6 weeks of NICU. I grow up with the babies. There are two twins who were born 10 weeks early just before I came on service. Their arms and legs are spindly and sticky, brown fat absent, skin not yet epithelialized. They have the fine hair of anorexics on their shoulders and faces, big bellies that protrude with each breath. We put tiny CPAP masks on them to inflate their immature lungs, spike their blood with caffeine to remind the premature brain to breathe. Each morning I sneak a tiny stethoscope over soft un-ossified ribs. Their limbs splay wildly, infant reflexes on overdrive in an unmyelinated brain, their mewling like new kittens, almost impossible to hear over the bubbling CPAP and the humming radiant warmers and the beeping of the continuous monitors.
On rounds I report their weights, climbing steadily, 20 or 30 grams each day. At birth they weren’t even a kilo, and by the time I leave they’ve doubled their weight. Every week or two I get a day off, and am surprised to find that after only 24 hours away they seem to have grown, their cheeks chubbier, arms and legs plumping up. The day before I rotate off service C. is tried off of her CPAP and ‘flies,’ as we say, lays unbothered in her crib (she’s long outgrown the isolette), breathing just fine on her own.
We won’t know for years whether or not their development will be affected. One of the twins has a tiny brain bleed in his cerebellum, which may make it impossible for him to walk or stand up straight. Equally possible is that he’ll grow up without any deviation from typical development at all, that he’ll stand and walk and run not much later than anyone else. This uncertainly means that I never quite feel like I’ve got my legs under me.
Between weeks 30 and 32 we watch them neurotically. This is the age that premature babies are most at risk for necrotizing fasciitis, a devastating infection that kills a third of babies outright and leaves another third with major complications. The infection is notorious for coming on quickly, out of the blue. Babies look fine one day and the next are septic, their blood swimming with bacteria, intestines necrosing, turning a nausea-inducing black hue when opened operatively. The signals are subtle: an elevated heart rate, a slowly climbing oxygen requirement, new apneic episodes, all of which can be part of a normal premie day.
I eye all the babies with suspicion on my early morning pre-rounding. On my walk into the unit first thing in the morning I glance in the pods, afraid to see the ventilator towering over my patients’ isolettes.
We go to all high-risk deliveries, often 5 or 6 a day, if not more. They call us just before the baby arrives, and we only have a minute or two to turn on the warmer bed, to prep the facemask and oxygen, to dial up the vacuum suction off the wall. If the baby’s heart rate tracing makes us nervous or if they’re less then 35 weeks we pull our intubation supplies, guessing at the size ET tube we’ll need if the child doesn’t breathe on their own. If the baby comes out crying we all exhale, finally breathing ourselves, but it’s not always that way.
I see babies come out blue and floppy. Often they are just stunned and spring awake when dried off and suctioned, or perk up after a little oxygen. Delivery seems to be a violent process for everyone, baby included, and I’m shocked all over again at the brutality of life. And sometimes the babies come out looking bad and never revive, their hearts un-startable, the lungs so small and crumpled that we can’t inflate them, or in what we call ‘interrupted fetal demise,’ which is when they die in the womb and our monitors pick up their dwindling heart rate and we rush their mothers to the OR and the OBs do a STAT c-section and we tear them out of the womb to see if the damage is reversible, but it feels like it never is. I’ve witnessed what feels like an unimaginable amount of horror this year but learn that there is no hell fresher than a dead infant, an ancient part of my brain recoiling in anger and fear and shame at the sight.
I’ve always imagined myself to be not far from having children, playfully resting a hand on my stomach to scare boyfriends, well-acquainted with the crystalline pull of longing that comes with an infant in my arms. These last few months I still scoop up every child, laughing, but along with delight I am gripped with fear. I already live with intrusive thoughts, nightmares about what could befall the people that I love, and having a child seems like the ultimate opening of oneself to loss. My waking hours are filled with the worst-case scenarios. It feels like madness to make my heart even more vulnerable than it already is.
I have a few days off for New Years. We drive north to see my cousin-brother’s 7-month-old. His eyes are large and liquid, his skin creamy and pink. He babbles and looks around, eyes lingering on our faces. His world is soft and expansive, full of pureed fruit and bright cotton prints. He laughs and coos continually. He looks at me and smiles. I have no choice. I smile back.