Before I Let You Go(41)
I can tell from the determination in my sister’s voice that she’s not going to change her mind, so I follow my niece and her medical entourage from the operating room into the NICU. As we walk, a registered nurse pushes the humidicrib with the baby, and every now and again I peer down at my niece. She is covered in patches of vernix, but in between, I can see her skin has that strange, translucent, purple-red tone that premature newborns tend to have. Still, I’m surprised by how well she’s doing—she’s much healthier so far than I had feared she would be given the rush of the C-section. She is breathing on her own, for a start, and she is active—pressing her fists around her face, and stretching her legs uncertainly as she adjusts to the realities of life outside the womb.
“Why did they deliver?” I ask the nurse.
“Mom’s BP was unstable overnight, then Bubba here had a few strange trace results during monitoring this morning. They did an ultrasound, and the blood flow had deteriorated over the weekend. Dr. Rogers decided it was too risky to wait. A good call, too, I’d say, given that meconium. She’s a teeny thing, but she’s breathing so well—maybe she was a bit closer to term than we expected.”
In the NICU, the staff performs a number of tests on the baby. There’s a series of criteria hospital staff use to evaluate a newborn’s physical condition in the moments immediately after birth, a scale of health known as the Apgar tests. The baby’s results on this scale are better than I expect—she scores a five on the first check, and then seven points out of ten on the second five minutes later. Annie’s nameless baby is crying now, a weak, warbling sound, and a nurse shushes her gently as she rocks her in her arms. Even the cry is a good sign, though, and the nurses and neonatologists are cheerful as the tests conclude.
“This is much more pleasant than what I feared we might be doing with this one today,” one of the NICU nurses remarks as she pulls a tiny knitted beanie onto the baby’s head.
“What does she weigh?” I ask.
“A little under five pounds—but she’s doing very well, considering. You ready for a hold, Aunt?”
I’ve held hundreds of newborns during my training and the three years I’ve spent in general practice. Something about this one seems different, though, and I hesitate a moment or two before I nod. The nurse glances toward my shirt and says, “Skin-to-skin is best, if you’re comfortable with it.”
“With me? But . . .”
“Baby doesn’t care whose skin she’s cuddled up to, Aunt. She just wants to be held—she wants to feel the warmth of your skin and hear your heartbeat against her ear. We do kangaroo care here with some of our preemies. It makes a huge difference for the stability of their vitals. And if this baby develops NAS, she’s likely to need all the help she can get—but if you aren’t comfortable with it . . .”
I shake my head hastily as I unbutton my shirt. I open it all the way, but leave it hanging over my shoulders, and I leave my bra on. Once I’ve taken a seat in the recliner beside the humidicrib, the nurse unwraps the baby and passes her to me. It’s awkward—the baby has monitoring leads attached to her chest and an oxygen cannula in her nose. She’s cool to the touch so I reach to take the blanket she’d been wrapped in and I pull it around both of us.
“Hi there, I’m your aunt,” I whisper. The baby’s tiny skull rests against my breast. I see the shape of Annie’s features in my niece, and I feel an odd contraction in my chest. The baby squirms a little, but then her tiny eyes fall closed, and she relaxes into me—apparently unfazed by all of the frantic activity surrounding her birth. I laugh weakly and look up to the nurse, who gives me a knowing nod.
“I’ll be right over here if you need anything.”
The staff all shift around to other activities, but left in this corner of the NICU, I’m effectively alone with my niece. I catch her little wrist in my forefinger and thumb, and I stroke my hand along her tiny little fingers. Her skin is soft, and I’m suddenly startled to remember that this fragile, innocent child has already been exposed to heroin for its entire existence.
I know from my previous experience of newborns with NAS that this baby is likely to be fine for a day or so. There’s yet another assessment scale the nurses and doctors will use to rate her symptoms hourly, maybe even more frequently if she’s suffering. Once her symptoms reach a threshold, she’ll start opiate treatments—morphine, most likely. I ponder this for a moment, and immediately begin to imagine this fragile infant in the throes of withdrawal. My throat constricts. Watching Annie withdraw had been one of the most difficult things I’d ever seen, including all of the difficult things I’ve dealt with in my medical career.
I don’t even want to think about what this baby is going to go through—I want to pretend everything is going to stay peaceful, but now that the thought has crossed my mind, it’s all I can think about. The NAS babies that I saw during my rotations through the hospital where I trained screamed and shook and turned purple, suffering pain that no mother or doctor could completely take from them. All the medical staff can really do is keep their morphine up regularly, and step it down as slowly as possible over the early weeks of their lives.
Suddenly I’m livid—full of rage toward Annie—and hot tears of fury fill my eyes. I know addiction is a disease—as a doctor, I’m well aware of that. But the disease has now spread its ugly roots into the most vulnerable stage of another life, and for all of the times Annie has hurt me and I’ve forgiven her, I wonder if this is just one selfish act too many. She could have called me earlier. She could have found a way into treatment, if she’d called me. Instead, she’d buried her head in the sand, held tight to her pride and her habit, and now this tiny baby has to deal with the consequences.