voice just sort of quietly but firmly say, ‘Can someone please fix the suction for him?’ and I looked around to see who it was and it was you! And then towards the end of the surgery, you just calmly said, ‘You know I can feel your stitches.’ And I remember thinking, my goodness, if this woman can be so calm in this situation, she will be able to handle anything parenthood throws at her!”

  “Hmm, did I seem calm? That’s funny because inside I definitely was not feeling calm,” I admitted.

  “Then you are ready for motherhood, my dear!” she laughed.

  She had been his primary nurse, which meant that if she was working, she was assigned to care for him. This paradigm allowed some continuity and a relationship to form. At that point, when we were leaving the NICU, I truly felt we shared the role of mother. She had done so much to care for him.

  Ironically, though we had months to prepare to take him home, we had resisted fully preparing. We’d achieved a moderate level of superstition after having to return the first set of baby furniture, and we were reluctant to prepare his room. We had friends who understood our struggle and comforted us with stories meant to relate their state of utter unpreparedness when they brought their baby home.

  My friend Dana, who had been with me the night I died, told us, “The truth is, you need a couple one
sies, some diapers and a few bottles. That’s it.” She’d adopted her two children and was similarly unwilling to populate a home with baby equipment that might never be used. “The problem with this plan, however,” she warned us, “is that once you do get home, you will almost certainly at some point find yourself parked in a Babies“R”Us parking lot, eating Taco Bell with one hand while frantically trying to figure out what items you actually do need to keep the baby alive.”

  Another friend kept his baby in a detached dresser drawer, cushioned with blankets, for the first two months until he and his wife had each slept enough to shop for a crib without arguing. He justified this by reminding us that he was raised in a Third World country and he understood this was not the standard for US parents.

  I had eventually conceded that we should buy furniture, accepting that in all likelihood we would bring this baby home. Even with his physical presence in the world, it somehow still felt like a tremendous leap of faith to do so. We bought an ivory crib, a dresser with antique brass pulls that doubled as a changing table, and a tall French blue armoire. We retained the rocker and ottoman from our first ill-fated shopping trip, it having come in so handy when I was sick. We attempted to redecorate it with a blue throw pillow and the one blanket I’d managed to successfully knit while in the hospital draped over the back of the chair. On the wall hung three paintings I had made. One, an impossibly large elephant in a tutu balancing on a miniature ball. The second a circus ringmaster in the form of a monkey in a tuxedo with top hat and cane. And the third a large bear in a birthday hat riding a very small bike on a high wire. I wanted to imprint on his tiny memory the certainty that even the most improbable, fantastical things could happen if you allowed yourself to believe.

  The first night home, I sat in the rocker to feed him. I laid the blanket I knitted over my lap and marveled at how, though it was a finished blanket, you could still see every loop and pull-through of the yarn. The process of its creation was evident, even long after it had been completed. I sat supporting the baby’s neck with my hand the way I’d been instructed to in the NICU. Randy stood, frozen and speechless, leading me to believe I was doing something wrong with regard to positioning or feeding.