An Intimate History of Premature Birth. Sarah DiGregorio

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СКАЧАТЬ soon be too familiar. I was weirdly calm, which is not like me. Amol looked nervous, which is not like him. After we parked the car, he was half jogging to get inside the hospital, and I said, “I don’t think it’s an emergency.” He gave me a funny look.

      Back up to labor and delivery. A nurse behind a desk. “I’m 28 weeks and I’m not in labor,” I announced. “So, why are you here?” she asked. “Oh, no fetal movement and IUGR,” I said. They put me in a bed behind a curtain. The woman on the other side of the curtain was in made-for-TV labor, panting and moaning.

      On ultrasound, Mira’s heart was still beating, but that was the only sign of life. She wasn’t moving; her tiny hands were slack. Her heart rate was completely steady—ominous, because heart rates are supposed to be variable; it’s a sign that the central nervous system is active. It was, I later learned, a category III fetal heart rate tracing, which necessitates delivery. It means death or brain damage is an imminent risk; there is no category IV.

      The obstetrics resident asked for a second opinion, and another, older doctor with a formidably serious countenance came in, looked at the heart rate tracing, took control of the gel-slicked wand, and stared at the motionless fetus on the monitor for a moment. There was no choice presented, for which I am grateful, because I could not really grasp what was happening. Being born nearly 12 weeks early is bad, but being stillborn is worse. The doctor turned to me and said, “Things are going to happen very fast now.”

      I lay back and covered my eyes with my hands. “Now?” I asked. “Right now?” A nurse was already taking my clothes off, putting a gown on me, finding a vein for an IV.

      And just like that, I was swiftly wheeled toward an operating room with what seemed like dozens of doctors and nurses trotting along beside. Dr. M. was on call, and she came quickly down the hallway. “What’s the presentation?” she asked. “Transverse,” someone else said. Amol said later that it was like being in a car crash: the cold clutch of fear, the way time seems to slow in a sickening, unnatural way. A nurse pulled him aside; he’d have to wait outside the operating room while they set up; he needed to put on scrubs.

      Someone warned me that they might not have time for an epidural—they were still looking for an anesthesiologist—in which case they’d just put me under. But as we got to the operating room, an anesthesiologist appeared out of nowhere and said he could do it. A nurse let me put my arms around her as he threaded the needle into my spinal column.

      I was half crying into an oxygen mask that had been hastily strapped over my face. The oxygen was for Mira’s benefit; she was perfectly still deep inside me. I lay back and my bottom half went heavy. Amol was still outside. “If something happens to me, can you tell my husband I love him?” I asked a nurse. “Oh, honey, we’re worried about your baby, not you,” she replied. I had a twist of shame. I knew that. But it was hard for me to tell the difference between us, to locate the threat of death, our bodies still knotted together.

      “Incision!” said Dr. M. A few minutes of tugging later she called out, “It’s a girl!”—which felt like a gift, a moment to pretend. The neonatal team snatched her up. Silence.

      I found out later that there had been nineteen clinicians there in the operating room, and for a while all I could hear was a low murmur of voices, a shuffling of feet. There was Dr. M., beyond the blue curtain, rummaging around in my empty uterus. There was the blinding flare of the lights above. There was Amol, wide-eyed and mute in his blue scrubs and hair net, sitting next to me. There was the neonatal team, huddled around a warmer. “Is she alive?” I asked the silence. “Yeah, they’re working on her,” said a nurse. It wasn’t quite an answer. Someone pulled the oxygen mask off my face.

      Mira’s medical record tells me that the cord was wrapped around her torso and neck and the amniotic fluid was stained with meconium. The cord was cut and she was immediately handed to the NICU team and brought to a warmer. “Limp, no spontaneous breaths,” reports the record. She was blue. “Stim [stimulated] and dried but no improvement,” it goes on. “PPV [positive pressure ventilation] started. Intubated in delivery room.”

      Once the ventilator was breathing for her, Mira stabilized. “Color and O2 status slowly improved,” says the record. There was a noticeable change in the air in the operating room; she had been successfully resuscitated, the first and most important of a long series of steps that would have to go right. A nurse took a photo of Mira; in it her eyes are squeezed shut and she is grimacing around the tube in her mouth. Lying on the operating table, I couldn’t see her, but I said her name out loud—“Mira”—so she would know I was there. And then, as I was being sewn up, she was whisked away.

      What strikes me now is how much human ingenuity and skill and technology was marshaled there to save her, and how utterly helpless and, in a way, incidental, she and I both were. My body was unable to sustain her; her body was unable to sustain itself. She was not so much alive as in limbo.

      Afterward, I was confused. Everything seemed to be moving slowly and strangely, reality twisted and distorted. My body felt like an empty house that had been vacated in a rush, leaving dirty dishes in the sink. I couldn’t figure out why I was bleeding from between my legs, since I seemed to have had an operation on my stomach. The muscles in my lower abdomen were twitching violently. It seemed suddenly crucial that I delete the pregnancy app on my phone, since I was no longer pregnant, and my baby was definitely not the size of a butternut squash. I remember a doctor plopping my placenta into what I thought was a takeout container for noodle soup. (It was actually a lab container.)

      During that first hour, we were not allowed to see Mira. After they stabilized her in the NICU, Amol was able to visit. The photos that a nurse took of that first father-daughter encounter showed Amol bent over a riot of tubes and lines that hid our 1-pound, 13-ounce daughter.

      I had to be able to stand up and get into a wheelchair without fainting before I could go to the NICU myself. In the middle of that first night, after a few false starts—one of which ended in a full-on blackout—I managed to plant myself in the wheelchair. I remember what seemed like a cold breeze on my face; the wheelchair seemed to be moving very fast down a very white hallway, into an elevator, down to the ninth floor, then another white hallway, shoes squeaking. As the automatic doors swept open, I had a sudden sense that I wasn’t ready, that this could not be happening, and an equally strong and contrary urge to get to her, find her, see her.

      Amol pushed me down a hallway, past rows of incubators, to a hushed, darkened back room, where Mira lay on her back inside what looked like a space-age pod, immobilized by the ventilator that rhythmically inflated her skeletal chest. She was naked except for the world’s tiniest diaper; her body was reddish, her forehead creased in what looked like discomfort or worry, lots of fine black hair tufting out of the tiny knit cap on her head. Her blunt little nose was so obviously Amol’s that we had recognized it on ultrasounds. Her hands looked long and elegant, her feet strangely large next to her emaciated legs. Her still-forming ears were fused to the side of her head in whorls. She didn’t seem to have nipples yet; weeks later they just appeared one day. Her torso was covered with sticky sensors that monitored her vital signs; she had an IV line in her umbilical stump. There were more leads, lines, and tubes than baby.

      “You can touch her,” a nurse said, popping open one of the portholes for me. I could touch her? I put my hand into the warm incubator and gingerly placed my index finger on the sole of her one-and-a-half-inch foot. There is a photo of that moment, me in a hospital gown looking down at her through the plastic. She is only a foot or so away, but I look like I am staring into the far distance.

      I didn’t think of it at the time, but I had been in a NICU once before.

      There is another photo, this one a Polaroid from 1979: It is of my mother and father standing in front of an incubator, this one more glass box СКАЧАТЬ